Sinovit – inflammatory process in a sinovialny cover, followed by a congestion of liquid (exudate) in a joint cavity. Most often the knee joint suffers. Perhaps also defeat talocrural, elbow, luchezapyastny and other joints. As a rule, the inflammation develops in one joint. Simultaneous damage of several joints is observed rather seldom. Sinovit can develop as a result of a trauma, an infection, an allergy, some diseases of blood, endocrine diseases and exchange violations. It is shown by pain, increase in volume of a joint, weakness and an indisposition. At accession of a purulent infection of pain amplify, there are symptoms of the general intoxication. The diagnosis is exposed on the basis of symptoms, a research of sinovialny liquid and other inspections. Treatment – an immobilization, punctures, if necessary drainage or surgery.
Sinovit – the inflammatory disease of a sinovialny cover of a joint which is followed by an exudate congestion. Arises at some diseases and exchange violations. In some cases develops at injuries. More often the knee joint is surprised, other joints suffer less often (humeral, talocrural). At injuries inflammatory process usually develops in one (injured) joint. At diseases and violations of exchange damage of several joints is in certain cases possible.
Taking into account a current allocate:
- Sharp sinovit – is followed by a thickening, polnokroviy and hypostasis of a sinovialny cover. The exudate represents translucent liquid, sometimes – with flakes of fibrin visible with the naked eye.
- Chronic sinovit – is shown by development of fibrous changes in the joint capsule. In some cases fibers of a sinovialny cover expand, on a cover there are fibrinozny imposings which are hanging down about a joint cavity (fleecy sinovit). At office of imposing are transformed to so-called "rice little bodies" which freely move in articulate liquid and in addition injure a sinovialny cover.
Taking into account a type of an inflammation and character of an exudate distinguish:
- Serous sinovit.
- Serous sinovit.
- Hemorrhagic sinovit.
- Purulent sinovit.
Taking into account the cause allocate:
1. Infectious sinovit. Results from hit of pathogenic microorganisms in a joint cavity. The causative agent of an infection can get into a sinovialny cover from the external environment (at the getting joint wounds), from surrounding fabrics (at the purulent wounds and abscesses located near a joint), and also from the remote centers of an infection. In the latter case microorganisms get into a joint on lymphatic or blood vessels.
- Nonspecific infectious sinovit. Is caused by nonspecific activators: pneumococci, stafilokokka, streptococci, etc.
- Specific infectious sinovit. Is caused by causative agents of specific infections: pale treponemy (at syphilis), a tubercular stick (at tuberculosis), etc.
2. Aseptic sinovit. Pathogenic microorganisms in a cavity of a joint are absent, the inflammation has jet character. The reason of development can become:
- Mechanical trauma (intra articulate fractures, joint bruises, ruptures of ligaments, injuries of meniscuses and so forth).
- Irritation of a sinovialny cover freely lying articulate bodies or the structure damaged as a result of the previous trauma (the torn-off meniscus injured by a cartilage and so forth).
- Endocrine diseases.
- Metabolic disorders.
3. Allergic sinovit. The contact of the patient with allergen becomes the cause.
Nonspecific sharp serous sinovit is followed by increase in a joint in volume. Contours of a joint smooth out, the feeling of a raspiraniye in certain cases appears. Sometimes there is unsharply expressed pain syndrome. The indisposition, slight increase of the general and local temperature is possible. The movements are limited, palpation of a joint weak or moderately painfully. At a palpation fluctuation is defined. Test is carried out as follows: the surgeon puts fingers on the opposite surfaces of a joint and then accurately presses on the one hand; if under fingers of other hand the push is felt, so in a joint there is a liquid. At a research of a knee joint balloting of a patella also comes to light: when pressing the patella "plunges" against the stop into a bone, and at the termination of pressure "emerges".
Sharp purulent sinovit is followed by bright clinical manifestations. The condition of the patient worsens, there are symptoms of sharp intoxication: temperature increase, oznoba, sharp weakness. In hard cases the nonsense is possible. The expressed pain syndrome is noted. The joint is edematous, increased in volume, skin over it is hyperemic. The movements are painful, development of a contracture of a joint is possible. In some cases regionarny lymphadenitis (increase in nearby lymph nodes) comes to light.
Chronic sinovit can be serous, but belongs to one of the mixed forms more often: seroznofibrinoidny, vileznogemorragichesky etc. The disease usually is followed by poor clinical symptomatology, especially at early stages. The patient is disturbed by the insignificant aching pains, at the repeating movements bystry emergence of "fatigue", "fatigue" of a joint from the sick party is noted.
