Synovitis of the shoulder joint: signs, treatment and prevention

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Synovitis of the shoulder joint is a disease in which an inflammatory process develops in the joint, externally manifested by swelling in the chest area.
Most often, the disease affects only one joint, but there are cases when the disease is multiple. The appearance of synovitis is caused by inflammation of the synovial membrane - the membrane that lines the inner surface of the joint capsule and secretes synovial fluid. If this shell is damaged, the liquid is produced in excessive quantities and changes its chemical properties. As a result, a substance called effusion forms in the joint cavity.

Swelling in the area affected by synovitis is caused by the accumulation of fluid with modified chemical properties - effusion. External manifestations of edema depend on the location of the disease:

Causes

Most often, pathology develops after injury to the shoulder joint. These could be fractures, dislocations, bruises. As a result, the synovium secretes excess fluid. It gradually accumulates in the joint, provoking an inflammatory process. Exudate leads to an increase in the size of the joint capsule.

But pathology does not always develop after a joint injury. During the research, several negative factors contributing to the development of the disease were identified:

• Frequent joint damage. For example, athletes and people involved in heavy physical labor constantly injure the same areas of the body.
• Hemophilia.
• Allergic reactions,
• Diseases that provoke weakening of the ligamentous apparatus (congenital or acquired).
• The disease may be a complication of tonsillitis or other infectious pathologies.
• Pneumonia.
• Osteoarthritis.
• Arthritis.
• Neurogenic disorders.
• Weakening of the body due to being in a state of constant stress.
• Improper treatment of shoulder joint diseases.

Chondroprotectors

The use of these structure-modifying drugs helps prevent further destruction of the structural elements of the shoulder joint. Medicines are intended for long-term use over several months and sometimes years. After several weeks of regular use, chondroprotectors accumulate in tissues and begin to have anti-inflammatory and analgesic effects. The doctor gradually reduces the dosage of NSAIDs or glucocorticosteroids that have a toxic effect on the human body.

Chondroprotectors stimulate the production of the body's own chondrocytes. Their use contributes not only to the prevention of destructive and degenerative changes, but also to the gradual restoration of damaged tissues. What medications can the doctor prescribe:

• Alflutop;
• Structum;
• Don;
• Glucosamine-Maximum;
• Chondroitin-Acos.

To accelerate joint regeneration and increase the clinical effectiveness of systemic chondroprotectors, patients are recommended to combine them with ointments and gels. This could be Teraflex or Alezan cream, Arthro-Active or Shark oil with glucosamine and chondroitin, Honda.

Treatment of synovitis with folk remedies is not only inappropriate, but also dangerous. Temporary elimination of painful sensations is not able to stop the development of pathology in the shoulder joint. A timely visit to a doctor will help provide adequate therapy and avoid the development of severe complications.

Classification

For convenience, doctors divided the disease into groups. The disease can be aseptic or acutely infectious. Among synovitis of the first group, the following types are most often diagnosed:

• traumatic;
• allergic;
• neurogenic synovitis;
• pathology caused by disturbances in the functioning of the endocrine system or failure of metabolic processes.

All types of disease are conditionally divided into 2 forms:

• acute;
• chronic stage.

The symptoms of the pathology vary depending on the stage of synovitis. The disease is also divided into several types, based on the nature of the effusion in the joint capsule:

• hemorrhagic synovitis;
• serous type;
• serous-fibrinous appearance;
• purulent.

It is customary to distinguish the disease by etiology. Infectious, aseptic, allergic forms are diagnosed.

Types of shoulder bursitis

The most common types of bursitis of the shoulder joint are localized:

• Subacromial and supracromial.
• Subcoracoid.
• Subdeltoid.

Pathology is distinguished according to the characteristics of its course:

• Acute is an intense process with severe pain, which lasts from several days to a month and develops 3-5 days after an injury or other cause of inflammation.
• Subacute is a form of pathology in which pain intensifies with movement and is absent at rest.
• Chronic – less noticeable and obvious inflammation with a protracted course (up to one year).
• Recurrent - bursitis in a chronic form, which worsens periodically for various reasons (from constant injury to the joint to chronic infections in the body).

