What Causes Synovitis of Elbow & How is it Treated?

Synovitis of the elbow is the inflammation of the synovial membrane that is the lining of the elbow joint and also surrounds the soft tissues like tendons and bursae. Synovitis of the elbow is an inflammatory condition, which causes swelling, pain in the area around the elbow joint and makes it difficult to move the elbow or lift weight in hands. While synovial fluid is normally present in the elbow joint, excess accumulation of fluid in the joint space and around the synovium can occur in synovitis of the elbow.

Synovitis of the elbow can be noted at any age and equally in both men and women however the causes may vary. However, people suffering from certain medical conditions, injuries of the elbow joint and types of arthritis may be at greater risk of synovitis of the elbow. Elbow joint is a common location for synovitis and can affect the normal functioning of the elbow. Synovitis of the elbow can occur only in a single joint and affect one elbow or sometimes involve multiple joints, which may appear like a general problem.

Synovitis of the elbow often occurs when the synovium gets irritated and results into an inflammatory reaction.
Common causes of elbow synovitis include,

• Overuse – Repeated use of the elbow joint resulting in small injuries and inflammation of the synovium; it can strain the soft tissues around the elbow joint resulting in synovitis of the elbow. Lifting of weights in the hands or sudden increase in the activity levels using elbow joint can contribute to synovitis of the elbow joint.
• Injury – Intense involvement in certain type of sports can increase the workload on the elbow joint; sports injuries, falls, accidents or injuries to the elbow joint, direct trauma, etc. can increase the risk of synovitis of the elbow.
• Infection – Synovitis of the elbow can sometimes be a result of certain infections like in case of tuberculosis or septic arthritis. In some cases, infections elsewhere in the body can travel to the elbow joint and cause synovitis of the elbow.
• Medical Conditions – Underlying medical conditions or joint problems including various types of arthritis like elbow rheumatoid arthritis, osteoarthritis, psoriatic arthritis, juvenile arthritis, gout or pseudogout in elbow, some autoimmune or connective tissue disorders etc. may increase the risk of synovitis of the elbow in some people.
• Others – People with increased risk of crystalline deposition disorders like gout in elbow include those undergoing chemotherapy or those having medical history of hypertension, psoriasis, leukemia, renal failure, lymphoma and excess alcohol consumption. Those having bleeding problems like hemophilia or blood induced joint disorders, which can cause bleeding in the elbow joint space can increase the risk of synovitis of the elbow. Certain types of cancers can result in synovitis of the elbow in some people.

Certain factors can increase the risk of injury to the elbow leading to synovitis of the elbow include:

• Presence of previous injury to the elbow joint, ligaments, tendons or other soft tissues.
• Weak shoulder or wrist muscles and other joint conditions
• Awkward positions of the hands or improper techniques of using the hand in sports or work related activities.
• Repeated activities with forceful exertion, overhead reaching, excess bending and straightening of the elbow joint and activities involved with overhead reaching.

Symptoms of synovitis of the elbow mainly include elbow pain, stiffness, swelling, joint tenderness, formation of lumps or nodules under the skin and inability to move the elbow joint freely. Synovitis of the elbow of an infective origin will have associated symptoms indicating an infection. Elbow synovitis in rheumatoid arthritis will have remarkable elbow joint swelling.

Symptom of pain may be worse on straightening or extending the forearm, grasping objects or lifting heavy objects. Sharp pain may be felt while performing activities using the part which is already inflamed due to synovitis of the elbow. Using the wrists and twisting activities may be painful. Rest may help relieve pain or sometimes dull pain may be present even at rest. Morning stiffness is often present and certain types of movements may cause discomfort. Synovitis of the elbow is a painful condition with inflammation and palpable swelling the elbow joint.