At a sharp and chronic aseptic sinovit infection of an exudate with development of heavier infectious sinovit is possible. If infectious process extends out of limits of a sinovialny cover and passes to a fibrous membrane, there is purulent arthritis. At further distribution of process on surrounding fabrics phlegmon of soft fabrics can develop or periartrit. A heavy complication of an infectious sinovit is pan-arthritis at which all structures participating in formation of a joint are involved in purulent process: bones, cartilages and ligaments. In some cases as a result of purulent process sepsis can develop.
It is long the existing chronic aseptic sinovit it is also fraught with unpleasant complications. The joint gradually increases in the volume as surplus of liquid does not manage to be soaked up back in a sinovialny cover. In the absence of treatment in such cases develops (joint dropsy). Long existence of a gidrartroz becomes the reason of looseness of a joint. His ligaments gradually weaken, there can be an incomplete dislocation or even dislocation.
The diagnosis is exposed on the basis of the clinical signs given a diagnostic puncture and other researches. At the same time important not only to confirm existence of a sinovit, but also to establish the reason of its emergence that in some cases represents rather difficult task. For specification of the diagnosis of the main disease at a sharp and chronic aseptic sinovit the arthroscopy and an artropnevmografiya can be appointed. The biopsy of a sinovialny cover and a cytologic research can be also required. At suspicion of hemophilia, endocrine or exchange violations the corresponding analyses are appointed. At suspicion on the allergic nature of a disease allergic tests are carried out.
One of the most informative researches is the research of a punktat (the liquid received as a result of a diagnostic puncture). The exudate research at a sharp aseptic traumatic form of a disease testifies to a large amount of protein that confirms high permeability of vessels. Because of reduction of amount of hyaluronic acid viscosity of such exudate is lower, than at normal sinovialny liquid. At chronic inflammatory processes hyperactivity of enzymes comes to light (hondrprotein, a gialuronidaza, a lizotsim etc.) that leads to disorganization and the accelerated destruction of a cartilage.
At a purulent sinovit in a punktata pus which is investigated bacteriological or bakterioskopichesky by methods is found. It gives the chance not only to establish a type of the pathogenic microorganisms which became the inflammation reason but also to pick up the most effective antibiotics. Besides, to patients with this form of a disease surely appoint blood test. By results of the analysis increase in SOE, increase in quantity of stab neutrophils and comes to light. At suspicion of sepsis crops of blood on sterility are in addition carried out.
Treatment of a sinovit
At the established cause of illness and insignificant amount of liquid in a joint treatment out-patient. If the exudate in a joint appeared as a result of a trauma, the patient is sent to emergency station. Secondary symptomatic sinovita doctors of the corresponding profile treat: hematologists, endocrinologists etc. Sharp aseptic sinovit not clear etiology, and also sinovit with a large number of an exudate is the indication for hospitalization in a hospital. Patients with a traumatic sinovit are hospitalized in traumatologic office, patients with a purulent sinovit – in surgical office, the others – in the offices corresponding to a profile of the main disease.
At an aseptic sinovit with small quantity of an exudate appoint hard bandaging of a joint, an immobilization and sublime position of an extremity. The patient is directed to UF-radiation, UVCh or an electrophoresis with novocaine. At a large number of an exudate, except the listed medical actions, carry out medical punctures of a joint. At a persistent current appoint with a hydrocortisone and an electrophoresis with gialuronidazy or iodide of potassium.
Treatment of a sharp purulent sinovit provides an obligatory immobilization with providing sublime position of an extremity. At an easy current pus from a cavity of a joint is deleted by means of a puncture. At purulent process of average weight continuous long flowing and aspiration washing of a cavity of a joint solution of antibiotics can be required. At a heavy current opening and drainage of a cavity of a joint is carried out.
At a chronic aseptic sinovit therapy of the main disease is carried out. Tactics of treatment of a sinovit is defined individually with weight of a disease, existence or lack of secondary changes in a joint etc. Carry out punctures, provide rest of an extremity. Appoint nonsteroid resolvents, salycylates, glucocorticoids, extract of cartilages of calfs and chymotrypsin. For 3-4 day of the patient direct to ozokerite, paraffin, magnetotherapy, , UVCh and other physiotherapeutic procedures. At considerable infiltration and a frequent recurrence enter into a joint cavity.
At the chronic sinovit which is followed by irreversible changes in a sinovialny cover and also at long and persistently recidivous forms of a sinovit surgical intervention – full or partial excision of a sinovialny cover is shown. In the postoperative period carry out recovery therapy which includes an immobilization, purpose of anti-inflammatory medicines and antibiotics, and also physical therapy.
At a sharp aseptic and allergic sinovit forecast, as a rule, favorable. After adequate therapy the inflammatory phenomena are completely liquidated, the exudate in a joint disappears, the movements remain in full. At a purulent form of a disease in some cases contractures can be formed, in hard cases development of dangerous complications, life-endangering the patient is not excluded. At a chronic aseptic sinovit rigidity can develop. After a sinovektomiya in some cases a recurrence and development of contractures are observed.