[Joint effusion = synovitis ← common manifestation of many diseases]
Synovitis is a specific manifestation of a variety of diseases (e.g., trauma, osteophytes, joint degeneration, intra-articular injury, osteoarthritis, osteoarthrosis, surgery, tuberculosis, rheumatic diseases, pigmented villonodular nodulitis, etc.) in the synovial tissues. These diseases can expose the synovial membrane to mechanical, biological and chemical stimuli, causing congestion, edema, increased vascular permeability, excessive secretion of synovial fluid, and decreased absorption, resulting in clinical symptoms such as joint swelling, pain, and restricted movement.
Strictly speaking, the presence of synovial inflammation is evidenced by the presence of exudative fluid in the joint. If left untreated. If left untreated, the synovial membrane will gradually thicken in response to long-term inflammatory stimulation. The synovial membrane is fibrous, causing adhesions and affecting the normal activities of the joint.
Therefore, synovitis is not a disease, but a common manifestation of many diseases. The synovial membrane of the knee is the most extensive and complex of the joints in the human body, and is also the largest synovial cavity. Because the synovial membrane of the knee is extensive and located in the superficial part of the limb, there are more opportunities for injury and infection, therefore, clinically synovitis is mostly manifested in the synovitis of the knee.
Knee synovitis can be divided into two types: acute traumatic synovitis and chronic injury synovitis.
【Diagnosis】.
(1), Acute knee synovitis [pain + joint hematoma]: Acute traumatic synovitis mostly occurs in young people who like sports. Mostly, swelling, pain, difficulty in movement, high local skin temperature, swelling and tension, and hemorrhagic fluid from joint puncture occur due to blows, twisting, excessive movement, and after surgical procedures. Joint hematoma mostly occurs immediately after the injury or within 1-2 hours afterwards, with large petechial hemorrhagic spots on the knee and lower leg (cold compress within 48h, hot compress after 48h.) .
(2), chronic knee synovitis [synovial hypertrophy + adhesions]: chronic knee injury synovitis comes from two conditions [injury / cold / fat / old].
(a) incomplete treatment of acute synovitis;
(b) The knee joint is subjected to repeated multiple minor trauma, strain, and cold accumulation (e.g., trauma, hyperplasia, degeneration, osteoarthritis, surgery, tuberculosis, rheumatism, etc.). Chronic injury synovitis occurs most often in middle-aged and elderly people or in people who are obese or who carry too much weight on the knee joint. The main pathological changes are synovial congestion, swelling, hypertrophy or mechanized adhesions. There may be multiple acute episodes of chronic lesions.
Clinical manifestations of chronic injurious knee synovitis [heavy complaints/light examination]: There is mostly a history of exertion or joint soreness and pain. Patients feel heavy in both legs, swollen joints, difficulty squatting, or pain going up and down stairs, which is aggravated after exertion and cold, and alleviated after rest and when it is warm. The patient complained of heavy and multiple discomfort. However, there is no significant impairment in passive motion, pain is not severe, local redness and heat are not present, and functional examination of the knee joint generally has no significant positive signs;
However, acute onset patients have symptoms of acute synovitis on top of this; those with long duration of disease are mostly seen in the elderly, with atrophy of the quadriceps muscle, joint instability, restricted movement, and pale yellow clear fluid can be extracted by arthrocentesis. And commonly in the patellar ligament on both sides of the knee eye bulge, full, palpation by hand, the place is soft, activity more wet cowhide shoes walking sound and tread snow feeling (synovial hypertrophy). Older people are more fat (more phlegm, more dampness, more qi deficiency), and there are degenerative changes in the bone joint X-ray, or there are bone spurs at the edge of the joint, narrowing of the gap, or with knee inversion, knee valgus or other knee deformities (osteoarthritis), etc.
[Treatment
(1) Mild synovitis of the knee joint.
[Rest + straight leg elevation] Generally, bed rest is not necessary, short distance walking is possible. If the amount of fluid accumulation is high, proper rest should be taken, the affected limb should be elevated, and functional exercises of the knee should be done in bed. Exercising the quadriceps is an important and effective therapeutic measure; straight leg elevation can promote blood circulation and facilitate the absorption of joint effusion.
(2) Acute traumatic synovitis.
A .【Braking+exercise】Once it occurs, early bed rest should be taken, elevate the affected limb, use elastic bandage with pressure bandage or use plaster brace to brake the knee joint in straight position for two weeks (Figure 1), and prohibit weight bearing. During the treatment period (including the immobilization period), the quadriceps flexion and contraction exercises, i.e., quadriceps isometric training and straight leg raising training, should be performed; later, the knee flexion and extension exercises should be strengthened. This has a positive effect on eliminating fluid accumulation, preventing muscle atrophy, preventing recurrent synovitis, and restoring knee extension and flexion function.
B .【Puncture+Sodium hyaluronate】Joint puncture can be performed when there is a large amount of joint fluid and tension. Normal synovial fluid is alkaline fluid, due to increased exudation after injury, the accumulation of acidic products in the joint, the synovial fluid becomes acidic, prompting fibrin precipitation, if the fluid is not removed in a timely manner, the synovial membrane of the joint long-term inflammatory stimulus response, prompting the synovial membrane gradually thickened, and there is fibrous mechanization, causing adhesions, affecting the normal activities of the joint.
The fluid extracted from the joint puncture is mostly yellow, clear, or pink with blood, and negative for bacterial culture. The fluid and blood are repeatedly flushed with saline, completely aspirated, and hyaluronic acid na, which is the main component of the joint cavity, is injected into the joint cavity. Studies have shown that the various pathological changes in arthritis are closely related to its reduction and altered physicochemical properties.
【Puncture + hormone】Adrenocorticotropic hormone: Although it has been reported to be beneficial to chondrocytes, there is no need for systemic application. It is only indicated for concomitant synovitis, and in case of joint cavity effusion, then local injection of Depo-Provera, Rimadex, etc. can be given to the joint cavity or lesion site under strict sterilization. The same joint should be administered no more than four times a year, and the interval between injections should not be shorter than two months.