Treatment of knee joint synovitis

Update: December 2018

There are not many diseases with which any person
be sure to meet in your life. Diseases of the joints and bones –
top 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
of time, osteoarthrosis and osteochondrosis develop, since cartilage
grow old with the whole body, their blood supply is deteriorating and
nutrition.

The first sign of joint damage is synovitis, that is, inflammation.
synovial membrane. It is located on the inner surface.
joint capsule and is designed to produce intra-articular
fluid that prevents cartilage friction. This is the most “gentle”
structure in the joint, so signs of synovitis are often ahead
symptoms of the underlying disease.

According to statistics from the National Association of Traumatology,
diseases of the knee are the first in frequency of occurrence,
among the lesions of the musculoskeletal structures. Therefore, synovitis often
всего возникает именно в этом place

Withчины и классификация

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

  • traumatic;
  • infectious – damage to the elements of the joint due to
    bacteria;
  • non-infectious – inflammation of the synovium, without
    exposure to microorganisms.

Since the cause depends on the treatment of synovitis of the knee joint,
Clinical practice uses more detailed
classification:

Synovitis form Withчина развития
Acute traumatic synovitis Any joint damage that injures the synovial
shell. There are two types of injuries:

  • Direct – impact directly on the joint (falling on
    knee, blow to the specified area);
  • Indirect – damage to the knee joint, when exposed to
    other areas of the body (a sharp turn of the body / thigh with a fixed
    foot).
Acute infectious synovitis With попадании бактерии на синовиальную shell. It may
take place:

  • With открытых травмах (проникающие ранения, открытые
    fractures);
  • After punctures of the knee joint.

The spread of infection through the circulatory or lymphatic
paths occur quite rarely.

Chronic synovitis This form is observed in chronic diseases of the joints or
metabolic disorders. It is peculiar to the following
diseases:

  • Osteoarthritis is a non-infectious joint disease in which
    its gradual destruction occurs;
  • Arthritis (rheumatoid, psoriatic, tubercular and so
    further) – infectious or post-infectious diseases
    joints;
  • Gout is a metabolic disorder of uric acid, in which
    there is deposition of its salts in the joint and inflammation of the synovial
    shell.
Migratory synovitis It occurs on the background of rheumatic fever.
Villous-nodular synovitis (synonyms – pigmented,
villonodular)
This is a very rare form of tumor in which it occurs.
разрастание клеток synovial membrane. Exact cause of development
unknown.

If it is not possible to reliably determine the cause of the disease, then
The diagnosis of doctors indicates “unspecified synovitis.”

Symptoms

Symptoms синовита коленного сустава не зависят от причины
development (exception is acute infectious synovitis). They
determined by the duration of the flow and severity
pathological process. Therefore, considered independently of
friend acute and chronic forms.

Symptoms острого синовита

The main feature of this form – the rapid emergence and growth
symptoms. First comes the pain. It has characteristic
traits:

  • extends to the entire joint area, and is not limited to
    specific point;
  • as a rule, pain syndrome is quite intense;
  • the pain intensifies in the morning hours, and by the evening it subsides (due to
    production of anti-inflammatory hormones);
  • at rest weakens slightly.

Soon after the onset of pain syndrome may form
�”Swollen” in the joint, due to increased production
intraarticular fluid. Active movement in the joint slightly
ограничиваются (на 10-15о), так как полное
extension / flexion increases pain.

If a patient has acute infectious synovitis, then to the local
symptoms may follow signs of intoxication:
температуры (до 37-38оС), слабость, головная боль,
loss of appetite. With отсутствии адекватного лечения,
bacterial synovitis can lead to the development of knee cellulitis
the joint.

Symptoms хронического синовита

In contrast to the acute form, chronic synovitis proceeds
periods of exacerbations and remissions (disappearance of symptoms). Painful
the syndrome, in the first few years of the onset of the disease, is practically
the same as in acute form. but в последующем, начинает
there is a gradual destruction of articular cartilage, weaken
связки, истончается капсула the joint. This leads to:

  • increased pain;
  • significant limitation of movement in the knee joint;
  • �”Instability” of the joint – sprains in such patients will be
    to meet much more often.

