Synovitis of the shoulder joint
Synovitis of the shoulder joint - acute or chronic inflammation of the synovium, accompanied by the formation of exudate or effusion. May be infectious or aseptic. It occurs as a result of injuries, chronic degenerative-dystrophic joint diseases, endocrine disorders, allergic reactions, etc. It is manifested by swelling, pain, restriction of movements and an increase in the volume of the joint. Diagnosis is clarified by X-ray, arthropneumography, arthroscopy, CT, MRI, joint ultrasound and synovial fluid. Treatment is usually conservative.
Synovitis of the shoulder joint
Synovitis of the shoulder joint is an inflammatory process in the synovial( internal) shell of the joint. Accompanied by the accumulation of excess fluid. It is a reaction to intraarticular damage, irritation of the synovium by a damaged fragment of cartilage or bone, insufficiency of the ligamentous apparatus, impaired metabolic processes, the action of an infectious agent or allergen. It occurs less frequently than other synovitis( for example, synovitis of the knee joint).Treatment of this disease, depending on the underlying pathology that caused it, can be performed by traumatologists, orthopedists, rheumatologists, allergists and other specialists.
Classification and pathogenesis of synovitis of the shoulder joint
Synovitis may be aseptic or infectious. The most common aseptic synovitis is traumatic, followed by allergic, neurogenic, provoked by metabolic and endocrine disorders, etc., in the order of decreasing, etc. Aseptic synovitis may be acute or chronic along the course of the process, in the nature of effusion - serous, vinous-hemorrhagic or serous-fibrinoid( adhesive).For acute synovitis is characterized by serous inflammation with a pronounced vascular reaction of the synovial membrane.
In chronic synovitis, serous inflammation is rare, mixed forms predominate. Chronic serous-fibrinoid synovitis is accompanied by the formation of exudate rich in fibrin. Fibrin falls out in the form of clots and threads, which in the future are condensed and can form free intraarticular bodies. In chronic villous( villous or villezno-hemorrhagic) synovitis, sclerotized and hypertrophied villi of the inner shell are identified, which can be loosened and form chondromic bodies and rice bodies.
In acute forms of synovitis, the inner shell of the capsule does not change, with chronic fibrotic degeneration and this provokes the formation of a vicious circle. The pathologically altered synovial membrane poorly absorbs liquid, chronic recrudescence of the joint is formed, the accumulating fluid compresses the synovial membrane, stretches the capsule and ligaments, adversely affects blood and lymph circulation and provokes further degenerative-dystrophic changes in the joint.
Infectious synovitis usually proceeds acutely and is accompanied by the formation of purulent exudate. The cause of the development of this form of synovitis is contact, hematogenous or lymphogenous infection. When contact microbial insemination, pathogenic microorganisms penetrate into the joint from a graze, cut, torn or chipped wound, boil, abscess or phlegmon in the joint region. Hematogenous and lymphogenous infection can be observed in acute infectious diseases and purulent foci located in remote segments. With hematogenous spreading, microbes penetrate into the shoulder joint through the blood, while in the lymphogenous through the lymph.
Symptoms of synovitis of the shoulder joint
Patient suffering from acute aseptic synovitis, complains of moderate or weak pain and discomfort in the shoulder joint. The affected area is slightly edematous, the joint is enlarged in volume, the contours are smoothed. Sometimes there is an inconspicuous local hyperemia and hyperthermia. Movement is slightly limited. At palpation weak soreness is defined, at accumulation of a plenty of a liquid fluctuation is revealed. In the case of chronic aseptic synovitis, pain and edema are less pronounced, with a long course of symptoms dominated by secondary degenerative changes in the joint.
Acute purulent synovitis begins suddenly, develops within a few hours or days and is accompanied by a sharp pain, aggravated by the slightest movements. The joint is swollen, the shoulder is round, the bony projections are smoothed, the skin over the affected area is hot, hyperemic. Palpation is very painful. There are signs of general intoxication: fever, weakness, weakness, nausea, chills and headache. In the blood, inflammatory changes are revealed.
Diagnostics and treatment of synovitis of the shoulder joint
The most informative studies that allow to determine the cause and nature of inflammation are a medical-diagnostic puncture followed by puncture examination, synovial biopsy, radiography, arthropneumography, ultrasound of the shoulder joint, CT of the joint and MRI of the shoulder joint. If necessary, use arthroscopy - a medical diagnostic method that allows you to assess changes in the joint by direct visual inspection using special equipment. When suspected of allergic reactions, endocrine and metabolic disorders prescribe consultations of an allergist, endocrinologist and other specialists.
