The knee joint is one of the most loaded joints of our body: a larger load extends only to the ankle joint. But, unlike the ankle joint, the knee area is much more mobile. This provides a large number of intra-articular structures.
In order to provide a combination of strength and safety, these elements( bones, cartilage, muscles and ligaments) are placed in a dense formation of connective tissue called the joint bag or bursa.
The inner, "more tender" part, facing the joint, is called the synovial membrane. It produces a synovial fluid, similar in composition to the joint fluid, which is located between the cartilages and provides a silent gliding of the articular surfaces. The synovial membrane has a multitude of sinuses, indentations and pockets that increase its area.
- 1 Synovitis - what is it?
- 2 Symptoms of synovitis of the knee joint
- 3 Diagnosis of synovitis
- 4 Treatment of synovitis of the knee joint, preparations
- 5 Complications, forecast
Synovitis - what is it?
Synovitis of the knee joint is a process of inflammation of the synovial joint of the joint, which is accompanied by an increase in the production of synovial fluid. Inflammation can be different for its causes, flow, complications and ways of flow.
Sometimes synovitis comes without a trace, but in some cases a long treatment, surgery and the following rehabilitation are required.
Classification and forms of synovitis
Like any disease, synovitis can be classified from various points of view. The most simple classification is etiologic, in which the causes of the disease are examined.
First of all, the synovitis can be both infectious and aseptic. With infectious synovitis of the knee joint pathogens can be many microorganisms, for example, brucella( causative agent of brucellosis), yersinia, or tubercle bacillus.
In the infectious process, synovitis often occurs not in isolation, but in the composition of arthritis.
Infectious synovitis can be either primary or secondary. In the first case, the joint's shell is affected directly, for example, with a joint wound. In a secondary process, the source may be at a remote distance, for example, in acute rheumatic fever, or in septic processes.
Aseptic synovitis is a "sterile" process in which inflammation occurs without the involvement of pathogenic flora. To such nosological categories are:
- Allergic lesions. It is known that not only soft tissue can swell, for example, subcutaneous tissue on the face, eyelids or lungs. The synovial membrane also produces a liquid, and it can react to a strong allergen;
- Reactive synovitis - develops under the influence of a process, for example, a mechanical damage that takes a permanent character. A good example is a callus on the heel: at first, rubbing the skin causes inflammation( with redness, swelling and soreness), and subsequent exposure results in aseptic secretion of the tissue fluid under the skin to form a bubble. A similar process takes place in the articular bag with a reactive synovitis;
- Post-traumatic synovitis develops with acute or chronic knee injury. The synovitis of the right knee joint develops more often in right-handers: when feeding in tennis, the right-handers fall more often to the right knee, the dancers use the right leg more often.
There are also two varieties of synovitis in terms of the nature of the secreted fluid: it can be exudative, that is, contain large amounts of protein, fibrin, and be inflammatory.
This is fraught with the subsequent deposition of adhesions in the joint cavity, which can interfere with movement. Infectious synovitis always proceeds precisely as an exudative process.
In aseptic forms, the synovial fluid is non-inflammatory, with its reverse absorption or resorption, there are almost no adhesions, as it contains insignificant amounts of protein.
Finally, there are forms of dry synovitis, in which the separation of the joint fluid is disturbed, but they are always secondary and are rare.
The inflammatory process in the joint bag can be both acute and chronic. As a rule, if the process lasts more than two months, and proceeds with "variable success", followed by periods of exacerbation and improvement of well-being, this synovitis is called chronic.
The course of the disease can be mild, moderate and severe - with pronounced general signs, a violation of the support function and movement. Moderate synovitis of the knee joint can bother periodically, a person can limp, but it can also move without the help of a cane and crutches.
There are many other classifications that are necessary for specialists, for example, for localization by ultrasound imaging or by cytological composition.
Symptoms of synovitis of knee joint
The name of all inflammatory diseases in medicine is the suffix "-it"( bronchitis, otitis, peritonitis, myocarditis) at the end. All inflammatory diseases differ from other signs of inflammation. I could not avoid the common fate and synovitis of the knee joint. Therefore, the classical course of this disease is manifested by the following symptoms:
- Skin over the joint becomes red;
- If you put your hand, you can feel the feeling of heat over the joint;
- The volume of the joint is increased, in comparison with a healthy leg, due to hyperproduction of the synovial fluid.
- Pain is felt, both at rest and during movement;
- The function of the joint is broken: due to swelling and soreness, movement is significantly hampered, or even impossible.
Synovitis of the knee, the symptoms of which we have considered, refers to severe, infectious lesions. In addition, there is a general symptomatology: fever, sometimes to very high values, headache, lack of appetite, sometimes confusion occurs.
All these signs indicate the proximity of infectious - toxic shock.