Conclusions about the nature of inflammation can also be drawn from how the composition of the synovial fluid has changed. There are different types of bursitis:

• Serous - the liquid becomes clear (sometimes with a slight cloudiness). It contains protein, leukocytes and synovial membrane cells.
• Hemorrhagic - exudate with blood.
• Purulent - inflammation caused by infection occurs rapidly and with severe pain. Antibiotics are required for treatment.

Symptoms

Reactive synovitis of the shoulder manifests itself differently in the acute and chronic stages. The disease can be easily confused with other pathologies of joint joints. However, there are signs that should alert you and make you see a doctor.

Let's look at them:

• The shoulder joint swells and a feeling of heat appears.
• Discomfort or pain when pressing, palpating, or moving your hands.
• The appearance of rashes in the area around the affected joint.
• Synovitis of the left shoulder joint gives the feeling that the heart hurts.

Swelling during synovitis manifests itself to an insignificant extent. The swelling does not have clear boundaries. Palpation makes it possible to understand that the joint has increased in volume and acquired a rounded shape.

The nature of the pain depends on the clinical picture. Regardless of its form, the disease makes hand movements painful. The person is in pain even at rest. Unpleasant sensations intensify at night.

The advanced pathological process leads to the fact that fibrous tissue begins to form in the joint capsule. After this, the symptoms change somewhat. In addition to pain, heat, swelling, the joint loses its functionality. Movements become constrained.

The disease can be distinguished from bursitis by the presence of a rash in the joint area. This is one of the characteristic symptoms of all synovitis.

Antibiotic therapy

Antibacterial drugs are prescribed when diagnosing infectious synovitis. Preference is given to antibiotics from the macrolide group - Azithromycin, Josamycin, Erythromycin, Clarithromycin. To prevent a decrease in the sensitivity of microorganisms to the action of antibiotics, patients are prescribed semisynthetic penicillins:

• Amoxiclav;
• Panclave;
• Augmentin.

They contain a therapeutically inert compound - clavulanic acid. It prevents pathogenic bacteria from developing resistance to antibiotics. This allows you not to change medications throughout the entire treatment. After antibiotic therapy, patients are recommended to take a course (10-14 days) of eubiotics to restore the intestinal biocenosis.

Which doctor treats synovitis of the shoulder joint?

To treat shoulder synovitis, you need to consult a rheumatologist.
An arthrologist and an orthopedist also treat joints. To improve the effectiveness of therapy, other highly specialized specialists are often involved in the process. Allergists, surgeons, massage therapists, and physiotherapists come to the aid of a patient with synovitis of the shoulder joint. If a person only assumes a diagnosis, then he can seek help from a therapist. The doctor will examine the patient and, if necessary, refer to a specialist.

Methods of conservative therapy

In rheumatology and traumatology, complex treatment of synovitis of any location is practiced. At the initial stage of therapy, the affected joint is immobilized. For fractures and dislocations, the patient is recommended to wear a bandage with rigid inserts that restricts movement. For minor injuries, fixing bandages of medium rigidity are used.

When examining a patient, swelling of the affected shoulder is most often detected. To eliminate the symptom, the excess amount of exudate accumulated in the joint is removed using a puncture. The treatment procedure is carried out at the diagnostic stage when a sample is taken for analysis.

Diagnostics

Several studies help the doctor diagnose synovitis of the shoulder joint. In general, a specialist is already able to identify the disease during a visual examination, palpation and listening to complaints.

To clarify, a puncture is performed. The study of biomaterial allows us to determine the nature and cause of the development of pathology.

Doctors have other informative diagnostic methods at their disposal:

• X-ray;
• biopsy of the synovium;
• Ultrasound;
• Magnetic resonance imaging;
• CT scan;
• arthropneumography.

In some cases, arthroscopy is used during the examination. The technique allows you to examine the joint almost bloodlessly by piercing the surface tissue with a needle. A special optical system is inserted into the hole. Thanks to innovative technologies, a specialist has the opportunity to completely examine the joint from the inside and make an accurate diagnosis.

If there is a suspicion that the cause of the pathology is endocrine diseases, allergic reactions, or disruptions in metabolic processes, an examination is prescribed by appropriate specialized specialists.

