Tendon inflammation is a common problem that occurs among professional athletes, people engaged in physical labor, and also with a sedentary lifestyle. Tendinitis of the knee joint is characterized not only by inflammation, but also by a complex of other signs indicating the development of a pathological process.
Patients of various ages come to the Yusupov Hospital with signs of tendinitis of the knee joint, each of them undergoes comprehensive diagnostics necessary to make a diagnosis and develop a treatment plan. The inflammatory process rapidly affects the joints; knee tendinitis is detected most often in men.
What is synovitis of the knee joint?
Synovitis is treated by an arthrologist or orthopedic surgeon
Synovitis is an inflammatory disease of the synovium. Synovitis of the knee joints is a common pathology. It is the knee that suffers most often due to the characteristics of the load and blood circulation of this joint. The disease is equally common in children and adults. If in a child synovitis of the knee joint is most often reactive in nature, as a complication after infections, in adults secondary, or traumatic, synovitis is usually diagnosed.
Synovitis of the knee joint according to ICD-10 is designated M65.9. According to the International Classification of Diseases (ICD-10), synovitis of the knee joint is classified as unspecified inflammation of the synovial membrane due to the variety of forms that this disease can take.
The synovium is a thin, elastic tissue that lines the inside of the joint capsule. With synovitis, this tissue becomes inflamed, which leads to increased secretion of effusion (exudate). Since the knee joint is very mobile, fluid accumulates quickly and the joint swells noticeably. The pathology is dangerous due to its rapid progression. If the inflammation goes directly to the joint capsule and the tissues around it, the prognosis for recovery is unfavorable.
Causes of development and types of disease
The causes of knee synovitis can be divided into three large groups:
- infectious,
- non-infectious,
- traumatic.
Infectious causes and types of inflammation
Infectious synovitis of the knee is associated with the penetration of infection directly into the synovium. This can happen in three ways:
- in case of joint damage,
- with blood flow,
- with the movement of lymph.
Traumatic causes of synovitis, including infectious ones, are discussed separately below, since the disease belongs to traumatic and post-traumatic synovitis.
There are two types of infectious synovitis: specific and nonspecific. Specific inflammation develops as a result of infection of the joint with pathogens of syphilis, gonorrhea, chlamydia, Koch's bacillus and other specific pathogenic agents. In fact, this disease is a complication of the listed pathologies.
Nonspecific synovitis develops due to the presence of a chronic source of infection in the body. They can occur against the background:
- caries,
- tonsillitis,
- boils,
- carbuncles,
- pneumonia,
- prostatitis,
- cystitis,
- urethritis,
- pyelonephritis.
The causative agent of the infection can be Staphylococcus aureus, streptococci, pneumococci, Pseudomonas aeruginosa. Very rarely, a fungal form of the disease is diagnosed, developing against the background of severe systemic mycoses that affect the entire body as a whole.
Read also: Causes and treatment of yellow snot in children
As a rule, the listed microorganisms penetrate the knee joint through the blood or lymph flow. The exception is infection due to furunculosis. Here, direct infection of the joint can occur if the boils are located in close proximity to the knee.
Infectious synovitis is also called purulent. In this case, purulent exudate accumulates in the synovial membrane. When the synovial membrane is infected, hemorrhagic synovitis of the left knee joint (or right) can also be diagnosed. In this case, exudate mixed with blood and proteins accumulates inside the joint.
As a rule, infectious synovitis of the knee joint is characterized by a rapid increase in symptoms.
The infection can affect one joint or both. In severe cases, pathogenic agents quickly spread throughout the entire limb, causing inflammation not only of the knee, but also of the hip, ankle and foot.
Non-infectious causes
The symptoms of synovitis of the knee together form a syndrome characteristic of many diseases and injuries of the knee (arthritis, arthrosis, dislocation, etc.)
Most often, doctors and patients are faced with non-infectious causes of the disease. These include:
- metabolic disorders,
- endocrine pathologies,
- psoriasis,
- gout,
- autoimmune connective tissue diseases,
- hemophilia,
- chronic joint pathologies.
The listed reasons cause aseptic inflammation in the knee. At the same time, no pathogenic agents are found in the synovial fluid or exudate that accumulates at the site of inflammation. At the same time, non-infectious causes can cause serous-fibrinous inflammation of the synovial membrane, in which a large amount of fibrin is found in the fluid.
