12 August

Treatment knee synovitis

Contents:

  • Causes and classification
  • Symptoms
    • Symptoms of acute synovitis
    • Symptoms of chronic synovitis
  • Diagnostics
  • Treatment
    • Treatment of acute traumatic synovitis
    • Treatment of acute infectionsynovitis
    • treatment of rheumatoid, psoriatic synovitis
    • treatment of tuberculous synovitis
    • treatment of non-infectious synovitis (on the background of osteoarthritis)
    • treatment migrating synovitis
    • treatment villous-nodular synovitis
    • treatment of gouty synovitis
    • People's treatment of synovitis

There is not a lot of diseases that any person is required to meet in my life.Diseases of the joints and bones - are headed this list.Musculoskeletal structures can be damaged due to constant static loads, injuries, infections and so on.And even in the absence of these factors, over time, develop osteoarthritis and osteochondrosis, as cartilage grow old together with the whole organism, worsening of the blood supply and nutrition.

first sign of joint disease - synovitis, ie inflam

mation of the synovial membrane.It is located on the inner surface of the joint capsule and designed to produce synovial fluid which prevents friction cartilage.This is the "soft" structure in the joint, so signs of synovitis often ahead of the symptoms of the underlying disease.

According to statistics from the National Association of Trauma, knee joint disease first frequency of occurrence among lesions musculoskeletal structures.Therefore synovitis often arises in this site.

Causes and classification

There are many factors that lead to the development of synovitis.They are divided into 3 groups:

  • traumatic;
  • infectious - damage to the joint elements of the bacteria;
  • noncommunicable - inflammation of the synovial membrane, without the action of microorganisms.

Since the cause depends on the treatment of synovitis of the knee in clinical practice is used more detailed classification:

Form synovitis reason of
acute traumatic synovitis Any joint damage, which injure the synovium.There are two types of injuries:
  • Direct - impacts directly on the joint (falling on his knee, a blow to this area);
  • indirect - damage to the knee joint, when subjected to other areas of the body (a sharp turn of a body / thigh at fixed stop).
Acute infectious synovitis case of contact with bacteria in the synovial membrane.This can happen:
  • In open injuries (penetrating wounds, open fractures);
  • After puncture of the knee joint.

Spread across the blood or lymphatic system occurs infrequently.

Chronic synovitis This form occurs in chronic diseases of the joints, or metabolic disorders.It is characterized by the following diseases:
  • Osteoarthritis - noninfectious joint disease in which there is its gradual destruction;
  • arthritis (rheumatoid, psoriatic, tuberculosis, and so on) - infectious or postinfekionnye joint diseases;
  • Gout - a violation of uric acid metabolism, in which the deposition of its salts takes place in the joint and synovial inflammation.
Migrant synovitis arises on the background of rheumatic fever.
villous-nodular synovitis (synonyms - pigmentosa, villonodulyarny) This is a very rare form of cancer in which there is overgrowth of synovial cells.The exact cause of is unknown.

If reliably determine the cause of the disease is not possible, then indicate "unspecified synovitis" in the diagnosis of the doctors.

Symptoms Symptoms of knee joint synovitis is not dependent on the development of the cause (with the exception of acute infectious synovitis).They are determined by the duration of the course and the severity of the pathological process.Therefore considered independently of each other acute and chronic forms.

Symptoms of acute synovitis

main feature of this form - the rapid emergence and exacerbation of symptoms.Primarily pain.It has the features of:


  • applies to the whole of the joint area, but not limited to a specific point;
  • usually quite intense pain;
  • pain gets worse in the morning and in the evening weakened (due to the production of anti-inflammatory hormones);
  • alone is weakening slightly.

Soon after the appearance of pain can be formed "swelling" in the joint, due to the increased production of synovial fluid.Active Movement in a joint slightly limited (at 10-15o) as full extension / flexion increases pain.

If the patient has an acute infectious synovitis, the local symptoms may be attached signs of intoxication: fever (up to 37-38 ° C), weakness, headache, decreased appetite.In the absence of adequate treatment, bacterial synovitis can lead to phlegmon knee.