Pathologies

The accumulation of fluid in the joints is a health hazard and can lead to the development of the following pathologies:

1. Hemarthrosis is formed due to damage and blood flow into the joint.
2. Arthrosis is the most common pathology and occurs as a result of mechanical damage or age-related changes.
3. Arthritis can occur for a variety of reasons, including infections or allergic reactions.
4. Synovitis is an inflammatory disease.
5. Bursitis can develop due to injury or after an infectious disease.

Treatment options

The key to effective treatment of synovitis of the shoulder joint is correct diagnosis. The disease is usually treated using medication, physical therapy, or surgery.

Surgery

Surgery is prescribed to the patient only if conservative therapy does not produce a positive effect or it is clear in advance that its implementation is inappropriate. Based on the clinical picture and individual characteristics of the patient, the doctor determines the type of intervention.

There are 2 types of joint surgery:

• partial removal of the shell;
• synovectomy or total surgery (the synovium is excised on a larger scale).

After surgery, the patient will undergo a course of rehabilitation therapy. Antibiotics (Augmentin, Amoxiclav) must be prescribed. Physical exercise helps to rehabilitate faster. treatments and massage.

Drug therapy

Treating shoulder synovitis with a conservative method is effective if you choose the right medications. A preliminary examination of the patient also plays a big role in this matter.

The results of studying joint exudate make it possible to establish the sensitivity of microorganisms to antibiotics. Considering the nature of the pathology, the doctor prescribes anti-inflammatory drugs and chondoprotectors.

Nonsteroidal anti-inflammatory drugs

They are prescribed to reduce the severity of symptoms. Typically, the average course duration is 7 days. Take medications 2-3 times a day. Such drugs include Meloxicam, Diclofenac, Ketorolac, Nimesil, Ibuprofen.

Medicines in this group have a negative effect on the digestive system. Therefore, supporting agents (Omeprozole, Pantoprozole) are prescribed in combination with them.

Local anti-inflammatory drugs are prescribed instead of tablets. They quickly relieve pain and swelling of the shoulder joint. Among such gels, Voltaren, Diclofenac, and Dolobene are in demand.

Antibiotic therapy

Synovitis of the shoulder joint of infectious etiology is treated with antibiotics. The most effective are macrolides (Erythromycin, Clarithromycin, Josamycin, Azithromycin). If patients are intolerant to drugs of this group, then the drugs are replaced with semi-synthetic penicillins (Augmentin, Amoxiclav, Panklav).

After antibiotic therapy, patients are recommended to take a course of prebiotics and probiotics. Depending on the drug, restoration of intestinal microflora will take from several weeks to 2-3 months. Bifiform and Lactobactrin are usually prescribed.

Chondroprotectors

Drugs in this group stop and prevent degeneration processes in bone and joint tissues. Chondoprotectors work on the principle of a cumulative effect. Therefore, they should be taken for months, and sometimes years.

By restoring the structure of affected tissues, the products relieve inflammation and produce an analgesic effect. Alflutop, Chondroitin-Akos, and Structum are popular among doctors.

Physiotherapy

Treatment of shoulder synovitis will be more effective if medications are combined with electrophoresis, heating, ultrasound or magnetic therapy.

These procedures stimulate regeneration processes and normalize blood circulation. Due to this, the manifestation of inflammation and pain syndrome is reduced.

Synovitis

Synovitis is an inflammatory process in the synovium, accompanied by the accumulation of fluid in the joint cavity or in the tendon sheath. The knee joint is most often affected, less often the ankle, elbow, and wrist joints. Of the tendons, the shell of the long head of the biceps brachii and the flexor of the toes are most often affected. As a rule, the localization of the process is one-sided; simultaneous damage to several joints and tendons is rarely observed.

According to the nature of the course, synovitis is divided into:

Acute synovitis - characterized by swelling and thickening of the synovial membrane, effusion - clear or translucent liquid;

Chronic synovitis is manifested by the growth of the villi of the membrane, its thickening and compaction, the deposition of fibrin, the appearance of free “rice bodies” moving in the joint fluid.

