I. Definition and anatomy
Synovitis of the hip joint in the current medical literature generally refers to acute synovitis of the hip joint in children, and so far no one has explicitly proposed the name “adult hip synovitis”. The onset of hip synovitis is related to viral colds, excessive activities and trauma, with pain as the main symptom. We have achieved good clinical results in treating synovitis of the hip joint in adults by using Chinese herbal medicine internally and externally.
The synovial membrane of the hip joint starts from the subcapsular groove of the cartilaginous surface of the femoral head, follows the surface of the supporting band of the femoral neck to the femoral attachment of the joint capsule, and then folds back along the inner surface of the joint capsule to the edge of the acetabulum, covering the inner and outer glenoid lips of the joint, the round ligament and the fibrous fat pad in the acetabular fossa. Like other parts of the synovial membrane, the synovial cells of the hip joint have the function of secreting synovial fluid, nourishing articular cartilage and lubricating the joint, as well as removing intra-articular debris and external injected particles. The heat energy generated by the joint during the body’s movement and the fine foreign bodies inside the joint all depend on the joint fluid and its blood circulation for distribution and absorption. When the synovial membrane is irritated and the balance between the production and absorption of joint fluid is disrupted, the intra-articular pressure changes and symptoms are produced.
Etiology and pathogenesis
The cause of hip synovitis is mostly related to viral infections, trauma, bacteria, etc. It is common in children, while adults put the hip joint in a state of long-term strain, and over time, chronic lesions are formed in the bones of the human body, and when attacked by wind, cold and moisture, the synovial part of the hip joint is damaged and pain occurs, which also causes synovitis. Chinese medicine calls synovitis as “paralysis”. The pathogenesis of synovitis is the deficiency of liver and kidney, and the loss of Qi and blood. If the liver is deficient, the tendons and veins are not moistened; if the kidney is deficient, the bone marrow is not biochemically adequate; if the Qi and blood are not smooth, the tendons and veins are paralyzed, and trauma and external wind, cold and dampness take advantage of the deficiency to develop the disease.
Diagnosis
①History of excessive activity or sprain of lower limbs;
②Age between 18 and 50 years old;
③lameness of the affected limb, unwilling to stand and walk, complaining of pain in the hip or knee joint;
The pelvis is tilted to the affected side, the pseudo-extension of the affected limb is within 2.5 cm, mild swelling and tenderness can be seen in the groin, the local skin temperature is not high or slightly high, there is resistance to hip flexion, inversion and rotation on the affected side, and the affected limb is in abduction and external rotation. Physical examination shows pressure pain in the front and back of the hip joint, and passive movement is limited, especially in internal rotation, abduction and extension position, and the “4” test is positive;
(⑤) X-ray, pelvic tilt, unequal bilateral foramina and widening of hip joint gap;
⑥Blood leukocyte count and blood sedimentation were sometimes increased, and the bacterial culture was negative.
(7) Orthopantomogram of the pelvis showed that the correspondence between the bilateral hip joints was acceptable or basically good;
(8) Bilateral hip MRI findings suggest the presence of fluid in one or both hip joints without pathological changes such as septic hip arthritis, traumatic hip synovitis, pigmented villous nodular synovitis intra-articular hematoma, rheumatic hip arthritis, rheumatoid hip arthritis, ankylosing spondylitis, sacroiliac arthritis, hip tuberculosis, hip osteoarthritis, ischemic necrosis of the femoral head.
IV. Treatment
Chinese medicine has many advantages in the treatment of paralysis. The treatment of paralysis originated in the era of the Nei Jing, and with the development of the understanding of the disease, each era has its own characteristics. Most contemporary TCM scholars use a combination of oral administration of drugs to benefit the qi and blood, dispel wind and dampness, resolve blood stasis and open the ligaments, together with massage and external application of Chinese medicine or fumigation. Patients with hip synovitis can be divided into Qi stagnation and blood stasis type, wind-cold and damp paralysis type, and spleen and kidney deficiency type, and they are treated with Peach Red Four Elements Soup with addition and subtraction, Rejuvenating Paralysis Soup with addition and subtraction, and Ten Perfect Tonic Soup with addition and subtraction with traction and manipulation to achieve satisfactory results.