Against the background of chronic joint diseases, such as arthritis or arthrosis, chronic forms of synovitis of the knee joint often develop. This is a dangerous disease that leads to changes in the structure of the synovial membrane and requires surgical treatment.
The development of synovitis of the right or left knee joint can be observed against the background of autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, vasculitis, etc.).
Also, inflammation in the knee can be caused by diabetes mellitus, which disrupts metabolic processes in the lower extremities. Against the background of rheumatoid arthritis, a rare and dangerous form of the disease, villonodular synovitis of the knee joint, can develop.
Allergy as a cause of synovitis
Allergic, or reactive, synovitis of the knee is a pathology often found in children. The cause is a specific reaction of the body to an allergen irritant. Such irritants can be medications, pollen, animal saliva, etc. The reactive form of the disease develops against the background of previous infections. The inflammation is aseptic, since the disease occurs as a result of the effects of antibodies produced by the body to fight infection, but in the absence of pathogenic agents.
Read also: Which doctor treats osteoporosis: which specialist to contact
As a rule, allergies cause minimal synovitis of the knee joint. This form of the disease is characterized by minor pain and almost complete absence of swelling. In case of allergies to medications, the development of moderate synovitis of the knee joint may occur. These forms of the disease respond well to treatment.
Traumatic causes of synovitis
Since the knee joint is very mobile and constantly loaded, traumatic causes of inflammation in the synovial membrane are separately identified. Thus, damage to the posterior horn of the meniscus causes severe synovitis of the knee joints. Synovitis of the knee joint after injuries to the tendons and ligaments of this joint is often found in professional athletes.
Among the traumatic factors and causes of the development of synovitis of the knee joint are damage to the cartilage tissue and the joint capsule. Inflammation in the synovium in these cases develops due to compression due to dysfunction of the ligaments, cartilage or the joint capsule itself.
Traumatic synovitis can be either infectious or non-infectious. The purulent exudative form of synovitis of the knee joint develops after severe injuries and open fractures, which create conditions for the penetration of pathogenic agents into the membrane of the joint.
How to treat synovitis?
How to cure synovitis depends on the exact form of the disease. The first thing the doctor will do is perform a puncture. Firstly, this diagnostic method allows you to accurately determine the composition of the exudate, and secondly, when the synovial membrane is punctured, the fluid pressure on the joint drops and the pain syndrome decreases. The puncture allows you to pump out part of the effusion and quickly improve the patient’s well-being.
After the puncture, the doctor applies an antiseptic bandage and prescribes immobilization of the joint. For this purpose, wearing a bandage or orthosis is indicated, depending on the location of the inflammation. Immobilization helps reduce stress on the joint, reduce intra-articular fluid pressure and prevent the progression of inflammation. Conservative therapy is then applied.
Drug treatment
How to treat synovitis depends on the nature of the inflammation. For this disease the following is used:
- antibiotics,
- non-steroidal anti-inflammatory drugs,
- decongestants,
- glucocorticosteroids,
- chondroprotectors.
Antibiotics are prescribed only if purulent inflammation is confirmed. Broad-spectrum drugs are usually used.
To relieve inflammation and reduce pain, injections of non-steroidal anti-inflammatory drugs are used, Diclofenac is most often used. For aseptic inflammation, this drug is the first-line drug of choice.
Heparin ointment may be recommended to reduce swelling. It is used only for chronic inflammation, since in case of acute symptoms a puncture is immediately performed and the exudate is pumped out.
Glucocorticosteroids (Prednisolone, Betamethasone, Hydrocortisone) are injected directly into the site of inflammation for severe symptoms. Intra-articular injections are made only by a doctor.
Chondroprotectors are indicated for damage to cartilage tissue and to reduce the risk of disease progression. These drugs restore the elasticity of cartilage.
Physiotherapy
The method is based on the ability of direct current to deliver drugs into the joint cavity; the anti-inflammatory and analgesic effect increases significantly
For synovitis of the joint, physiotherapeutic procedures are indicated; treatment with this method begins 3-4 days after the puncture. Electrophoresis (with heparin or other decongestant), phonophoresis with corticosteroids, and magnetic therapy are prescribed. Such methods ensure better penetration of drugs into the joint, stimulate rapid restoration of metabolic processes and mobility.