Fever is not characteristic of the chronic form. AT period
обострений, возможно повышение температуры до 37оС. With
adequate treatment, the patient has only the symptoms of moderate
synovitis, which practically does not reduce its quality of life.

Diagnostics

After collecting complaints, you can suspect the presence of synovitis. For
form determination need to pay attention to the presence of reasons
заболевания в прошлом the patient. but для подтверждения диагноза
It is necessary to conduct an additional examination:

  • Blood tests:
    • In general, blood tests can detect signs of inflammation:
      увеличение количества лейкоцитов (более 9,0*109/л),
      increased ESR (above 15);
    • in the biochemical analysis should pay attention to
      C-reactive protein. Its significant increase (more than 10 ng / ml)
      is an indirect sign of immune inflammation (rheumatic
      or psoriatic synovitis);
    • in serological analysis antibodies to
      Streptococcus (anti-streptokinase, ASLO, anti-streptohalogaluronidase) –
      This is a reliable sign of rheumatoid or migratory
      synovitis.
  • Fluorography – to exclude tuberculous synovitis (however,
    quite often it proceeds at “pure” lungs as extra pulmonary
    pathology);
  • X-ray (in two standard projections – direct and
    lateral) affected joint;
  • Arthroscopy is performed in difficult diagnostic cases.
    AT ходе этой процедуры, врач делает надрез и вводит в полость
    joint camera with flashlight. Often, when a pathological
    the outbreak, the doctor conducts treatment “on the spot”

Reliably confirming the presence of synovitis and its shape, you can
decide on treatment tactics.

Treatment

TOак лечить синовит коленного сустава? It depends on two
highlights: causes of the disease and its mechanism
development. If the doctor manages to get rid of these factors, synovitis
for the patient will be a thing of the past. TO сожалению, существует ряд
diseases that cure him forever fails. TO ним
relate:

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

For каждой формы синовита разработаны схемы терапии, которые
allow you to regain normal joint function or maintain
the patient’s quality of life is up to standard.

Treatment острого травматического синовита

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

  • Treatment травмы — если это открытый перелом, то хирург
    restores the normal position of the bones inside the joint, stitches
    damaged ligaments and areas of the capsule (if damaged) and
    sucks the skin over the wound;
  • With внутрисуставных переломах (закрытых или открытых)
    Be sure to put the patient on “skeletal traction” – through the bones,
    which form the joint, thread the spokes and hang the load to
    there was no re-bias. TOак правило, этот этап продолжается
    about 3 weeks if the operation was performed;
  • With возникновении симптомов синовита в любой period времени,
    patient is prescribed:

    • Негормональные препараты противовоспалительного действия (НПATС)
      intramuscularly or in pill form. Most commonly used:
      Диклофенак, TOеторолак (TOетопрофен, TOеторол), Ибупрофен, Нимесулид
      (Nise);
    • For устранения побочных эффектов (образование язв желудка и
      12-перстной кишки), вместе с любым НПATС обязательно назначают
      �”Proton pump inhibitors” – Omeprazole, Rabeprazole and so
      Further.
    • At the time of “skeletal traction” the patient is given
      physiotherapeutic procedures (in Russia it is magnetic or
      phototherapy), which accelerate the healing of tissues. They также
      have anti-inflammatory effect, reducing severity
      synovitis;
    • If there is significant swelling in the knee area or
      examination methods found a large amount of fluid inside
      joint, the patient is punctured and remove excess volume.
  • After removing the needles, the damaged leg is cast, not less than
    6-8 weeks. AT этот period, синовит бывает достаточно редко. And even
    if it occurs, it can only be detected by removing the plaster
    bandage. Treat according to the above scheme.

Стоит ли использовать НПATС-мази? AT настоящее время,
It is widely believed that ointments act better than tablets or
внутримышечных уколов препаратами НПATС, так как их наносят
directly on the affected area. Recent Clinical
Studies have shown that this is a fallacy. ATсе НПATС действуют на
an enzyme that promotes the formation of inflammatory substances,
regardless of the place of introduction. Ointments have the worst absorption, of
of the listed forms therefore they are not recommended to apply now
time.