Symptoms of chronic synovitis

Unlike the acute form, chronic synovitis occurs periods of exacerbation and remission (disappearance of symptoms).Pain, in the first few years of onset, is almost the same as that in the acute form.However, subsequently, begins a gradual destruction of articular cartilage, ligaments are weakened, thinner joint capsule.This leads to:

  • increased pain;
  • significant limitation of motion in the knee joint;
  • «instability» joint - dislocation in such patients will meet much more often.

fever is not typical for the chronic form.During exacerbations, may increase the temperature to 37 ° C.With adequate treatment, the patient remains only moderate symptoms of synovitis, which practically does not reduce the quality of his life.

Diagnostics

After collecting complaints can suspect the presence of synovitis.To determine the shape you need to pay attention to the presence of the causes of disease in the patient's past.However, to confirm the diagnosis is necessary to conduct additional tests:

  • Blood tests:
    • in the general analysis of blood can detect signs of inflammation: increased white blood cell count (more than 9.0 * 109 / l), increased erythrocyte sedimentation rate (above 15);
    • in the biochemical analysis should pay attention to C-reactive protein.His significant increase (more than 10 ng / mL) is an indirect sign of immune inflammation (rheumatoid or psoriatic synovitis);
    • in serological tests can detect antibodies to streptococci (antistreptokinaza, ASO, antistreptogialuronidaza) - a reliable sign of rheumatoid synovitis or migrating.
  • fluorography - to exclude tuberculous synovitis (but often it takes place at the "clean" light as the extrapulmonary pathology);
  • Radiography (in two standard projections - direct and lateral) of the affected joint;
  • Arthroscopy - performed in difficult diagnostic cases.During this procedure, the doctor makes an incision and inserts a camera into the joint cavity with a flashlight.Often, upon detection of the pathological center, the doctor treats "on the spot".

reliably confirm the presence of synovitis and its shape, you can define the tactics of treatment.


Treatment How to treat synovitis of the knee?It depends on two main issues: the causes of disease and the mechanism of its development.If the doctor will be able to get rid of these factors, synovitis for the patient to remain in the past.Unfortunately, there are a number of diseases in which to cure it permanently fails.These include:

  • osteoarthritis;
  • rheumatoid and psoriatic arthritis;
  • gout and others.

For each form of synovitis developed regimens that allow you to regain normal joint function or maintain the quality of life of the patient at the appropriate level.

Treatment of acute traumatic synovitis

treatment regimen of this form of synovitis can be divided into the following items:

  • Treatment injury - if it is an open fracture, the surgeon restores the normal position of bones within the joint, stitches damaged ligaments and portions of the capsule (if damaged) and the skin is sutured over the wound;
  • When intraarticular fractures (closed or open) is required to put the patient on a "skeletal traction" - through the bones that form the joint, threaded needles and suspended load, to avoid re-displacement.Typically, this phase lasts about 3 weeks, if the operation was carried out;
  • If you have any symptoms of synovitis in any period of time, the patient is prescribed:
    • nonhormonal drugs anti-inflammatory action (NSAIDs) or by intramuscular injection in the form of tablets.Most often used: Diclofenac, Ketorolac (Ketoprofen, Ketorol), Ibuprofen, Nimesulide (Nise);
    • To eliminate the side effects (formation of stomach ulcers and 12 duodenal ulcer), together with any NSAID necessarily prescribe "proton pump inhibitors" - omeprazole, rabeprazole, and so on.
    • On the "skeletal traction," the patient is carried out physiotherapy (in Russia this magneto or phototherapy) that accelerate the healing of tissue.They also possess anti-inflammatory effect, reducing the severity of synovitis;
    • If there is significant swelling in the knee or methods of examination found a large amount of fluid within the joint, the patient carried a puncture and remove the excess amount.
  • After removing the spokes , injured leg plaster, at least 6-8 weeks.During this period, synovitis is quite rare.And even if it occurs, it can be discovered only by removing the plaster cast.Treated by the above scheme.

Should I use a NSAID ointment?Currently, it is common opinion that the ointment are best tablets or intramuscular injections NSAID drugs, as they are applied directly to the affected area.Recent clinical studies have shown that this is misleading.All NSAIDs act on an enzyme that promotes the formation of inflammatory substances, regardless of the site of administration.Ointments are the worst absorption of these forms, so they are not recommended for use at the moment.

On average, symptoms of synovitis, with adequate treatment, go through 5-11 days.

