Sinovit an ankle joint – the inflammation of an internal sinovialny cover which is followed by accumulation of liquid in a joint. Meets seldom. It can be provoked by a trauma, arthrosis, arthritis, allergic reaction, endocrine or exchange violations, and also penetration of an infection into a joint cavity. It is shown by pains, increase in volume of a joint, fluctuation and restriction of movements. In the presence of an infection the expressed hyperaemia and symptoms of the general intoxication is observed. The diagnosis is exposed on the basis of clinical signs, apply a X-ray analysis, MPT, KT, ultrasonography, a research of a punktat etc. to identification of the reason of a sinovit. Treatment is usually conservative.
Sinovit an ankle joint
Sinovit an ankle joint – the aseptic or infectious inflammation of a sinovialny cover which is followed by accumulation of liquid in a joint cavity. Arises less than sinovita of other joints, comes to light at people of all age categories. Can be infectious or aseptic, sharp or chronic. Depending on the reason of its development traumatologists, orthopedists, rheumatologists, hematologists and other experts can perform treatment of a sinovit of an ankle joint.
Reasons and classification
In orthopedics and traumatology allocate aseptic and infectious sinovita. Aseptic arise without participation of microbes and are reaction of a sinovialny cover to any pathogenic irritants. Infectious develop owing to penetration and reproduction of microorganisms in joint cavities. The joint injury can become the reason of an aseptic sinovit: bruise, sprain, rupture of sheaves etc. Sometimes the jet aseptic inflammation "is started" by allergic reaction of an organism.
In some cases aseptic sinovit is provoked by the constant irritant action rendered on a sinovialny cover by any part of a joint, for example, the cartilage which lost the smoothness at arthrosis. The aseptic sinovita which arose under the influence of endocrine violations (for example, diabetes), neurogenetic factors (neuritis, neyropatiya), arthritis, hemophilias, static deformation of a joint, and also the congenital or acquired weakness of the copular device are possible.
Nonspecific or specific pathogenic microorganisms become the reason of development of an infectious sinovit. Specific sinovit it can be provoked by a tubercular stick, today such pathology meets very seldom. Also streptococci usually act as the activator at nonspecific sinovita staphylococcus, is more rare – other bacteria. The infection gets into a joint kontaktno, hematogenic (on blood vessels) or a limfogenny way.
Contact infection arises at the grazes hurt, cut or chipped wounds, the suppurated hematomas, furuncles, abscesses or phlegmons in a joint or near it. Hematogenic or limfogenny spread of an infection can be observed at some general infectious diseases and existence of the remote inflammatory centers. The contributing factor is decrease in immunity, exhaustion and the weakened condition of an organism.
Taking into account features of a clinical current allocate sharp and chronic sinovita, taking into account character of an exudate (inflammatory liquid in a joint) – serous, purulent, hemorrhagic and slipchivy (serous ). At a serous inflammation an exudate liquid, transparent, with a small amount of cages, at hemorrhagic – too liquid, but reddish or brownish, at purulent – muddy, yellowish-greenish, with a smell. Existence of small amount of the liquid rich with fibrin is characteristic of a slipchivy inflammation.
The patient suffering from a sharp aseptic sinovit is disturbed by the weight and pains which are (often holding apart) in a joint. At an insignificant inflammation the pain syndrome is expressed poorly and appears mainly during movements. At the expressed sinovit the patient notes pain and feeling of a raspiraniye even at rest. The movements are limited. At survey unsharply expressed hypostasis of soft fabrics, smoothing of contours and increase in the sizes of a joint comes to light (extent of increase depends on quantity of an exudate). Perhaps insignificant reddening and increase in local temperature. At a palpation fluctuation is defined.
Current of a chronic aseptic sinovit usually wavy, the periods of aggravations alternate with more or less long remissions. During remission symptoms of a sinovit are absent or are poorly expressed, the clinical picture is defined by the main disease (for example, arthrosis of an ankle joint). In the period of an aggravation there is a symptomatology reminding a picture of a sharp aseptic sinovit, however details can differ depending on an inflammation form.
The sudden beginning with the advent of moderate or sharp pains and the general symptoms of intoxication is characteristic of an infectious sinovit: temperature increase, weakness, weakness, headache etc. The joint is edematous, increased in volume, skin over it is hyperemic, its temperature is increased. The movements are sharply complicated because of pain, the support is limited. The palpation of a joint is sharply painful.
For confirmation of the diagnosis and specification of the reason of development of a sinovit carry out a joint puncture with the subsequent cytologic and microscopic research of sinovialny liquid. According to testimonies of the patient direct to consultations to various experts: to rheumatologists, phthisiatricians, endocrinologists, allergists. If necessary appoint additional researches: a X-ray analysis of an ankle joint, ultrasonography, KT of an ankle joint and MRT of an ankle joint, allergic tests, blood test on immunoglobulins and S-jet protein etc.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment is complex, including therapy of the main disease. The ankle joint is fixed the pressing bandage (the bandage needs to be weakened every 2-3 hour), in hard cases imposed plaster to steak. For elimination of an inflammation at aseptic sinovita appoint NPVS and physiotherapeutic procedures: UVCh, electrophoresis and . In the presence of a large number of an exudate carry out punctures. In need of a joint inject glyukokortikosteroidny drugs.
At infectious sinovita carry out antibacterial therapy, after definition of sensitivity of the activator in a joint enter novocaine into mixes with antibiotics, for example, levomitsetiny, lincomycin or penicillin. At a chronic inflammation of an ankle joint appoint inhibitors of a proteoliz: etc. Surgical interventions are required very seldom, at inefficiency of conservative therapy carry out partial or full removal of a sinovialny cover.