AT среднем, симптомы синовита, при адекватном лечении, проходят
in 5-11 days.

Treatment острого инфекционного синовита

With этой форме, внутри сустава помимо избыточного количества
fluid is pus and bacteria that gradually destroy
cartilage, ligament and capsule. Therefore, it is important to timely
puncture of the knee with the introduction of disinfectants
solutions.

TOак проводят пункцию коленного сустава? Not required from patient
any training. The puncture area is treated first with alcohol.
(solution of 70%) two times, then with iodine solution. After that, locally
numb the skin with lidocaine or novocaine and make a puncture.
First, the contents of the joint are pumped out, then it is washed.
antiseptic and re-evacuate until completely removed
purulent contents.

After puncture, prescribe antibacterial drugs and NSAIDs.
Anti-inflammatory therapy is carried out similarly to that with
acute traumatic synovitis. Antibiotics are prescribed
penicillin series or macrolides. They have the best effect when
minimal amount of side effects. The following are shown
drugs:синовит

  • Penicillins:
    • Amoxicillin;
    • Ampicillin;
    • Amoxiclav (if the above medicines are ineffective or
      the patient has recently taken antibiotics).
  • Macrolides:
    • Erythromycin;
    • Azithromycin;
    • Josamycin (recommended for use in children or pregnant
      women).

Physical therapy is not carried out in infectious processes, since these
procedures promote bacterial growth. Therefore, this treatment method
not used for infectious synovitis.

TOак лечат ревматоидныйо, псориатический синовит

This synovitis develops in the presence of rheumatoid arthritis. Therefore,
to eliminate its symptoms it is necessary to treat the main
disease. Therapy should be comprehensive and include
following items:

  • Anti-inflammatory treatment – if there is a good effect from
    NSAIDs can be limited to the regular use of these drugs,
    in combination with omeprazole. If ineffective, the doctor prescribes
    hormones (Prednisolone, Hydrocortisone and so on), calculating the dose
    individually;
  • Chondroprotective agents – designed to preserve
    joint tissue. Inexpensive and effective drug is
    Chondroitin;
  • Physiotherapy – these procedures are aimed at pain relief
    the patient. You can use any technique: galvanization,
    magnetic and phototherapy, UHF-therapy and so on;
  • Reducing the load on the affected joint – also reduces pain
    syndrome. Unloading of the knee joint can be done
    recommending to the patient to use the cane when walking.

The treatment should be done by a rheumatologist. On their own
therapy of this form of synovitis is not recommended.

Treatment of tuberculous synovitis

This particular form of synovitis, which occurs only as
pulmonary tuberculosis complication. His treatment is made only in
specialized clinics, together with the underlying disease.
Contact, if you suspect the presence of tuberculous synovitis,
follows a TB doctor or general practitioner who will refer a patient
to a specialist.

TOак правило, исход заболевания благоприятный. After adequate
therapy that lasts about 9 months, the symptoms of synovitis
completely disappear.

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

Sinovitis arising on the background of osteoarthritis requires a special approach
in treatment. NSAIDs are used as the main therapy. but
This is not enough. To prevent re-development
synovitis, it is necessary to improve the blood supply to the joint. Easiest
do this with the help of physiotherapy, which can be started with
first day of illness.

Treatment of migrating synovitis

To get rid of this form, you should conduct a comprehensive
therapy not only synovitis, but also rheumatic fever.
The following treatment regimen is recommended:

  • Bed rest for 2-4 weeks;
  • Benzylpenicillin is an antibiotic designed to eliminate
    streptococcus, which caused the disease;
  • НПATС (TOеторолак или Ибупрофен) – для устранения болевого
    syndrome and reduce the severity of inflammation;
  • Intravenous infusions with saline (staging
    droppers with sodium chloride) – necessary to eliminate
    intoxication.

