Synovitis is a result of inflammation along the joint lining. The characteristic feature is pain and swelling around the joint or joint effusion due to accumulation of excess fluid.
What Is Synovitis?
Synovial fluid is a normal fluid secreted by synovial membrane (lining) of the joint. It is present in joint cavities and surrounding soft tissues. Synovial fluid normally functions as a protective lubricant and prevents friction between the bones and other structures. However, certain factors affecting the joint can trigger irritation and cause excess secretion of the fluid. This is an inflammatory response causing pain, joint effusion or swelling, which limits joint movement.
What Are The Causes Of Synovitis Of Knee, Hip, Wrist, Ankle And Other Joints?
The common causes of synovitis knee, hip, wrist, ankle and other joints include:
- Overuse of the joint due to repetitive movements or sports
- Joint injury or trauma
- Arthritis – rheumatoid arthritis, gout, osteoarthritis
- Infection like tuberculosis, septic arthritis, etc.
- Allergic reactions
- Other conditions like pigmented villonodular synovitis, systemic sclerosis, type A hemophilia, etc.
How Does Synovitis Of Joints Present Itself?
Synovitis is the inflammation of the synovial membrane or the joint lining. It is generally linked with joint disorders, overuse, injuries or infection. The common presentation is pain with difficulty in joint movement and swelling. Redness and warmth around the affected joint and sometimes fever may also be seen.
The common sites of synovitis are the knees, hips, ankles, shoulders, wrists, jaw joint (temporomandibular joint) and almost any joint in the body. While there may be slight variation in the way synovitis affects different joints, the presenting features are similar. It can affect a single joint or sometimes multiple joints may be involved.
- Synovitis of knees is very common; makes knee bending or straightening difficult and painful.
- Synovitis of hips and ankles can cause difficulty in walking and joint movement. Pain may even cause limping.
- Synovitis of shoulders causes pain in shoulders and can have pain and difficulty in lifting the hands.
- Synovitis of wrists can cause pain with difficulty in lifting objects or fine movements of the hands.
- Synovitis of temporomandibular joint can cause pain at the jaw, which may extend to the ears, head and neck. There may be difficulty in opening mouth, chewing and yawning.
How Is Synovitis Of Knee, Hip, Wrist, Ankle And Other Joints Diagnosed?
As synovitis affects the joints, there is some history related to the underlying cause. History may reveal overuse of joint, presence of fever or infection, trauma, chronic joint conditions, any inflammatory or autoimmune disease. Clinical examination of the affected joint can confirm pain, swelling and joint stiffness. Joint may be warm; effusion gives a puffy or boggy appearance to the joint and the range of motion may be reduced.
Investigations include laboratory tests like complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) to determine inflammation or presence of infection. RA factor and other tests may be done if rheumatoid arthritis is suspected. Any other specific tests may be ordered based on the clinical symptoms and suspected condition.
Joint aspiration and synovial fluid analysis may be done to detect the nature of the fluid, presence of infective organisms, crystals, blood, etc. Imaging studies may include joint X-rays to study bone changes, injuries and degeneration. MRI studies or other advanced scans may be performed if appropriate.
How is Synovitis of Knee, Hip, Wrist, Ankle and Other Joints Treated?
Treatment of synovitis mainly includes anti-inflammatory medicines to reduce pain and swelling. Other symptomatic treatment may be given. Steroid medications may be given orally or injected in the joint as appropriate.
Application of hot or cold packs can be helpful. Rest is usually advised to limit the movement of the joint and allow healing. Depending on which joint is affected, appropriate measures to restrict the movements need to be taken.
Other treatment for synovitis (mostly in rheumatoid arthritis and other destructive conditions) also includes surgical intervention, in which a part of the synovium is removed with surgery, ablation or laser therapy.
What Care Is Taken For Synovitis Of Joints?
Joints like knees, ankles and hips are involved in weight bearing activities, hence those should be avoided. Shoulders or wrists are involved in lifting or handling objects, which can cause strain on the inflamed joint and should be avoided. Splinting may be required to immobilize and support the joint.
Braces may be advised to protect the joint and support the surrounding tissues. There are variations in braces and splints depending on the location of synovitis of knees, hips, ankles, shoulder, wrist and other joints. If temporomandibular joint is affected limiting its movement by eating a soft diet and avoiding wide mouth opening yawning, singing can help.
After the acute episode subsides, rehabilitation is necessary. Relevant muscle strengthening exercises should be done to reduce pain and improve range of joint motion.
What Is Transient Synovitis Or Toxic Synovitis?
Transient synovitis, also called toxic synovitis is inflammation of tissues around the hip joint, causing swelling, pain and difficulty in walking. It is a type of arthritis that affects children causing hip pain and limping. It usually affects children before puberty, around 3 to 10 years of age. While the exact cause is not known a possible relation to viral infection or allergy may be present.
The presenting complaints include pain in hips, groins, thighs and knees on one side. Some children may have mild to no hip pain but only thigh pain. Pain may cause limping, tip-toe walking or difficulty in standing. Fever may also be present.
Hip X-rays and other tests may be done to determine this condition and rule out injury or other causes of hip pain. Treatment of toxic synovitis includes anti-inflammatory medicines, rest and other symptomatic treatment. With prompt treatment, recovery can be expected in a few days.