Joint stiffness is a common symptom in synovitis of elbow and more commonly when associated with elbow rheumatoid arthritis. Stiffness is more common in the morning and may last for longer periods. Stiffness in the elbow joint can make it difficult and painful to move, bend and extend the elbow. Restricted movements due to pain add to the stiffness of the joint in synovitis of the elbow.

The elbow joint affected with synovitis of the elbow is often swollen and stiff. It may also appear red and may be warm to touch. Joint complaints may be present on both sides affecting both left and right elbow or may affect the joint alternately one after the other if associated with elbow rheumatoid arthritis.

Joint movements may be restricted and elbow movements may be painful. Bending or fully extending the hand, which requires folding at the elbow joint is very painful and hence restricted. Lifting weights in the hands may cause more discomfort. Flexibility of the elbow joint is affected, which makes movements difficult. Gradually, it can affect the functioning of the elbow joint and also affect the surrounding muscles.

In progressive conditions, nodules or lumps may develop around the elbow. The elbow joint may get deformed and contractures can develop in some people. These are also noticed more when elbow rheumatoid arthritis is present with synovitis of the elbow.

Sometimes, a nerve passing through the hand can get compressed, causing more symptoms due to the swelling in synovitis of the elbow. In elbow rheumatoid arthritis, the nerve passing through the arms can also get affected and cause numbness, tingling sensation in the hand. It can sometimes even affect the performance and functioning of the hands, making it feel weak with lack of co-ordination.

Other symptoms associated with synovitis of the elbow include mild fever coming off and on, feeling of warmth in the body or a chilly feeling, decreased appetite, fatigue or lack of energy, malaise and a general feeling of being unwell, when caused due to an infection or in septic arthritis. A tired feeling, inability to move, particularly the affected joint, in this, the elbow joint and generalized weakness may be noted.

Synovitis of the elbow may not necessarily be caused by increased activities of the elbow joint or overuse. However, in most cases, history taking reveals repetitive use of the elbow joint or increased workload on the elbow, which could have triggered synovitis of the elbow.

History and clinical examination can reveal a great deal of information, which can help in deciding the necessary investigations. Any history of injury, fall or accident, repeated use of hands, occupation of the person, recent infections, surgeries, other medical illnesses and history of medications is taken. Any history of rheumatoid arthritis, infective arthritis, synovitis, nerve disorder or previous ailments related to this is important.

Clinical examination in synovitis of the elbow includes assessment of the elbow pain, degree of severity of elbow pain and range of motion of the elbow joint. Swelling and tenderness is noted around the elbow joint. Redness, warmth and difficulty in movements, affected range of motion is noted. Swelling in synovitis of the elbow gives a boggy feeling to the elbow joint on palpation.

Some of the investigations done to diagnose synovitis of the elbow include

Blood tests – These are done to rule out other forms of arthritis, inflammatory joint conditions and possibility of infections. Blood tests are done to detect presence of infection causing synovitis of the elbow and to rule out possibility of septic or infective arthritis. They are also done to rule out other forms of arthritis. Blood tests like CBC, ESR, CRP, are usually done to detect inflammation and understand its severity; or other forms of arthritis; detecting blood uric acids levels to rule out gout in elbow, RF, rheumatoid factor and rheumatoid panel to rule out rheumatoid arthritis and other rheumatoid disorders; other tests to rule out autoimmune disorders may be done.

Imaging studies like X-rays, CT scans and MRI can help to detect changes in the bone, joint deformities and damage occurring to other tissues. Damage to the cartilage and bony erosions can be ruled out through these imaging studies. Performing these tests may also be useful in monitoring the progress of the disease and efficacy of the treatment plan, wherein damage to the joints and tissues needs to be studied.

X-ray – X-rays give an idea of the bones of the elbow joint. They are used to rule out any trauma, fractures in case of suspected injuries, degenerative changes and rule out other forms of arthritis.

MRI – MRI gives an idea of the soft tissues damage around the elbow joint. MRI can help to detect any damage to the soft tissues around the elbow joint or arthritis. It can be helpful in detecting joint effusion, soft tissue swelling and aid in diagnosing bursitis elbow.

