Synovitis

When functioning properly, the synovium is very useful. But when it is damaged, it can cause extreme pain. Hence, medical treatment is necessary to provide relief since the pain becomes worse over time. However, some cases are even more challenging. New and improved treatment will hopefully be available soon.

Synovial fluid is secreted by the synovial membrane. It is a viscous fluid found in the joint cavities, tendon sheaths, and bursae. Surrounding the knees, shoulders, hips, wrists, and ankles is this clear, thick synovial fluid. It lubricates and protects the bones from damage caused by friction. Inflammation of the synovial membrane is called synovitis. Synovium is the inner lining of the joint capsule and is also called the synovial membrane. Synovitis affects the joints, especially the knees. The movement of the affected part is then limited. Inflammation occurs in response to any foreign particle or microorganism.

The inflammation may also cause increased blood flow, tenderness, and increased fluid production. If synovial fluid is present in excess, it causes extreme pain, limits motion, and causes swelling. The fluid level may increase due to various factors. To confirm or rule out other conditions linked to synovitis, analysis of synovial fluid taken from a joint must be done. The synovial joint is enclosed in a synovium. The synovium is adapted to a different range of motions, such as stretching, folding, rolling, etc.

If the synovitis is acute, it responds well to conservative treatment. Within a few days, the synovitis will show improvement if the affected joint is given proper rest, but to fully recover, it will take eight weeks. However, if the synovitis is chronic, the outcome is determined by the course. If, after a synovectomy or chemical ablation, the synovium regrows, the synovitis may recur.

Generally, the cause of synovitis is associated with various health conditions and trauma. Some causes include:

• Repetitive motion that puts strain on the joint due to overworking
• Underlying medical conditions, such as rheumatoid arthritis, gout, and osteoarthritis
• Allergic reactions
• Injury or trauma to the joint due to accidents
• Septic arthritis and tuberculosis
• Excess body weight
• Fluid accumulation around the knee capsule
• Some past injury that has shown up again, causing inflammation
• Over-exercising
• Strain, sprain, or wound; mostly, football, soccer, and other sports players suffer from synovitis of the knee.
• Hazards from climbing stairs, slippery staircases, and scrubbing floors
• Nervous system disorders, hormonal disorders, or bacterial or viral infections causing disease

Rheumatoid arthritis is closely associated with synovitis. As the condition progresses, the inflammation of other tissue cells is stimulated, which increases the pain.
Synovitis is more common in individuals performing repetitive motions, such as climbing, running, and jumping using the knees, feet, and ankles. However, there have been cases of synovitis affecting joints of the lower extremities, too.

People with a history of leukemia, psoriasis, lymphoma, and those undergoing chemotherapy are at risk of gout. Furthermore, people with an overproduction of uric acid due to gout are at an increased risk of synovitis. Also, alcohol consumption, hypertension, and chronic renal failure can decrease the excretion of uric acid, which leads to their accumulation and thus further increases the risk of gout and synovitis. Chronic synovitis also occurs in people with hemarthrosis of the knees, elbow joints, and ankles and in people with severe hemophilia.

Synovitis can affect males and females equally, although rheumatoid arthritis linked to synovitis is three times more likely to occur in females than in males. Rheumatoid arthritis is prevalent in 0.8% of the population. Synovitis linked to bacterial infections occurs in 10 out of 10,000 procedures of intra-articular steroid injections. Septic arthritis is commonly seen in individuals under the age of 15 and above the age of 55. It is also more common in men. It is prevalent in 6–10 per 100,000 populations. A joint prevalent may be needed in 30–70 per 100,000 populations. 

Common symptoms are swelling, excruciating pain, warmth, and redness surrounding the affected area.

In the case of synovitis due to rheumatoid arthritis, the affected joint appears puffy and swollen. The increased blood flow makes the affected joint warm. Further pain and irritation is caused by the cells that release enzymes in the joint space. If this condition is not treated, these enzymes may digest the cartilage and bone, causing degenerative changes and chronic pain.

Other structural damage such as labrum tears, ligamentum teres tears, and cartilage damage at the hip joint are also associated with synovitis.

Synovial fluid surrounds the joint, so this condition may occur anywhere in the body; it can occur in the shoulders, hips, knees, ankles, jaw, or wrists. It can even affect more than one joint at the same time.

• Synovitis of the jaw: The temporomandibular joint becomes inflamed. There is restriction of and problems with jaw movement. Motions such as chewing, opening the mouth, and yawning become difficult. This pain may spread from the jaw to the ears, neck, and head.
• Synovitis of the shoulder: One or both shoulders may be affected at one time. Even simple tasks, such as raising the arms, become difficult, and the person experiences pain in the shoulder.
• Synovitis of the wrist: The wrist becomes inflamed and motor skills are affected. Even tasks such as writing and lifting the hand become difficult.
• Synovitis of the hip: There is great difficulty bending and walking since, during such actions, a great deal of pressure is applied on the hips.
• Synovitis of the knees: Bending of the knees and walking become difficult and painful. This is very commonly experienced. The usual complaint is excruciating pain in the knee.
• Synovitis of the ankle: An afflicted person tends to limp, since walking creates pain. This type is similar to synovitis of the hip.

Even though the symptoms separate it from other joint issues, sometimes synovitis can be misdiagnosed. For a correct diagnosis, the symptoms experienced and the results of tests on the joint and synovial fluid will be taken into consideration.