Treatment of synovitis is usually conservative. The patient is recommended to rest, if necessary, immobilize using a bandage bandage. When a large amount of fluid accumulates, the joint is punctured. Prescribe analgesics and NSAIDs, with infectious synovitis apply antibiotics. In a chronic aseptic process, metabolic disorders are corrected using inhibitors of proteolytic enzymes( hyaluronidase, proteinase, lysozyme) and stabilizers of lysosome membranes( contrikal, trazylol).
Patients are referred to physiotherapeutic procedures: phonophoresis with corticosteroid drugs, UHF, magnetotherapy, electrophoresis with lazonil, heparin and contrial. In the recovery period, exercise therapy is performed. Surgical intervention is indicated with prolonged flow of chronic synovitis, inefficiency of conservative therapy and the presence of irreversible changes in the synovial membrane. Depending on the prevalence and severity of the process, a total, subtotal or partial synovectomy of the shoulder joint is performed. In the postoperative period prescribe antibiotics, physiotherapy, exercise therapy and massage.
How to treat pain and swelling in the shoulder
Among diseases of the shoulder joint in the practice of orthopedists and traumatologists, one sometimes has to deal with synovitis - an inflammation of the synovial membrane lining the inside of the joint bag. It is the synovitis of the shoulder joint that can give frightening edema and pain. What can lead to it?
Causes of synovitis of the shoulder joint
Inflammations of the soft tissues of the joint are most often the result of:
- acute rheumatic fever;
- of osteoarthritis;
- of neighboring inflammatory processes;
- infectious diseases( more often staphylococcal or streptococcal);
- tuberculosis, syphilis, gonorrhea.
Among other more rare causes - exposure to allergens, toxic substances, metabolic and hormonal disorders, neurogenic diseases.
Deforming dorsopathies can also contribute to synovitis of the shoulder joint:
- scoliosis, kyphosis( stoop), kyphoscoliosis.
The shoulder is characterized by traumatic injuries during the fall, with sweeping, often repetitive movements:
- , for example, volleyball players, basketball players, throwers of the core, and other athletes with similar dynamics of movements.
With prolonged position with raised hands, there is a fatigue tension in the muscles of the shoulder joint, transmitted to other tissues. On this basis, people whose activities are associated with work that requires constant lifting of hands can also develop chronic inflammation in the shoulder joint:
- painters, plasterers, ceiling installers, etc.
The nature of the lesion with synovitis of the shoulder
Most often this is a one-sided lesion. However, with certain diseases( rheumatoid or infectious arthritis, acute rheumatism), bilateral inflammation of the synovial membranes of the shoulder is also possible.
At the same time, there may be inflammation of other small and medium joints( knee, wrist, elbow, ankle).
Types and stages of synovitis
The synovitis of the shoulder joint can be of the type:
- serous or purulent
The course of the disease can be divided into three main stages:
The structure of the shoulder joint: the figure shows the synovial membrane lining the capsule. It is her inflammation that leads to excessive effusion in the synovial cavity, pain and swelling of the joint.
- The first stage( primary reaction):
- In the synovial membrane there is a slight reactive irritation and hyperemia.
- Swelling and excretion of synovium( synovial fluid) is insignificant.
- Second stage( serous):
- If the action of the stimulus( traumatic, infectious and other effects) does not stop, then the reactive stimulation passes into the serous form - a serous effusion is formed.
- The synovial membrane becomes full-blooded and sharply edematous, and its surface looks velvety, with enlarged villi.
- Intracavitary exudate - yellow with clots of fibrin.
- Microscopic examination of the synovial membrane and of the subsidonovial tissue shows small-cell infiltration and proliferation( division) of synovial cells.
- Third stage( purulent):
- With the progression of the process of the phenomenon of hyperemia( fullness with blood vessels) increases.
- The synovial membrane is even more thickened and impregnated with purulent bodies and purulent sticks.
- In exudate, fibrin flakes are mixed with pus.
- Chronic purulent synovitis gradually changes to joint tissue and bone.
- Acute purulent synovitis is fraught with sepsis - this is the most dangerous form of it.
Symptoms of synovitis of the shoulder joint
- The main symptom of the disease is the flow of the shoulder in the area of the clavicle and deltoid muscle:
- the bones joints are not probed, the shoulder becomes round
- Simple movements, heavy weights begin to cause pain.
- The patient holds his arm in a half-bent state, pushing it slightly forward: the feeling that the forearm is in the sling.
- In posttraumatic synovitis, the temperature may be normal or slightly elevated.
Symptoms of acute synovitis
- Acute serous synovitis is characterized by severe soreness in movements and palpation. Pain can be delivered to the neck or arm.
