The synovial membrane is one of the main structures that make up the joints and is a layer of membranous tissue that surrounds the joints. The synovial cells secrete fluid that lubricates and nourishes the cartilage of the joints, and the heat generated by the joints during the body’s movement depends on the synovial fluid and its blood circulation, which is a tissue that nourishes and protects the joints.
So what is synovitis? Synovitis is a condition in which the synovial membrane’s ability to secrete and absorb fluid is imbalanced by internal or external stimuli, resulting in a large amount of fluid accumulation in the joint. It often occurs in the knee joint, and patients may experience pain or mild swelling in the knee joint, a creaking sound when walking, and increased discomfort in the knee joint when walking up and down stairs or squatting hard.
Synovitis is a mostly aseptic inflammatory disease in which abnormal synovial function results in failure to produce and absorb joint fluid properly, and massive synovial hyperplasia attacks the knee cartilage. Some patients with synovitis heal on their own, but most do not. Untreated or untimely treatment can lead to traumatic osteoarthritis or aggravation of existing osteoarthritis. Synovitis of the knee is mainly caused by knee sprains and a variety of intra-articular injuries such as meniscal injuries and anterior and posterior cruciate ligament injuries that can cause synovitis, resulting in a range of symptoms.
What are the main symptoms of synovitis
(1) Pain, which is the main symptom of synovitis, usually occurs in varying degrees when inflammation is present and can be aggravated by activity. For example, in synovitis of the knee joint, patients may feel pain or have increased pain when walking up and down stairs, squatting hard or walking for long periods of time.
(2) Swelling. In the early stages of synovitis, patients may experience varying degrees of joint swelling at the beginning of the painful period. This is due to aseptic inflammation in the joint, which disrupts the dynamic balance of joint fluid production and absorption, resulting in greater production than absorption of joint fluid, which leads to joint effusion causing swelling.
(3) Joint dysfunction: Patients with synovitis have an inflammatory response in the soft tissues surrounding the knee joint due to joint swelling and aseptic inflammation, causing adverse knee movement and inability to extend and flex normally.
Why are young people susceptible to synovitis? Synovitis of the knee is mainly caused by knee sprains and various intra-articular injuries, such as meniscal injury, synovial injury, cruciate ligament or collateral ligament injury, and is mostly manifested as acute traumatic synovitis of the knee. If the trauma is mild, or if there is a long-term chronic knee strain that causes gradual swelling and dysfunction of the knee joint, then chronic knee synovitis develops. Another cause is infection, of which synovial tuberculosis is common.
How synovitis can be diagnosed
(1) X-ray: This can exclude diseases such as fractures.
(2) Physical examination: Patients often have a limp gait, unfavorable joint movement, swollen joints, slightly high local skin temperature, pressure pain around the knee joint, atrophy of the affected thigh muscles, and a positive floating patella test.
(3) Blood biochemical examination such as blood routine and blood sedimentation to exclude rheumatic immune system diseases.
(4) Magnetic resonance imaging (MRI) can expose the condition of the joint more visually and clearly than X-ray examination, so MRI is generally recommended.
What are the diseases that need to be differentiated from synovitis?
(1) Acute septic arthritis, which is caused by bacterial invasion of the joint, has an initial presentation similar to synovitis, but has a more serious prognosis than synovitis. The initial presentation is similar to that of synovitis, but the prognosis is more serious than that of synovitis. It is often characterized by sudden onset of chills and high fever, with localized redness, swelling, pain and obvious pressure pain. Treatment is based on antibiotics and massive rehydration, and surgery is required in severe cases.
(2) Cellulitis: the general manifestation is localized skin redness, swelling, severe pain, there may be significant depressed edema, initially hard mass, then the central softening, breaking and ulcer formation, about 2
The prognosis is worse than that of synovitis.
(3) Rheumatoid arthritis is generally milder, with lower fever and milder local symptoms, with lesions in the joints and often multiple joint involvement.
What are the common treatments for synovitis?
Conservative treatment includes
(1) medication: the current treatment drugs are mainly hormones and non-steroidal anti-inflammatory and analgesic drugs, mainly divided into two categories: oral and topical.
(2) Extraction of joint cavity fluid.
(3) Joint cavity injection therapy, including closed needle, sodium glass acid injection, etc.
(4) Physiotherapy, scientific rehabilitation exercises. In the early stage, bed rest, elevation of the affected limb and prohibition of weight-bearing should be performed. Exercising the quadriceps is an important and effective therapeutic measure. Straight leg elevation can promote blood circulation and facilitate absorption of joint effusion, and flexion and extension exercises of the knee should be strengthened in the later stage, which can play a positive role in eliminating joint effusion, preventing quadriceps atrophy, preventing recurrent synovitis, and restoring knee extension and flexion functions. In short use exercises that both exercise the knee joint and do not damage it, see my article. Surgery is highly recommended if synovitis is not cured by conservative treatment. Minimally invasive arthroscopic surgery can be considered for acute, traumatic synovitis or for younger patients, which removes the diseased synovial membrane, cleans and flushes the joint cavity through an arthroscopic electric shaver, with small incisions, little cost and fast recovery.
Older patients with severe synovitis secondary to osteophytes or osteoarthritis may consider arthroplasty to increase their quality of life by replacing the diseased joint with an artificial material joint.
Prevention of synovitis is important
(1) Avoid prolonged strenuous exercise. Prolonged strenuous exercise is one of the basic causes of synovial degeneration, and excessive exercise increases the stress on the joint surface and increases wear and tear.
(2) Appropriate physical exercise, avoiding long-term strenuous exercise is not inactivity, on the contrary, appropriate physical exercise is one of the good ways to prevent osteophytes. Because the nutrition of joint cartilage comes from the joint fluid, and the joint fluid can only enter the cartilage by “squeezing” to promote the metabolism of cartilage.
(3) Reduce weight. Excess weight is one of the major causes of osteophytes in the spine and joints. Excess weight accelerates the wear and tear of articular cartilage, causing uneven pressure on the articular cartilage surfaces and causing synovial inflammation.