• Medical history: It is not believed that synovitis is activity-related, but the individual may describe their history of receiving forces that have caused strain on the joint, or repetitive motions performed for extended periods. The doctor will look for any past symptoms of illnesses, fevers, autoimmune diseases, infections, etc. The person may complain of pain in the joints, stiffness, or warmth, as well as share if the use of hot or cold compresses provides relief.
• Physical examination: Swelling, redness, and warmth upon touching the affected joint area are signs of synovitis, which help with the analysis. They can determine the severity of the inflammation and the possible underlying medical condition. The muscle is tested around the joint for any pain or weakness. Evaluation of joint-play movements is performed as well to check for mobility or irritability. Joint play may be excessive if the synovitis has occurred due to a traumatic injury. The joints will not have a boggy feel and will appear red, warm to the touch, and swollen. A patella tap test may be performed by the doctor by firmly pressing the region just above the knee.
• Analysis of synovial fluid: The skin over the joint is first cleaned with an antiseptic, and a local anesthetic is then injected. With the help of a needle, synovial fluid is withdrawn. This is done in a medical clinic and takes about half an hour.
• Laboratory test: Complete blood count, urinalysis, erythrocyte sedimentation rate, and C-reactive protein are all done to measure inflammation. To evaluate the joint surface of the articular surface, X-rays may be needed. A nuclear medical scan can also provide information during the early stages of the inflammation. Other tests, such as a bone scan or ultrasound, can also be done.

A steroid injection at the joint is known to reduce inflammation and synovitis. Mostly, the effect is long-term; rarely is it a short-term relief. Other remedies include:

• Anti-inflammatory drugs: These drugs are used to treat swelling and pain. They are commonly prescribed by a doctor and include steroids, aspirin, corticosteroids, and ibuprofen.
• Draining the fluid: If the pain is severe, the synovial fluid is drained to provide relief. This is mostly done for synovitis of the knee. It is a temporary procedure; with time, the synovial fluid will collect in that area again.
• Surgery: This is done to remove the affected tissue. A portion of the synovium is removed and, sometimes, even the joint is replaced.
• Ice and hot packs: This is to provide temporary relief from the pain and swelling.
• Rest: During the healing process, it is recommended to rest the joint and avoid movement. If the synovitis is at the knees, hips, or ankles, avoid keeping any weight on them. If the synovitis is at the shoulder or wrists, avoid motions such as carrying or lifting. If the synovitis is at the jaw, eat a diet of soft foods, since moving the mouth will be difficult.
• Splints or braces: These can be used to combat pain and swelling.
• Rehabilitation: This may be required depending on the condition, location, and severity. It will alleviate any pain that exists, as well as improve the range of motions.

Many people are affected by synovitis, but with the right treatment, it is possible to lead a healthy and productive life. The knee is most often affected by this disorder. Any underlying medical condition linked to synovitis may cause debilitating symptoms. The correct option for treatment depends on the therapy done at home and the severity of the condition.

The Multicenter Arthroscopy Study of the Hip is studying patients undergoing hip arthroscopy. They are defining the extent of synovitis and, while controlling other injuries of the joint, seeing how outcomes are related to it.

The aim is to reduce the inflammation and pain, as well as restore any range of motion or strength lost. The therapy first begins with elevation of the affected joint in order to reduce the swelling. Also, the person is taught how to avoid applying pressure on the synovial tissues that are inflamed either by using a soft foam pad, a sling, or an elastic bandage. This will reduce the swelling as well as protect the affected area. Other rehabilitation procedures are:

• Cold and heat treatments: Initially, an ice pack is used to control pain and swelling. Cold treatment is given when the area is warm to the touch. To reduce muscle spasms, the cold treatment may be combined with electrostimulation. This will help reduce pain and inflammation. When the pain and inflammation lessen, the heat treatment can be introduced. Heat packs are used to reduce stiffness and pain and increase blood flow, which helps the healing process.
• Ultrasound: In an ultrasound, high frequency sound waves are used to cause circulatory changes in the soft tissues. Heat may be applied so that it penetrates deep.
• Iontophoresis: This makes use of a small electric current. It helps push the anti-inflammatory medication deep into the inflamed tissues.
• Exercises: After the pain and swelling are greatly reduced, a therapist can help the patient perform passive stretching exercises. This is to help regain the loss of range of motion. Gradually, the exercises become more active. This is to restore the function of the joint. Depending on the joint that is affected and the condition (whether it is acute or chronic), accordingly, modifications may be made in the therapy.

The selection of therapy is individual-based and depends on the symptoms experienced. It often uses a holistic approach. The main goal here is not to treat synovitis, but to address its cause and the susceptibility of the individual. Since the remedy and treatment are individualized, one will need to consult a qualified homeopathic doctor. Homeopathic remedies include:

• Apis mellifica: This is used for synovitis to give relief from pain, soreness, swelling, and stinging. Usually, when cold is applied, the joint pain becomes better, and when heat is applied, the pain becomes worse. When pressure is applied, the pain becomes stiff and painful. Also, there may be swelling and edema. Apis mellifica affects the tissues around the joint, not the joint itself. It acts on the tendons, ligaments, and synovium.
• Rhus tox: This is used as a remedy for joint and muscle pain. With this remedy, the sheaths around the muscle and the fibrous tissue around the joint may be relieved.