Surgical methods
The operation is performed only when the structure of the synovial membrane changes due to chronic or acute inflammation. This method of treatment can be practiced for traumatic synovitis, which results in the destruction of ligament and tendon tissue.
During the procedure, all changed tissue is excised. The disadvantage of this method is that surgical intervention does not guarantee the absence of relapses of synovitis in the future.
Characteristic symptoms
The diagnosis is made based on symptoms, examination of synovial fluid and other examinations
It is very easy to recognize the features of synovitis of the knee joint from a photo. Due to the structural features of the knee, during inflammation there is a rapid accumulation of exudate or effusion, therefore exudative synovitis is manifested by severe swelling.
Specific symptoms depend on the type of synovitis of the knee joint.
- In the acute form, pronounced swelling is observed, the knee can increase several times. The skin turns red and pain appears, worsening in the morning. The range of motion in the joint decreases by an average of a quarter.
- Moderate synovitis of the knee joint is manifested by slight swelling of the joint and quickly passing pain, intensifying only with exercise.
- With purulent synovitis of the knee joint, severe pain, severe swelling, fever, and symptoms of intoxication appear. The swollen joint pulsates and hurts, and upon palpation the pain increases many times over.
- In the chronic form of the disease, there is no swelling, pain appears when the knee is extended. Such synovitis can worsen, then the symptoms completely repeat the symptoms of acute synovitis of the knee.
Knowing how to recognize the disease, you should remember that synovitis of the knee joint can be cured only if you consult a doctor in a timely manner.
Symptoms of the disease
The severity of symptoms varies depending on the form of the disease
With synovitis, the symptoms depend on the location of the inflammation and the course of the disease. The following signs are characteristic of an acute inflammatory process:
- severe pain over the entire area of the joint,
- Peak pain occurs in the morning,
- during exercise and at rest, the nature of the pain does not change,
- severe swelling of the affected joint,
- decreased range of motion in the joint.
Read also: Sweet cherries for gout: can you eat them and in what quantities?
With purulent inflammation, body temperature rises, headache, nausea and weakness appear. Acute synovitis can easily be mistaken for arthritis. The main differences are severe swelling during synovitis and the rapid increase in symptoms. No more than a few days pass from the onset of pain to pronounced swelling, while arthritis develops slowly.
Chronic synovitis is characterized by alternating periods of exacerbation and subsidence of symptoms. During exacerbation, swelling and pain appear; when symptoms subside, impaired joint mobility persists.
Damage to the wrist and hand
Damage to the wrist joint is characterized by a slow increase in symptoms. This synovitis is asymmetrical, that is, it affects only one arm. Most often, the disease develops as a complication of rheumatoid arthritis or against the background of injuries.
Symptoms:
- swelling of the hand,
- pain with rotational movements,
- impaired finger mobility.
With this form of the disease, the pain syndrome intensifies when trying to bring the index and thumb together with the little finger. As a result, a person cannot hold something in his hands for a long time.
Synovitis of the elbow joint
This type of inflammation is quite simply diagnosed by the type of joint. During inflammation, an accumulation of effusion is formed, manifested by noticeable swelling or edema. When palpating this “tubercle,” the pain intensifies and fluid pressure is felt, which makes it possible to suspect synovitis.
Otherwise, the symptoms are the same as with any other acute or chronic inflammation. Synovitis of the elbow is asymmetrical and often occurs against the background of damage to the joint.
Synovitis of the hip joint
The cause of development is usually joint injuries, including sports
The inflammation is localized at the junction of the femur and pelvis. This form of the disease is characterized by the absence of visible symptoms. Due to the structural features of the joint, the swelling is invisible externally, but can be felt upon palpation.
The cause of this form of the disease is often infections of the genitourinary system. Synovitis of the hip joint is characterized by a slow increase in symptoms.
ICD-10 code – M.65.8 (other synovitis and unstable hip joint).
Knee joint damage
This form of the disease occurs most often due to the pronounced load on the joint. The first symptoms and manifestations of synovitis of the knee joint are a noticeable increase in the size of the knee.
Inflammation of the membrane of the knee joint can be:
- infectious,
- purulent,
- reactive,
- aseptic.
Due to the nature of the blood supply, the risk of penetration of pathogenic microbes into the knee joint is much higher than into other joints, so infectious inflammation is common.