- In acute form, there is an increase in temperature( with a purulent synovitis - above 38˚C).
- The skin of the shoulder surface turns red.
- In the future, the inflammation can spread to neighboring tissues and proceed in the form of parosynovitis.
- Joint tissues swell and become dough-like and glossy in appearance.
Chronic synovitis of the shoulder joint
Chronic synovitis develops for the following reasons:
- The constant source of irritation has not been eliminated, and the disease continuously recurs.
- Has not been performed as should a puncture.
- There was no complete absorption of exudate due to the fact that the joint was not immobilized and the patient did not observe rest.
An independent disease is not a chronic synovitis - this is the result of neglected and unresolved problems.
Symptoms of chronic synovitis of the shoulder
- With this form there are no sharply expressed symptoms of pain or swelling due to the fact that the fluid no longer overflows the joint cavity.
- Only a slight swelling of the shoulder can be observed.
- The synovium is thickened due to fibrous degeneration.
- Patients complain of rapid fatigue and a feeling of heaviness in the shoulder joint.
- In the future, looseness of the shoulder and limited movements develop.
Diagnosis of shoulder synovitis
For all acute shoulder pain accompanied by swelling, you need to visit a traumatologist or orthopedist.
Clinical external examination and collection of information on previous events and illnesses may be sufficient to make a diagnosis. Otherwise, the doctor will conduct additional tests:
- radiography or MRI;
- laboratory diagnostics with blood, urine and synovia analyzes.
The composition and color of the exudate represents an important diagnostic value of :
- murky color, for example, and the presence of leukocytes can talk about the rheumatic origin of synovitis;
- abundance of protein - about rheumatoid arthritis;
- the presence of pus in the exudate indicates a purulent form of synovitis.
Treatment of synovitis of the shoulder joint
Serous synovitis of the shoulder joint often does not require treatment:
- It is enough to apply a tight bandage and restrict movement.
- After several days of rest, exudate can be absorbed into the synovial membrane, and the puffiness and pain pass.
- If the effusion is excessive, puncture is performed and the cavity is released from the liquid.
- If the pathology is purulent, a purulent cavity it is necessary to open and remove its contents by means of a puncture or a joint cut with drainage.
Surgery for shoulder synovitis is rare.
When purulent parosynovitis requires a wide excision of the synovium with deep drainage, as this complication can lead to wrinkling and scarring of connective tissues and a decrease in the functionality of the shoulder joint.
In severe, non-conservative cases, the synovial membrane is completely removed.
After operation, the shoulder must be immobilized by overlapping the tire.
What medicines do you need?
- Drug treatment is aimed at reducing the symptoms of pain and inflammation with NSAIDs( diclofenac, ketoprofen, ibuprofen, etc.).
- In rare cases, with an acute synovitis accompanied by a dropsy and adjacent tissues, hydrocortisone, dexamethasone and similar corticosteroids are injected.
- Purulent forms of synovitis require treatment with antibiotics and antiseptics. Antibiotic is prescribed according to the results of bacteriological analysis of synovia: this analysis is extremely important in the treatment of chronic forms of synovitis.
Physiotherapy with synovitis of the shoulder joint
Physiotherapy has a multifaceted effect:
- analgesic and anti-inflammatory;
- stimulating blood and lymph flow;
- has a beneficial effect on the nervous system.
With shoulder synovitis effective:
- curative mud;
- UHT, etc.
Prevention of synovitis of the shoulder
Synovitis is prevented through emergency relief of inflammatory processes in the joints and treatment of the main causes of synovitis - trauma, arthrosis, infectious diseases.
Do not postpone visiting a doctor in a "long box", much less try to eradicate the problem.
Such a disease, as a synovitis of the shoulder joint, usually has a favorable prognosis:
Recovery occurs about two weeks later, and as many as needed for complete recovery.
However, improper treatment( usually in the form of self-treatment) causes the disease to become chronic, and this is a completely different story.(c)
Video: Treatment of shoulder pain.
Synovitis of the shoulder joint
Synovitis of the shoulder joint - inflammation of the synovial membrane. This affliction is accompanied by the formation of exudate or effusion. This disease can be both infectious and aseptic. In most cases, it occurs due to severe injuries, but sometimes it is caused by chronic degenerative-dystrophic diseases.Symptoms of joint synovitis
The main signs of synovitis of the shoulder joint are moderate or very weak pain. The affected area can be slightly edematous. Also, some patients have mild hyperthermia or hyperemia. Movement in almost all who suffer from this disease is slightly limited.
