The knee joint is the largest element of the musculoskeletal system, which is endowed with important functions. It is designed to maintain the weight of the whole body, so the maximum load is placed on the knee - one of the reasons why the joint becomes vulnerable to various diseases with age. For example, what is synovitis of the knee? This is one of them.
Description of the pathological process
In accordance with ICD-10, synovitis of the knee joint belongs to category M00-M99 "Diseases of the musculoskeletal system and connective tissue." The disease has different developmental mechanisms. In the appearance of this ailment, both internal processes and external influences play a role. The disease itself is very painful.
What is synovitis of the knee joint? This is a pathological process that occurs in the synovial membrane and is accompanied by severe inflammation. The disease has a separate code for the ICD. Synovitis of the knee joint is endowed with the M65 code. This disease belongs to subsection M65-M68 "Lesions of the synovial membranes and tendons."
It is the synovial membrane that serves as a kind of shock absorber of the musculoskeletal system. It synthesizes a special fluid that protects the cartilage and bone tissue of the joint from destruction during friction, a strong impact.
The total amount of synovial fluid does not exceed a few milliliters - this is enough for the full functioning of the knee joint. If the synovial membrane is damaged, inflammation develops in the knee, as a result of which the volume of fluid increases. Moreover, in its composition, in addition to water, proteins and hyaluronic acid, red blood cells, pathogenic microbes and pus are found.
The main causes of the disease
Various factors can cause the development of the pathological process. The most common causes that provoke synovitis of the knee joint (according to ICD-10 code M65) are:
- frequent mechanical injuries;
- rheumatic complications;
- increased physical activity and professional sports;
- allergic reaction to medicines or exotic products.
Some infectious diseases (syphilis, hepatitis, tuberculosis) can also cause inflammation. Synovitis often develops in old age against the background of changes provoked by the lack of motor activity. Sometimes the cause of synovitis are diseases of the urinary system, as well as acute intestinal infections, respiratory, autoimmune and dermatological diseases, among which:
- vasculitis;
- dermatopolymiosis;
- diabetes;
- psoriasis;
- sarcoidosis of the lungs.
An important condition for the development of synovitis of the knee is a decrease in immunity and a sedentary lifestyle.
Disease classification
In modern practice, knee inflammation is divided into several varieties, depending on the cause of its development. Most often they mean one of the subtypes of synovitis of the knee joint (not one of them is indicated in the ICD):
- primary - is an independent pathology that arose against the background of arthrosis, arthritis and other rheumatic complications;
- secondary - is an allergic reaction or a consequence of a meniscus injury, ligaments, the progression of infectious viral diseases;
- post-traumatic form - it is diagnosed more often than other varieties.
The last type of synovitis occurs, as a rule, after a strong bruise or kneecap, as a result of which the process of accelerated synthesis of intraarticular fluid is activated. To eliminate primary and secondary synovitis, it is important to get rid of the root cause.
Regardless of the classification given, each of the varieties of the disease can develop aseptic, infectious or allergic. In the first case, inflammation of the knee joint, in which bacteria are not involved, is implied. By aseptic type, synovitis occurs after trauma or against the background of endocrine, rheumatic, autoimmune disorders. The infectious form is provoked by bacteria, viral agents, protozoa. In the ICD-10, a separate code is allocated to it. Synovitis of the knee joint of an infectious type causes tuberculosis and Escherichia coli, pneumococcus, and brucella. The pathogen penetrates the joint with the bloodstream and forms a focus of inflammation. The allergic form is the body's response to contact with allergens.
Without determining the exact type of disease, it is impossible to prescribe an effective therapy. In addition, synovitis can occur in acute, reactive and chronic form.
Clinical picture
Symptoms of knee synovitis occur a few days after the occurrence of circumstances that served as an impetus for the development of the disease. With the infectious type, the incubation period lasts no more than three days from the moment the pathogen penetrates the synovial membrane.
What is synovitis of the knee joint and how to understand that it is he? The characteristic signs of the disease are:
- drawing pain in the patella;
- joint enlargement and swelling;
- knee deformity;
- difficulty driving;
- redness of the skin.
With suprapatellar synovitis of the knee joint, the symptoms are more pronounced in its upper part, above the calyx. Often, the disease is complicated by malaise, low-grade fever, impaired functioning of other organs.
How to recognize acute synovitis
This form can last from several days to two weeks. If the inflammatory process is provoked by an infection, the patient has the following symptoms:
- a significant increase in the amount of content in the joint;
- swelling on the knee has a pronounced red color, and to the touch is hot;
- pain when trying to bend and unbend a leg;
- lameness when walking.
In addition, the general condition of the patient worsens. There is weakness, muscle hypotension, mild nausea due to bacterial intoxication is not excluded. Acute synovitis of the knee joint in the photo is difficult to distinguish from bursitis. An increase in body temperature is also characteristic of this disease.