Synovitis of the elbow can cause sufficient amount of swelling around the elbow joint. The elbow becomes swollen and tender to touch, severely painful and sometimes also becomes stiff. Joint fluid aspiration is performed as a diagnostic procedure in synovitis of the elbow to aspirate excess fluid accumulated in the elbow joint.

Joint fluid aspiration is a procedure performed taking aseptic precautions, in which a sterile needle is inserted into the elbow joint space around the swollen area. The excess synovial fluid accumulated in the swollen area, is aspirated through the needle. The aspirated fluid is sent for laboratory testing, where fluid analysis is done for detailed study regarding the presence of different types of cells, blood, crystals or infective organisms, based on which a diagnosis can be made. Inflammatory process in the elbow joint due to synovitis of the elbow can show presence of other cells like white blood cells, etc. which can aid in the diagnosis.

Fluid analysis helps to detect the presence of pus cells, white blood cells, bacteria, which can help to rule out other forms of arthritis including septic arthritis and tuberculosis. Presence of bacteria or pus cells can point towards an infection. It can also help to detect the presence of any presence of uric acid crystals can direct towards the diagnosis of gout in elbow or calcium pyrophosphate crystals, which can confirm the diagnosis of pseudogout in elbow.

Treatment of synovitis of the elbow mainly includes conservative treatment, which also includes medicines and resting the elbow joint.

In acute attacks of elbow pain due to synovitis of the elbow, pain management aims at reducing the pain and swelling in the elbow joint.

• Rest – Rest is an important factor in the recovery process of synovitis of the elbow. As repeated injuries, stress and strain on the inflamed tendons can cause more elbow pain and damage, resting the elbow joint is essential. Sportspersons, need to take a break from their sports and so should others involved in occupations that can hurt the elbow more in an already inflamed state.
• Ice Packs – Applying cold compresses, ice packs rolled in a cloth and gently rubbing over the inflamed area can help. Elevation of the joint and keeping the elbow joint raised above the heart level can help to reduce the swelling and pain in synovitis of the elbow. Using ice packs for 10-15 mins can help reduce inflammation. Ice packs can also be used after exercising or after performing activities that cause elbow pain, once routine is resumed.
• Braces – Sometimes, light compression of the elbow joint can help in reducing the swelling and also allows the joint to rest, but care should be taken and bandages should not be kept for too long, not too tight or not while sleeping. Using a splint or a brace that supports the inflamed region can help in relieving symptoms of synovitis of the elbow. The type of brace depends on the location of swelling in synovitis of the elbow and the underlying cause, hence following medical advice is essential.

Acute attacks of pain, swelling and inflammation of the elbow joint in synovitis of the elbow are treated with non-steroidal anti-inflammatory medicines (NSAIDs) that can provide relief in the joint symptoms. These medicines can cause irritation of the gastric mucosa and the one that suits an individual should be taken.

Steroids are another class of medicines that can help to fight inflammation and bring quick relief in synovitis of the elbow. There are oral and injectable steroids, which can also be taken directly into the inflamed elbow joint for immediate relief of symptoms. All medications and their side-effects should be discussed with the treating physician to plan the most effective and safe treatment plan.

Treatment of synovitis of elbow due to septic arthritis includes administration of antibiotics to clear the infection. In most cases, if there is a strong suspicion of elbow joint septic or infective arthritis, anti-biotic treatment is immediately initiated, while other investigations are still going on to confirm the diagnosis and detect the infective microorganism. Intravenous administration of antibiotics is generally initiated and bed rest may be advised till the joint swelling subsides. Following, this and based on the test results, oral antibiotics along with anti-inflammatories may be given. Any specific infections like tuberculosis, etc. may be treated appropriately, as required.