Treatment of acute infectious synovitis

In this form, in addition to joint excess liquid is pus and bacteria, which gradually destroys the cartilage, ligament and capsule.Therefore, it is crucial to carry out a puncture of the knee joint with introduction of disinfecting solutions.

How to spend a puncture of the knee?The patient does not require any preparation.FIELD puncture first treated with alcohol (70% solution) twice, then with a solution of iodine.After that, the local anesthetic lidocaine or novocaine the skin and make the puncture.First evacuated joint content, then it is washed with an antiseptic and re-evacuated until completely purulent contents will be deleted.

After the puncture, prescribe antibiotics and NSAIDs.The anti-inflammatory therapy is carried out similarly to that in acute traumatic synovitis.Antibiotics are prescribed penicillin or macrolides.They have better effect with a minimum of side effects.Showing the following drugs:

  • Penicillin :
    • Amoxicillin;
    • Ampicillin;
    • Amoxiclav (if the above medications are not effective or the patient has recently taken antibiotics).
  • Macrolides :
    • Erythromycin;
    • Azithromycin;
    • Josamycin (recommended for admission in children or pregnant women).

Physiotherapy is not carried out with infectious processes, as these procedures contribute to the growth of bacteria.Therefore, this treatment is not used in infectious synovitis.

How to treat revmatoidnyyo, psoriatic synovitis

This synovitis develops on the background of rheumatoid arthritis.Therefore, to eliminate the symptoms you need to treat the underlying disease.Therapy should be conducted in a comprehensive and include the following elements:

  • anti-inflammatory treatment - if you have a good effect of NSAIDs may be limited to the regular use of these drugs in combination with omeprazole.If inefficient doctor prescribes hormones (prednisolone, hydrocortisone, etc.), calculating individual dose;
  • chondroprotective funds - designed to preserve the joint tissues.Inexpensive and effective drug is chondroitin;
  • Physiotherapy - these procedures are aimed at the patient's anesthesia.You can use any methods: electroplating, magnetic and phototherapy, UHF-therapy, and so on;
  • Reducing the load on the affected joint - also reduces the pain.Unloading of the knee can be performed by recommending the patient to use a cane when walking.

treatment should be engaged rheumatologist.Alone it is not recommended for treatment of this form of synovitis.

Treatment of tuberculous synovitis

This special form of synovitis, which only occurs as a complication of pulmonary tuberculosis.His treatment is carried out only in specialized clinics, along with the underlying disease.Treat as suspected presence of tuberculosis synovitis should be a doctor, a TB specialist or therapist who will direct the patient to a specialist.

As a rule, the favorable outcome of the disease.After adequate treatment, which lasts about 9 months, synovitis symptoms completely disappear.

Therapy non-infectious synovitis (on the background of osteoarthritis)

Synovitis arising on a background of osteoarthritis, requires a special approach in treatment.As a primary therapy used NPVSy.However, this is not enough.To prevent recurrence of synovitis, it is necessary to improve the blood supply to the joint.The easiest way to do this with the help of physical therapy, which can be started from the first day of illness.

Treatment migrating synovitis

To get rid of this form, there should be not only the complex therapy of synovitis, and rheumatic fever.It recommended the following regimen:

  • Bed rest for 2-4 weeks;
  • Penicillin - an antibiotic designed to eliminate streptococcus, which became the cause of the disease;
  • NSAIDs (Ketorolac or ibuprofen) - to eliminate the pain and reduce the severity of inflammation;
  • Intravenous infusion with saline solution (formulation of intravenous sodium chloride) - it is necessary to eliminate the toxicity.

If necessary, your doctor may extend the treatment regimen.When migrating synovitis requiring hospitalization, the average time which can be up to 30 days.

Therapy villous-nodular synovitis

By its nature, this form of synovitis is a benign tumor.The most effective method is to delete it.At the moment, for this purpose use arthroscopic surgery:

  • make two small incisions, 1-2 cm;
  • introduce instruments into the joint.One of them is a camera with a flashlight, and the second - an electric knife or tweezers;
  • using them remove the tumor;
  • after the procedure sutured incisions.

Complications after such manipulations are very rare.They require long hospitalization - on average, the patient stays in the hospital 4-7 days.Full course - 2 months.