Symptoms of acute synovitis increase very quickly, swelling develops rapidly, literally after a few hours you can not recognize the leg. Patient purulent synovitis of the knee joint is most severely tolerated by patients. ICD does not separate this type of pathology as a separate code, despite its danger. The knee, as described by patients suffering from purulent synovitis, is very pulsating, the pain is bursting. The skin above the patella remains hyperemic for a long time, it is possible to turn the knee blue with a specific shine.
With a purulent form of pathology, general symptoms of poisoning of the body due to bacterial intoxication are expressed. In severe cases, in addition to malaise and weakness, there is persistent fever, dizziness, hallucinations and delirium, as well as the death of tissues covered with the synovial membrane.
Synovitis, resulting from a knee injury, is accompanied by increasing swelling, painful sensations when touched, restriction of movement. According to the results of laboratory tests, elevated ESR indicators are detected. Post-traumatic synovitis usually has a longer course. It may take several months for the patient to recover completely from the disease. And after a while the pain remains, especially with a load on the limbs. The remaining symptoms are no different from primary synovitis.
In case of characteristic symptoms of the disease, you should consult a doctor as soon as possible. The treatment of this disease is carried out by rheumatologists, orthopedists and surgeons.
Signs of chronic inflammation
In medical practice, chronic knee synovitis is rare. The main reason for the transition of the disease from acute to chronic stage is its lack of treatment. Chronic synovitis of the joint proceeds with less severity, accompanied by muffled paroxysmal pain. As a rule, the disease does not cause significant discomfort and does not affect the patient’s usual lifestyle.
In chronic synovitis, the affected knee looks slightly swollen, while the skin is not hyperemic, unpleasant sensations can occur when the joint is bent. A characteristic symptom is a knee crunch during bending, squats. Patients with such a disease quickly get tired of walking, despite the fact that the disease does not cause general malaise, weakness. A complication of the chronic form of inflammation of the knee joint can be gout, as well as hydrarthrosis, irreversible changes in the ligamentous apparatus.
Diagnostic Methods
In order to make an accurate diagnosis, the patient is prescribed differential diagnosis. First of all, it is important to exclude bursitis, arthrosis or gonarthrosis. Mandatory for suspected synovitis is a laboratory examination of the patient, before which the doctor conducts a detailed examination, palpates the affected joint in order to determine the degree of swelling, deformation, level of restriction of its movement. When collecting an anamnesis, information on the possible causes of inflammation, the presence of diseases in which the likelihood of developing synovitis increases is important.
Laboratory diagnostics involves passing several tests:
- biochemical blood test;
- general analysis of urine;
- immunological research;
- synovial fluid intake.
If the examination is uninformative, the patient will be prescribed an x-ray of the knee, ultrasound or MRI. The latter procedure is often used to visualize synovial structures. If difficulties arise in the diagnosis, magnetic resonance imaging with a contrast medium is performed. Certain conclusions can be drawn on the conclusion of ultrasound. For example, an excess of the permissible volume of synovial fluid and a visual thickening of the joint capsule are confirmation of the inflammatory process.
What are the treatment options?
The therapeutic program for knee inflammation is compiled individually for each patient according to the results of the examination. The doctor will decide how to treat synovitis of the knee joint, based on the type of disease, its stage and the characteristics of the patient’s body. The most effective is a comprehensive treatment, involving the use of several techniques. In complicated cases, conservative therapy may be ineffective. Then a decision is made on the surgical intervention.
Why do they need a puncture?
Many patients, answering the question about what is synovitis of the knee joint, call this disease a direct indication for puncture. Indeed, with this procedure, the treatment of pathology begins. Puncture is performed not only for medical, but also for diagnostic purposes. Intra-articular fluid intake allows you to clarify the type of pathology and determine the type of infection. In addition, due to the puncture, excess exudate is eliminated from the synovial cavity, due to which it is possible to remove the load from the joint for some time, relieve pain, improve knee mobility.
Manipulation is carried out in several stages:
- First, the doctor prepares tools (a syringe and a special puncture needle) and an antibiotic solution.
- Then a puncture is performed under local anesthesia and removal of exudative fluid.
- After the excess fluid is withdrawn, an antibiotic solution is injected into the joint bag.
To remove the load from the limb, especially the first time after a puncture, an immobilizing dressing is applied to the patient or an orthosis is installed. With moderate synovitis of the knee joint, the need for complete rest, as a rule, does not arise, but restriction of movement plays an important role. To completely immobilize the limb, a plaster cast can be applied for a period of not more than a week.
Knee surgery
A radical method of treatment is an extreme measure that is resorted to in neglected cases when the patient is at risk of disability, and conservative therapy does not produce a noticeable result. The essence of the operation is to remove menisci, destroyed fragments of the intraarticular membrane, and to remove foreign bodies. After a synovectomy, the patient needs bed rest and medication, and as he heals, joint development and physiotherapy rehabilitation courses are required.
What drugs help with synovitis
Medications for knee inflammation are prescribed to patients with only one goal - to relieve inflammation. Synovitis of the knee joint on the left and right limbs is treated the same way, no differences in the appointment of drugs are noted.