The minimal synovitis of the shoulder joint is characterized by rather intense unpleasant sensations. It can be accompanied by a change in the joint due to the accumulation of a large amount of serous fluid in its cavity. In this case, almost always the mobility of the organ decreases significantly, and the ligamentous apparatus is greatly weakened. With the chronic form of the disease, the symptoms predominate, which are caused by degenerative changes in the joint. For example, exudative synovitis of the shoulder joint is accompanied by an effusion:
Treatment of synovitis of the shoulder joint is usually only conservative. The patient must ensure absolute rest and immobilize using a bandage bandage. If a large amount of fluid has accumulated, the joint must be punctured. In infectious inflammation, the patient is shown antibiotics.
Surgical treatment of synovitis of the shoulder joint is carried out only if conservative therapy is ineffective or the course of the disease is protracted. It is also prescribed when any irreversible changes are found in the synovial membrane. In the postoperative period, patients are prescribed physiotherapy and massage.
Treatment of synovitis of the shoulder joint, symptoms and causes of
Synovitis is the inflammation of the synovial membrane of the joint, resulting in an overabundance of synovial fluid in the joint cavity. Normally, the healthy synovial membrane surrounding the joint secrete synovial fluid in very small amounts( but sufficient to provide natural "lubrication" of the joints).Inflamed, the membrane begins to produce an excessive amount of "lubrication", which provokes discomfort and pain and leads to "swelling" of the joint. The synovitis of the shoulder joint most often develops as a result of injuries, but it can also have an infectious nature or arise against the background of arthritis.
Symptoms of acute and chronic synovitis
When infectious or traumatic synovitis, the disease progresses rapidly - for 1-2 days, with non-infectious - for 1-2 weeks. Key features:
- Painful swelling in the area between deltoid muscle and clavicle.
- Strong unpleasant sensations when trying to move the shoulder, the stiffness of the shoulder joint. Pain can irradiate( give) to the neck or arm from the side of the affected shoulder. Often the pain occurs when changing clothes, a patient with a hand is difficult to lift and carry objects regardless of their weight.
- To reduce the intensity of pain, the synovitis sufferers often hold their hand, as in a sling, that is, bending it at the elbow and pressing it to the chest.
- There is weakness, general malaise, often the temperature rises - either the whole body, or exclusively in the affected area. The difference is not difficult to see by putting the back of the palm first to the skin on the affected area of the shoulder, then to the skin on the adjacent healthy areas.
- With a purulent synovitis, pronounced edema and severe redness of the shoulder skin are observed, the temperature rises sharply to 38 ° C and above, chills are observed, vomiting is possible.
Chronic synovitis develops as a consequence of an untreated acute synovitis. Symptoms - persistent( although tolerable) aching pain, increasing at night, malaise. It is possible to develop a dropsy of the joint, because the constantly evolving synovial fluid accumulates, not having time to suck in the membrane.
Inflammatory processes occurring in the synovial membrane, are divided into infectious and aseptic( that is, non-infectious).Possible causes of synovitis:
- bruises, dislocations, fractures, sports injuries that lead to significant damage to the joint;
- monotonous and regularly repeating movements of the shoulders - for example, swimmers, basketball players, volleyball players;
- untrained weak ligaments;
- open wounds on the shoulder, deep cuts or scratches through which the infection penetrates;
- endocrine disorders( diabetes), neuritis, damage or pinched nerves in scoliosis or some neoplasms;
- arthritis, secondary osteoarthritis;
- infectious synovitis often develops as a complication after having suffered angina, bronchitis, pneumonia or in patients with tuberculosis or syphilis when an infection enters the synovial membrane through lymph or blood;
- an allergic variety of synovitis develops with increased sensitivity of the cells of the joint capsule to certain endogenous chemicals.
Important! Among the terrible complications of synovitis - periarthritis( inflammation of the periarticular tissues) and panartrite, in which inflammation spreads to the bones, cartilages and ligaments. A sad result of the development of the inflammatory process can be a general sepsis. Among the complications of chronic non-infectious synovitis is dropsy, which causes joint loosening, which in turn can lead to chronic subluxation or dislocation of the shoulder.
Synovial joint cyst
is visible in the picture. Treatment and prevention of
Synovitis is diagnosed by an orthopedic traumatologist during external examination. In addition, an examination is performed to identify other disorders in the operation of the shoulder joint, which may complicate the treatment( lordosis, kyphosis, scoliosis).Assign tests - total blood, urine, as well as the study of synovial fluid to identify the causative agent of infection. In doubtful cases, to differentiate synovitis from arthritis or bursitis, an MRI or radiography is prescribed.
