Chronic sinovit – a chronic inflammation of a sinovialny cover of a joint. As a rule, arises against the background of osteoarthrosis or chronic arthritis, it is less often observed at hemophilia and after joint injuries. Is followed by accumulation of liquid (exudate) in a joint cavity. It is shown by pains, puffiness and restriction of movements. The current is wavy, alternation of remissions and aggravations is observed. For specification of the diagnosis and definition of the reason of development of a sinovit appoint a X-ray analysis, ultrasonography, an arthroscopy, an artropnevmografiya, MPT, KT and other researches. Treatment is more often conservative.
Chronic sinovit – the inflammatory process striking a sinovialny cover and which is followed by accumulation of liquid in a joint cavity. It is most often diagnosed at osteoarthrosis, a little less often this pathology is observed at chronic arthritis. In some cases sinovita develop at hemophilia. After joint injuries (fractures, dislocations, heavy bruises, ruptures of ligaments) chronic sinovit is observed seldom. First place on prevalence is won by sinovita of a knee joint, coxofemoral and humeral joints are surprised less often, it is very rare – elbow, talocrural, luchezapyastny joints, joints of feet and brushes.
Chronic sinovit - it is a secondary pathological state which develops against the background of some previous changes of a joint. In the subsequent mutual weighting is observed: the main pathology provokes a recurrence of a sinovit, and inflammatory and degenerate changes in an internal cover of a joint aggravate the course of the main disease. Therefore along with elimination of symptoms of a sinovit the plan of treatment surely includes the pathogenetic actions directed to fight against the main pathology. Depending on the reason of its emergence experts in the sphere of orthopedics and traumatology, hematology, rheumatology can perform treatment of a sinovit.
Pathogenesis of a chronic sinovit
Normal sinovialny liquid reminds blood plasma. However there are also certain differences: in a sinoviya there are less proteins, there is no fibrinogen, but there is rum acid on the basis of which the difficult connections providing viscosity of sinovialny liquid are formed. Besides, the sinoviya contains a quantity of bacteria, salts, crystals and microscopic fragments of fabrics which naturally die off, being replaced with new cages, get into an articulate cavity from the surface of a cartilage and an internal cover of a joint, and then resolve.
Any change of a condition of an organism affects composition of sinovialny liquid. Especially strongly the players of liquid are changed at inflammatory processes in the joint. The quantity of a sinoviya increases from 1-2 ml (normal indicators) to 50-60 ml, and in hard cases – and to 100-150 ml. Liquid becomes more viscous. All this, along with inflammatory changes of a sinovialny cover and the increased liquid pressure, provokes the progressing changes in all structures of a joint.
The Sinovialny cover at a chronic sinovit is thickened, becomes uneven, in it sites of fibrous regeneration are formed. Pathological growth of fibers or loss of fibrin with the subsequent formation of freely lying intra articulate bodies can be observed. Not only the internal cover, but also the capsular and copular device suffers because of pressure of liquid. In the capsule there are cicatricial changes, sheaves excessively stretch. Looseness of a joint leads to a travmatization of cartilages, the capsule and other structures and, finally, provokes development of osteoarthrosis.
Symptoms of a chronic sinovit
Most of patients address the traumatologist in connection with joint pains. It is the main symptom giving to patients an inconvenience. Pain becomes the main circumstance influencing working capacity, causing restriction of movements, giving constant trouble and reducing quality of life. At the same time, pain is a subjective indicator which depends on a set of factors (including – on the main disease) and often does not correlate with expressiveness of pathological changes in a joint.
The objective indicator testifying to degree of activity of pathological process and defining treatment tactics – quantity and character of an exudate. Complexity of identification of an exudate depends on localization of chronic pathological process. Availability of liquid at a sinovita of a knee joint is confirmed by a simple palpatorny research. The exudate congestion also rather well is noticeable at damage of luchezapyastny, elbow joints and small joints of a brush. To reveal an exudate in ankle and shoulder joints at usual external examination rather difficult. The coxofemoral joint is inaccessible to visual survey and cannot be on existence of an exudate therefore it is possible to find in it liquid only when carrying out special researches.
All patients with a chronic sinovit are directed to a radiological research for detection of the main disease and assessment of a condition of dense structures of a joint. The X-ray analysis allows to exclude rough changes: incomplete dislocations, bone growths and centers of an aseptic necrosis. Then to patients appoint ultrasonography of a joint – it the research gives the chance to precisely define amount of liquid in a joint cavity, and also to estimate a condition of a sinovialny cover (expressiveness of an inflammation, existence of thickenings, centers of fibrous regeneration etc.). If necessary use an arthroscopy. In the presence of an exudate carry out a joint puncture, direct the received liquid to a research. According to indications appoint consultations of adjacent experts.
Treatment of a chronic sinovit
Tactics of treatment of a chronic sinovit is defined with the main disease and expressiveness of ekssudativny manifestations. At absence or a small amount of an exudate medical punctures are not required. To patients appoint NPVS of local action (diclofenac, an ibuprofen, indometacin). For anesthesia advise to apply the ointments and gels containing menthol. Recommend to provide rest of an extremity, and during loading to use elastic bandage or special orthopedic clamps. Give the direction on UVCh, magnetotherapy and an electrophoresis.
In the presence of an exudate carry out punctures then impose plaster or the pressing bandage. At a persistent sinovit carry out intra articulate introduction of medicines. Use of hormonal means allows to eliminate quickly an inflammation, to reduce amount of exudate and to reduce a pain syndrome. At rare introduction glucocorticoids can have the stimulating effect and promote restoration of cartilaginous tissue. At too frequent blockade the effect changes on opposite – medicines begin to destroy a hyaline cartilage therefore frequency rate of introduction is limited to 3-4 blockade within a year. Besides, enter into a joint .
At a long current of a chronic sinovit and irreversible changes in an internal cover of a joint carry out a sinovektomiya. Removal of a sinovialny cover can be full or partial, depending on the data on a condition of a sinoviya obtained when performing ultrasonography and an arthroscopy. Partial excision is carried out through one section, full removal of a sinoviya sometimes requires several cuts (through additional cuts excise the changed fabrics in the field of zavorot). Then carry out anti-inflammatory therapy, from 3-5 in the afternoon appoint LFK.