The following groups of drugs help prevent the development of complications and reduce the likelihood of a repeated exacerbation of the disease:
- NSAIDs. Non-hormonal drugs have analgesic properties, relieve inflammation. Depending on the severity of the symptoms of the disease, not only therapeutic ointments can be prescribed, but also tablets, injections. The combined use of non-steroidal drugs helps to enhance the therapeutic effect. With minimal synovitis of the knee joint, Diclofenac, Fastum Gel, Voltaren, Nimulide ointments are used, as well as drugs of the same name and their analogues in tablets and ampoules.
- Inhibitors that reduce the activity of proteolytic enzymes. Usually prescribed for chronic synovitis of the knee joint on the right and left sides ("Trasilol", "Gordoks").
- Steroid drugs. Assigned to patients with a severe form of the disease. Moreover, hormonal drugs are injected directly into the joint ("Dexamethasone", "Prednisolone", "Kenalog").
- Antibacterial drugs. Mandatory in the treatment of infectious synovitis of the knee joint.
It is worth noting that antibiotics are prescribed, as a rule, in combination with prebiotics or bacteriophages. Preparations of this group are necessary to maintain the balance of intestinal microflora. Also, with synovitis, it is necessary to drink vitamins and minerals that stabilize the microcirculation in the body.
Will physiotherapy help
How to treat synovitis of the knee joint? In addition to the above methods of therapy, physiotherapy is very effective. The course of procedures aimed at eliminating pain and restoring joint mobility is at least 10 days.
Physiotherapy can increase lymphatic drainage and blood supply to the affected joint. With knee synovitis on the right and left limbs, the following physiotherapy methods are used:
- Impact by sinusoidal modulated currents (SMT) - the principle of action of the procedures is to dull the sensitivity of tissues and inhibit pain receptors.
- Electrophoresis - has been used for many years, recognized as an effective method, the essence of which is to transport the drug directly to the synovial membrane. Due to the rapid penetration of the active substance into the area of inflammation, relief comes after the first procedures.
- Magnetotherapy - a course of treatment with low-frequency pulses helps to relieve swelling, restore joint mobility and start recovery processes.
Each of the methods of physiotherapy will be effective at a particular stage of the disease. For example, treatment of SMT is more often used in the initial stages of the development of synovitis, and magnetotherapy will be more effective in the chronic form. This method of treatment involves increasing the flow of blood, due to which the regeneration of articular cartilage is gradually achieved. Most often, a course of magnetotherapy is prescribed to elderly patients.
Features of synovitis in childhood
In children, this disease is many times less common than in adults, but it can be much more severe. The reasons why synovitis of the knee joint develops in a child are usually the same factors as in adults. There are no special differences in the clinical picture. Symptoms typical of this disease are not much different in patients of different ages.
In children under 15 years of age, transient or transient synovitis occurs. If the child complains of pain in the knee, it must be shown to the doctor, but parents should be prepared for the fact that a routine examination and palpation will tell the specialist little. It is likely that, in addition to laboratory tests, a puncture is also required. According to reviews, with synovitis of the knee joint, many refuse to carry it out, referring to the fear of this kind of invasive intervention. , .
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The use of alternative methods alone in the treatment of a disease such as synovitis is unlikely to succeed. On the other hand, folk remedies can serve as a good help in the treatment of various ailments. If you use them in combination with traditional drugs, you can speed up the healing process.
At the same time, one must not forget that folk remedies, like medicines, cannot be used arbitrarily. Before you start taking medications, you should definitely consult a doctor. According to user reviews, with synovitis, simple preparations and application tools help.
For example, a decoction of bay leaves. To prepare it, 10 dry sheets will require 300 ml of hot water. The broth is put on the stove, brought to a boil and left for 5-10 minutes, reducing the heat to a minimum. After which the drink is filtered and allowed to cool, then consumed 100 ml before bedtime for three days. After a course of treatment, take a week break and repeat the reception. It is important to note that you should drink exclusively fresh broth, so every day you need to prepare the medicine again. And with the drink that remains from the previous day, you can make lotions and compresses.
Comfrey ointment is also effective for synovitis of the knee joint. Folk remedy, in addition to the gruel from the plant, contains lard. Both ingredients should be taken in equal proportions. Comfrey and lard should be passed through a meat grinder, mix well and send to the refrigerator. Once the ointment has hardened, it must be applied to the right or left knee joint.
With synovitis, which is accompanied by pain and swelling, ice cubes prepared from saline solution (4 tablespoons of salt per 1 liter of water) help.
Can synovitis be prevented
The most effective method of prevention is to contact a doctor in a timely manner when the first alarming symptoms appear. If you start therapy at an early stage, the disease can be cured without surgery and complications.
In order to prevent knee synovitis, it is necessary:
- to be examined after bruises and injuries to the limb;
- give preference to comfortable shoes;
- use knee pads, especially during physical exertion (to a greater extent this applies to patients with chronic synovitis).
When signs of the disease appear, in no case do you need to engage in experimental self-medication. Otherwise, the situation may worsen so much that sepsis develops - blood poisoning, which often leads to death.