A reactive synovitis, for example, of an allergic genesis, proceeds slightly differently: the main feature is an increase in the joint volume due to a significant accumulation of fluid. Soreness is expressed slightly, redness and local hyperthermia over the joint is not observed.
A characteristic symptom of synovitis and arthritis with pronounced edema is a patellar ballot: when you try to press it, it drops into the body, and then again, the fluid pressure is pushed back.
Even less pronounced symptoms of chronic synovitis. All that can be clarified to the doctor are complaints about periodic pains "on the weather", pain in the knee of a noisy character, periodic swelling of the joint.
Diagnosis of synovitis
Clinically, during the patient's questioning, it is impossible to distinguish synovitis from arthritis. In fact, all the signs are similar. In addition, the joint includes a joint bag. Therefore, to some extent, synovitis can be considered as a kind of arthritis of the knee, which proceeds "at a distance" from surfaces covered with cartilage and ligaments.
And, if with an aseptic synovitis this "parity" is preserved, then with purulent bursitis and synovitis of the knee joint, soon all components are involved in the inflammatory and purulent process. Therefore, timely diagnosis is a pledge of timely treatment and early recovery. The most popular methods include the following:
- Patient interview and medical examination;
- General analysis of blood and urine, biochemical blood test. Allow to determine the presence and severity of the body's response to inflammation, determine the autoimmune character( rheumatoid factor, CRP, fibrinogen, globulins);
- Radiography of joints. It allows to reveal the involvement of bone tissue( foci of destruction, necrosis or melting of bone tissue), joint joint condition, condition of articular ends of bones, end plates;
- ultrasound. Unlike the roentgenogram, it shows the condition of the soft tissues of the joint, the ligamentous apparatus;
- Arthroscopy. A modern method that allows you to examine the synovial membrane from the inside, if necessary - take a biopsy, administer medications and even perform arthroscopic surgery;
- Puncture of the articular bag, with cytological and histological examination of cellular composition;
- MRI-magnetic resonance imaging, with a high accuracy showing all soft tissues, all pockets and cavities of the joint bag.
In addition, there are other methods of research, but they are all additional: for example, bacteriological culture of synovial fluid.
Treatment of synovitis of the knee joint, preparations
Treatment of synovitis of the knee joint is necessary depending on its cause, and always complex. So, the basis of the course of infectious lesions is targeted antibiotic therapy.
With a purulent synovitis, all tight bandages and orthoses are prohibited, and in the chronic and subacute course of the aseptic process, they are, on the contrary, shown to limit mobility and reduce edema.
First of all, the patient must comply with the motor regime: he needs rest, during a period of exacerbation in a chronic process it is desirable to observe bed rest, or to move with a cane or crutches.
- The basis of noninfectious synovitis therapy is the use of non-steroidal anti-inflammatory drugs.
Ketonal, Xefokam, Movalis have a good effect. The medication can be administered intramuscularly or in tablet form. Their task is pathogenetic and symptomatic therapy, that is, reducing the symptoms of pain and affecting the process of inflammation.
Anti-inflammatory ointments, gels and creams are widely used, which are rubbed into the skin of the joint, both with warming( Finalgon, Capsicum), and with anti-inflammatory action( Fastum-gel).Help Apizartron and Nayatoks - ointments based on bee and snake venom.
Folk remedies that are used for rubbing are a tincture of comfrey, apple cider vinegar. In the form of infusion or tea, drink the violet grass.
An anesthetic action is possessed by tincture of rhizomes of creeping wheatgrass. Very useful for synovitis eggplant, as well as fresh and wok lingonberry.
In case the treatment of synovitis of the knee joint with folk remedies was ineffective, you need to show the doctor - therapist, rheumatologist or orthopedist - traumatologist.
To prevent the attachment of secondary infection, antibiotics of a wide spectrum of action are also used, but with a preventive purpose.
In case of ineffectiveness, it is possible to introduce hormonal drugs - long-acting corticosteroids, such as Diprospan and Kenalog into the joint bag. They allow for several months to stop the pain syndrome and reduce swelling, by reducing the production of synovial fluid.
If the treatment is ineffective, surgery may be indicated, including by arthroscopic means. Sometimes, with pronounced deposition of lime, sclerosing, it is required to open the joint capsule, drainage, removal( excision) of adhesions, as well as altered parts of the shell.
The rehabilitation stage shows sanatorium treatment, physical education, medical wrapping, paraffin ozokeritotherapy.
Prognosis is serious in purulent and secondary septic synovitis. Complications can be purulent panartrite, phlegmon with lesions of cartilage and bones. In the case of reactive synovitis, the prognosis is favorable.
Synovitis of the knee, the symptoms and treatment of which we have considered, refers to relatively frequent diseases. Often it is a secondary process, a complication of arthritis. Therefore, any pain, discomfort when moving or swelling, should be on the control.
If the symptoms do not pass for several days, you should see the doctor.