The above drugs were crushed into powder, mixed with 50ml of warm water and honey, and mixed until the drug was thick enough to be squeezed into a lump by hand, and put in a container. Before applying the medicine, assess the skin’s integrity first, if the skin is intact and not damaged, then operate. Clean the skin first and apply the medicine to the painful hip joint, with the area increased appropriately, including the inner thigh and 1/4 of the hip, and then wrap the area of the medicine completely with plastic wrap, so as not to make the medicine seep out, and fix the prepared 3 rolls of elastic bandage securely on the affected area once a day.
②Chinese herbal fumigation Recipe and preparation: Dahurica dahurica 15g, Curcuma longa 20g, Trigonella sp. 20g, Lingxian 20g, Qianjian Jian 20g, Pepper 10g, Peach kernel 10g, Bonesetter 30g, Stretching grass 30g, Safflower 10g, Mugwort 10g, Wujiapi 20g, Haitongpi 20g, Sumac 10g. Add 5000ml of water to the above drugs, soak for 24 hours and then decoct on high heat for about The above drugs were soaked in 5000 ml of water for 24 hours and then decocted on high heat for 30 min before use. Assess the skin integrity of the patient before fumigation, and fumigate only if the skin is intact and not damaged. After adjusting the water temperature (generally 68℃), place the patient on the fumigation bed, fully expose the fumigation area, cover with a towel and use the drug steam to fumigate for 30 min. when the water temperature drops to 40℃, use a towel dipped in the drug solution to scrub and massage the affected hip once a day.
③Red light or magnetic therapy After the patient’s hip is treated with dressing, use electromagnetic wave or red light therapy instrument to irradiate the dressing area, about 30 ~ 40cm away from the affected part, using heat to play the role of anti-inflammation, pain relief, promote blood circulation and improve the immunity of the body.
④ Mechanism of shock wave treatment for orthopedic diseases
(1) Stress effect Specifically, the tensile stress (tension) and compressive stress (pressure) acting on tissue cells cause relaxation between tissues, elastic deformation of cells, and physical changes in focal tissue cells, resulting in a series of physiological changes such as accelerated capillary microcirculation and enhanced cellular oxygen absorption, so as to achieve the purpose of treatment.
(2) Cavitation effect The cavitation effect is a unique characteristic of shock waves. In the treatment of bone tissue and soft tissue diseases, the cavitation effect of a large number of bubbles within the lesion is a favorable factor to open the physiologically closed microvessels and loosen the joint soft tissue adhesions, which turns from a side effect into a therapeutic effect.
Western medicine describes it only as a symptom – synovial inflammation, and the treatment mostly adopts anti-inflammatory and anti-viral methods or intra-articular injection of hormones and local anesthetics, and in severe cases, arthroscopic techniques are used to remove synovial tissue. Chinese medicine mostly adopts the methods of internal and external use of Chinese medicine, massage, acupuncture and massage, and has achieved satisfactory results.
V. Summary
Synovitis of the hip joint in adults is proposed as an independent disease name, and the advantages of Chinese medicine are brought into play to explore an effective method of combining Chinese and Western medicine to treat the disease in combination with modern medicine. Proper braking and resting of the affected limb can relieve the tension of the soft tissues around the hip joint, alleviate the symptoms, and facilitate the repair of damaged synovium and recovery of joint function. The treatment of adult hip synovitis by the intervention of Chinese medicine internally and externally has achieved good clinical results, and the method is easy and safe to operate and economical, which is worthy of further clinical research and promotion, and to a certain extent makes up for the shortcomings of Western medicine.