Classification by reason of occurrence:

1. Aseptic synovitis. There are no microorganisms in the joint cavity, the inflammation is reactive. The cause may be trauma (intra-articular fractures, damage to the meniscus, ligaments, chondromic bodies), metabolic disorders, hemophilia.
2. Infectious synovitis. In the joint cavity there are pathogenic microorganisms (direct hit in case of a joint injury, lymphogenous - in case of nearby purulent wounds, hematogenous - in case of a pronounced purulent process in the body.
3. Specific infectious synovitis. Caused by pathogens of specific infections (tuberculosis bacillus - in tuberculosis, treponema pallidum - in syphilis, chlamydia - in Reiter's syndrome).
4. Specific non-infectious synovitis. More often occurs with gout or rheumatoid arthritis.

Clinically, synovitis is manifested by complaints of a feeling of fullness, pain in the joint, locally - an increase in the volume of the joint, limitation of movements, moderate pain in movements.

Purulent synovitis is accompanied by general symptoms (fever, chills, severe pain. Locally, large swelling, redness, joint contracture, and enlargement of nearby lymph nodes are added.

Long-term aseptic synovitis leads to joint laxity. If infectious synovitis is not treated, the process spreads to the entire joint and soft tissues.

The diagnosis of synovitis is based on the clinic, diagnostic puncture and other studies.

A special role is played by ultrasound of the joint, which helps to understand the configuration of fluid accumulation, the nature of the fluid, and its quantity. In some cases, the puncture is performed under ultrasound guidance.

MRI of the joint allows you to study the anatomy of the joint, possible mechanical damage (cause of synovitis), and see the accumulation of fluid.

A clinical blood test changes with infectious synovitis (increased ESR, increased number of leukocytes). A biochemical blood test is important for causes of synovitis such as gout (increased uric acid levels) and rheumatoid arthritis (the appearance and growth of CRP, RF, ASLO).

An informative diagnosis is the examination of the fluid. In acute aseptic synovitis, the punctate contains a large amount of protein and the viscosity decreases. In case of purulent synovitis, puncture evacuates pus, which is examined for the presence of pathogenic microorganisms and their sensitivity to antibacterial agents. This makes it possible to select effective antibiotics for treatment.

Treatment of synovitis.

Acute synovitis of unknown etiology and synovitis with a large accumulation of effusion is subject to inpatient treatment. Traumatic synovitis is treated in the trauma department, purulent synovitis in the surgical department, and the rest in the specialized department for the underlying disease (hematology, rheumatology, endocrinology).

The main method of treatment is therapeutic puncture (it is also diagnostic). After this, tightly bandage the joint or use an orthosis. A course of NSAIDs (ibuprofen, diclofenac, nimulide, movalis, arcoxia, etc.) is also prescribed. Physiotherapy includes magnetic therapy, UHF, phonophoresis with hydrocortisone. For purulent synovitis, the emphasis is on antibiotic therapy, taking into account the sensitivity of the cultured microorganism, both general and local puncture.

For persistent chronic synovitis with synovial hypertrophy, surgical treatment is performed - synovectomy (open and arthroscopic is possible).

This treatment will not be complete unless the underlying cause of synovitis is eliminated. Mechanical problems are treated with therapeutic arthroscopy. For gout, a protein-restricted diet and the use of medications to reduce uric acid levels are necessary. Basic therapy for rheumatoid arthritis includes Methodject, Arava. Reiter's syndrome requires long-term treatment by a urologist.

PATERO CLINIC has an effective diagnostic base for this pathology: expert-class ultrasound equipment, high-resolution MRI diagnostics, and its own laboratory diagnostics. If necessary, puncture of the fluid collector is performed under ultrasound control. On the underlying disease that caused the synovitis, the patient will be consulted by a specialized specialist from PATEROCLINIC; if it is absent or surgical treatment is necessary, contacts of the Federal Centers will be given.

Prevention

Certain actions cannot be guaranteed to prevent shoulder synovitis. However, taking a responsible attitude towards your health has always been considered the best prevention.

Doctors' recommendations include timely treatment of pathologies of infectious etiology, joint diseases, and moderate exercise. Try not to get too cold, get rid of bad habits and eat right. All this together will make your body stronger.

Author: Tatyana Grosova, nurse, especially for Ortopediya.pro