- Restriction of joint motor activity( immobilization).Used pressing bandages, tires, longs. In mild cases, when there is a high probability that the body will cope with inflammation on its own, the treatment consists in tight bandaging of the joint.
- In more difficult cases, a puncture is indicated: the joint is pierced with a thin needle, the synovial fluid is sucked off, then anti-inflammatory drugs or antibiotics are injected into the joint. Antibiotics are used if the inflammation is of an infectious nature. Penicillin, lincomycin, levomycetin are used, which are diluted in a solution of novocaine or other analgesics. If the inflammation is caused not by infection, mixtures of anti-inflammatory drugs( for example, betamezon and aprotinin), also diluted in a solution of novocaine, are used. After puncture appoint UHF or electrophoresis, if necessary, prescribe analgesics and ointments( for example, "Voltaren") and vitamin complexes.
- A triggered synovitis that persistently fails to treat with antibiotics or anti-inflammatory drugs is treated surgically - a complete or partial resection( removal) of the synovial membrane is performed.
Important! In the overwhelming majority of cases, the diagnosed synovitis in time is very succesful to conservative treatment. The recovery takes 1-2 weeks, as much as full rehabilitation. After elimination of the most acute symptoms, physiotherapy is prescribed, spa treatment with mud and hydrogen sulphide baths is recommended.
For the prevention of synovitis, urgent consultation is required in case of inflammation and in the presence of infectious diseases. While doing sports, excessive loads should be avoided and not only muscles but also ligaments should be trained.
The synovitis of the shoulder joint is an inflammation of the joint bag, which is characterized by changes in the composition of the synovial fluid followed by the accumulation of effusion. As a rule, inflammation occurs in one joint. The defeat of several joints is quite rare.
It should be noted that synovitis may act as a secondary sign of another disease. For example, often a synovitis of the shoulder joint is present with secondary brachial osteoarthritis or arthritis. In this case, the treatment of the disease will be carried out in a complex manner, thus eliminating the cause of the inflammation of the synovial bag.
Causes of the disease
The most common cause of the disease is chronic or acute shoulder injury. It can be as fractures, and usual bruises and dislocations. Because of the injury, the synovial capsule produces an excessive amount of synovial fluid, which accumulates, inflames the joint capsule.
Synovitis of the shoulder joint, resulting from chronic trauma, is most often observed in athletes and people who in the process of physical work constantly perform monotonous movements of hands. The risk group includes people of the following professions: plasterers, painters, throwers, etc. Chronic synovitis usually occurs without obvious damage to the joint. His treatment often implies the elimination of the consequences of the injury.
Significantly less common is the infectious form of synovitis, the treatment of which involves fighting infection that has fallen into the joint, both from the periarticular tissues, and from individual foci.
Symptoms of synovitis
In acute aseptic synovitis of the shoulder joint, the patient complains of discomfort and moderate pain in the shoulder area. The affected joint and periarticular tissues are enlarged in volume and have a small edema. In some situations, little local hyperthermia can be observed, while the movement is slightly limited.
Puncture of the shoulder joint
Performing palpation of the joint, the patient may experience soreness. It should also be noted that with chronic synovitis, swelling and pain in the shoulder area is less pronounced.
Acute purulent form of synovitis develops rapidly and is accompanied by severe pain, even with the slightest movements of the shoulder. The skin in the shoulder region is hyperemic and the palpation is painful. The purulent form of synovitis is characterized by fever, chills, weakness of the headache, etc.
Diagnosis and treatment of
The most informative diagnosis that can determine the cause and form of the sinophyte is a puncture, followed by examination of the synovial fluid, as well as ultrasound and CT of the shoulder joint. If necessary, the treating physician can be used arthroscopy. In case of suspicion of possible metabolic and endocrine disorders or allergic reaction, the patient is given advice of an endocrinologist, an allergist and other specialists.
In most cases, a favorable prognosis is achieved through conservative treatment. The patient is given peace and, if necessary, immobilizes the shoulder joint with a bandage bandage. When a large amount of synovial fluid accumulates, joint puncture is performed.
In the aseptic form of the disease, non-steroidal anti-inflammatory drugs are prescribed to the patient, if the synovitis is infectious, antibiotics are used. Chronic form of synovitis is characterized by a correction of metabolic disorders with the use of stabilizers of lysosome membranes and inhibitors.
Depending on the course of the disease, the patient is referred to phonophoresis, UHF, electrophoresis and various physiotherapy procedures. If during a long period of medication and the above procedures do not lead to a positive result, surgical intervention is performed. Depending on the severity of the disease, a partial, subtotal or total synovectomy of the shoulder joint is performed.
Below you can see the video of the blockade of the shoulder joint with synovitis.