With необходимости, врач может расширить схему лечения. With
Migratory synovitis requires hospitalization, average time
which can be up to 30 days.

Vaginal-nodular synovitis therapy

By nature, this form of synovitis is
benign tumor. The most effective method is its
deletion. Currently, for this purpose use
arthroscopic surgery:

  • make two small cuts of 1-2 cm;
  • вводят инструменты inside the joint. One of them is
    is a camera with a flashlight, and the second is an electric knife or
    tweezers;
  • they are used to remove the tumor;
  • after the procedure, incisions are sutured.

Complications after such manipulations are very rare. They are not
require long hospitalization – on average, the patient remains in
hospital 4-7 days.

Treatment of gouty synovitis

With подагре, очень часто возникают синовиты из-за отложения
uric acid salts in the joint cavity, capsule irritation and
inflammation of the synovial membrane. The most effective treatment
is a diet that should:

  • exclude meat and fish products;
  • eliminate alcohol;
  • limit tea, coffee;
  • exclude legumes, mushrooms, beets and “greens” (onions, parsley,
    sorrel, salad and so on);
  • include in the diet of mineral water (Narzan, Esentuki).

Drug therapy includes:

  • NSAIDs in exacerbations, if they are ineffective – hormones
    (Prednisolone or Hydrocortisone);
  • TOолхицин – для устранения приступов;
  • For regular use – medications that remove urinary
    Benzbromarone or Allopurinol acid.

Should note that the use of drugs without a diet
useless in the treatment of gouty synovitis.

Folk treatment of synovitis

In addition to traditional therapy, there is a treatment of synovitis.
knee joint folk methods. Their effectiveness is not proven.
clinical trials however this practice is common
among the population. Basically, these techniques are aimed at local
reduction of inflammation with the help of tinctures, ointments and herbal. TO
These include the following recipes:

Recipe name Pharmacy counterparts (registered in the register of drugs) Homemade method and method of application
Comfrey tincture Absent in radar
  • Grind 30-40 g (half a cup) comfrey root;
  • Pour 500 ml of vodka;
  • Pour into an airtight container and infuse for 7-10 days in a dark
    place

Drink the resulting tincture of 1 teaspoon, 3 times a day.

Comfrey decoction Absent in radar
  • Steamed 15 g (tablespoon) of minced comfrey root
    boiling water;
  • Insist for an hour.

Spread the resulting solution into 3-4 servings and drink for
of the day TOурс приема – месяц.

Detum ointment �”Doctor Theiss Comfrey”, “Wildlife”
  • Take 70 grams (cup) of comfrey grass;
  • Mix with salted pork lard;
  • Put everything in an airtight container and leave in the refrigerator
    for 5 days.

Make lotions from the received ointment and apply to the joint with
synovitis 2 times a day.

Anti-inflammatory herbal tea �”Evkar” – for local use; �”Rotokan” – for use
inside
  • Mix equal amounts: mistletoe, calendula, St. John’s wort, thyme,
    tansy, valerian, oregano, eucalyptus, bearberry, althea, celandine,
    licorice, calamus root;
  • Dry and fold into glass / metal dishes;
  • Before use, pour 1 tablespoon of boiling water and
    leave for 3-4 minutes.

Spread the resulting solution into 4 doses and drink for
of the day Full course – 2 months.

Bay oil Absent in radar
  • Grind 40 g (2 tablespoons) bay leaf;
  • Mix with 200-250 years of sunflower / olive oil;
  • Stir, seal in container and infuse for at least 7
    days;
  • The resulting solution is filtered and poured into a new container.

Apply topically, making lotions from the resulting balm and
applying on the affected joint for several hours.

It should be noted that the above recipes are not recommended.
traditional medicine. Treat the synovitis of the knee
joint folk remedies can only be combined with
classical therapy prescribed by a doctor. Otherwise,
there will be no effect from it.

Symptoms and treatment of synovitis of the knee joint are ambiguous,
which makes it difficult to primary diagnosis and choice of therapy. With
suspected disease, should consult a qualified
a doctor who will determine the cause of synovitis and help you from it
get rid of.

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