Ankle lesion
The cause of ankle synovitis is most often injuries and bruises. This is due to the peculiarity of the load on this joint when walking. If the skin around the joint becomes infected, there is a risk of developing infectious synovitis. The peculiarity of inflammation in this area is a noticeable disturbance in gait due to swelling of the synovial membrane. Otherwise, the disease manifests itself with the same symptoms - swelling, pain, decreased range of motion in the joint.
Symptoms of ankle synovitis are the same as in other localizations: severe swelling and pain
Synovitis of the feet
Inflammation of the synovial membrane of the small joints of the foot is quite rare and most often acts as a complication of bursitis or gouty arthritis. Typically, the disease affects the metatarsophalangeal joint of the big toe. The disease is accompanied by severe pain when walking and swelling of the joint; it is difficult to distinguish it from arthritis and bursitis.
Principles of disease treatment
The impact of various methods of physiotherapy leads to active contraction of muscle fibers, as a result, inflammation subsides, exudate resolves, swelling decreases
For synovitis of the knee joint, treatment is complex and depends on the cause of the disease.
- To quickly reduce swelling, a puncture is performed. During the procedure, part of the exudate is pumped out with a needle, the pressure inside the joint drops, and the pain decreases.
- Next, immobilization of the joint is shown to reduce the traumatic effects when walking and other loads.
- Drug therapy must be used. For infectious synovitis, antibiotics are needed; for other forms of the disease, nonsteroidal anti-inflammatory drugs are needed. The doctor may also prescribe corticosteroids (in case of severe swelling and inflammation). After relief of inflammation, chondroprotectors and special dietary supplements for joints are used.
- Physiotherapy is indicated to restore joint mobility. Electrophoresis with heparin will help relieve swelling, phonophoresis with corticosteroids is prescribed for severe inflammation, magnetic therapy and UHF are prescribed for aseptic synovitis, for rapid tissue restoration.
- Surgical methods are indicated for tissue changes, which is often observed in chronic synovitis. In this case, the damaged areas of the synovial membrane and soft tissue around the joint are excised.
- Therapy with folk remedies for synovitis of the knee will complement drug treatment. For this purpose, comfrey ointment is used (10 g of herb per 100 g of fat base). You can also take comfrey infusion internally.
Only the attending physician can accurately answer the question of how to treat synovitis of the knee. You should not delay your visit to a specialist and do not self-medicate.
Complications of synovitis
In case of synovitis, treatment must be started immediately. Otherwise, the inflammatory process will spread to the soft tissue around the joint, ligament and tendon. In severe cases of purulent synovitis, destruction of the synovial membrane and spread of the pathological process to the entire joint is possible. When pathogenic agents penetrate into the joint cavity, acute infectious arthritis develops. It is potentially dangerous by limiting mobility in the affected joint, leading to disability of the patient.
Read also: Synovitis of the foot: causes, symptoms and treatment
Forecast
The prognosis for allergic synovitis is most favorable. In this case, drug therapy allows you to completely get rid of the pathology. Chronic synovitis is the most difficult to treat. As a rule, with a protracted course of the disease, irreversible changes occur in the joint, leading to contractures.
Purulent synovitis is dangerous due to damage to neighboring tissues and the entire body as a whole. This form of the disease can become chronic.
To avoid the development of irreversible problems in the joint, you should consult a doctor when the first symptoms appear. The earlier treatment is started, the more favorable the further prognosis.
Diagnostics
Treatment of synovitis should begin after doctors are convinced that the diagnosis is correct.
Almost all joint diseases have similar symptoms, so it is important to correctly diagnose and differentiate the disease from bursitis, tendonitis, arthritis and arthrosis. Necessary examinations:
- radiography – to visualize the condition of bone and cartilage tissue,
- Ultrasound – to determine the condition of soft tissues,
- puncture – to take a sample of exudate for analysis,
- arthroscopy,
- general blood analysis.
X-ray helps to exclude bone pathologies and accurately determine the location of the inflammatory process. An ultrasound is also necessary to rule out salt deposits in the joint, which can cause inflammation. Puncture of synovial fluid and subsequent bacterial analysis allows us to determine the type of inflammation, which is necessary for an accurate diagnosis and selection of effective therapy. Arthroscopy can serve as both a diagnostic and therapeutic procedure.