The culture and sensitivity tests performed on the drained synovial fluid from the elbow joint, may take 3 to 5 days to produce results. Based on the laboratory reports, the antibiotics and medicines to treat the infection may be modified to treat the specific infection. Treatment usually lasts from two to six weeks, depending on the severity of the elbow joint septic arthritis, which has caused synovitis of the elbow.

Physical therapy for synovitis of the elbow is an important part of the recovery process of synovitis of the elbow. It includes using therapeutic modalities like ultrasound, manual therapy, electrical stimulation and massage therapy to relieve pain and swelling in the elbow. Exercises are a crucial part of rehabilitation for synovitis of the elbow.

Physical therapy includes therapeutic exercises aimed at improving flexibility of the elbow joint, regaining elbow joint function, muscle strengthening and protecting it from further damage.

For sportspersons and others who use tools for their work, need to get their equipment checked so as to use the best equipment and tools, if required modified ones to suit individual needs and help in minimizing recurrent injuries to soft tissues of the elbow. It is also important to learn the correct techniques of handling the equipment and tools and learn ways in which elbow pain can be minimized and further injuries can be prevented. Any modifications in seating arrangements, working tables, etc. should be considered as appropriate.

People with synovitis of the elbow and suffering from elbow injuries, rheumatoid arthritis or other joint problems need to follow proper physical therapy advice to minimize their complaints. Proper training under expert’s guidance is important to maintain joint function.

Synovitis of the elbow, which is caused by inflammation of the synovium of elbow, can be protected and prevented from further damage with the help of exercises. Muscles strengthening exercises for the elbow are important during recovery period, by sportspersons during recovery and regular practice and those with an increased risk of synovitis of the elbow to maintain the strength of the elbow tendons.

Exercises that focus on improvement in range of motion, elbow joint flexibility and strength training can be of great help. Some of these exercises include

These include:

• Gentle movements of the elbow joint, bend and straighten the elbow joint within its comfortable range of motion, while supporting the arm with the other hand.
• Gentle movements of the wrist joint, upwards, downwards and rotation of the wrists, while supporting the arm with the other hand.
• Raise one hand overhead and bend its elbow to reach the back. Gently push the elbow backwards with the other hand to feel the stretch.

These include:

• Keep your arms stretched out, with elbow straight and bend the wrists to point the fingers towards the floor. Gently push the fingers towards the body with the other hand to feel a stretch at the wrist and the forearm.
• Keep your arms stretched out, with elbow straight and bend the wrists to point the fingers towards the roof. Gently push the fingers towards the body with the other hand to feel a stretch at the wrist and the forearm.
• Stretch out the arms in front of the body and make a fist. Bend at the elbow joint to bring the fist close to the body, hold and again straighten the elbow joint and stretch out the arm.

These include:

• Hold a light weight dumbbell in the hand with palm side down. Turn the wrist downwards and raise it upwards while supporting it with the other hand.
• Hold the light weight dumbbell in the hand with palm side down and twist the wrist to face the palm side upwards and rotate back to original position.
• Hold a light weight dumbbell in the hand with palm side up and elbow placed at right angle. Rotate the wrist, to twist and slowly face the palm side down.
• Hold a light weight dumbbell with palm side up keeping wrist straight and elbow placed at right angle. Gently bend the wrist inwards, towards the body, hold for few seconds and release.
• Hold a light weight dumbbell in the hand and place the hand over head, with elbow bent above the head and the dumbbell reaching the opposite shoulder. Gently raise the forearm to straighten the elbow, so that the hand is raised up and bring it back to the original position.

References:

Also Read:

• Synovitis and Tenosynovitis
• Toxic Synovitis In Children: Causes, Symptoms and Treatment
• Synovitis of Knees, Hips, Ankles, Shoulders, Wrists, Jaw Joint
• Synovitis of the Hip: Causes, Risk Factors, Symptoms, Treatment, Prevention, Tests
• Knee Synovitis: Causes, Symptoms, Treatment, PVNS of Knee