Synovitis of the ankle joint is an ailment that appears as a concomitant pathology of arthrosis, injuries and other pathological processes. The disease with a proper diagnosis and treatment has a favorable prognosis, but in some cases it threatens to develop serious complications: contracture (immobilization) of the joint or sepsis (general infection of the body with an infection).
What is synovitis of the ankle joint?
Synovitis is called the inflammatory process in the articular (synovial) bag, leading to the accumulation of fluid in its cavity – effusion.
Exudation is the liquid part of the blood – plasma – which actively enters the joint bag during the development of inflammation. Such changes in the joint lead to the classic picture of synovitis: soreness, swelling of the ankle and limitation of its mobility.
Synovitis of the ankle joint is a rather rare disease, but its incidence increases sharply in old age. The reason for this is the frequent injuries of the legs and feet, systemic diseases and irreversible changes in the body.
Types of pathology
In medical practice, synovitis is usually divided into acute and chronic (depending on the activity of the process):
- The first type of synovitis is a rapid inflammatory reaction with a vivid clinical picture. The joint bag is thickened and full-blooded, a large amount of fluid accumulates in its cavity. The effusion at a puncture is transparent, sometimes white fibrin flakes are observed;
- Inflammation of the synovitis of the chronic course has scant symptoms, differs in the restructuring (compaction) of the capsule. Fibrin filaments, a fibrous protein, appear in the joint cavity, which “fixes” toxic agents in the focus of inflammation. Sometimes fibrin is transformed into rounded “rice grains” circulating in the joint bag. Such free movement of fibrin bodies can lead to additional trauma to the joint.
Depending on the characteristics of the effusion, the following types of synovitis are distinguished:
- serous (with a predominance of clear protein fluid);
- serous-fibrinous (with the formation of filaments of fibrin or “rice bodies”);
- hemorrhagic (a combination of the inflammatory and tumor process in the synovial membrane with the formation of specific nodules; the pathology is also known as pigmented Villesonodular synovitis);
- purulent (with the addition of pathogenic microorganisms and the development of purulent inflammation).
Causes of synovitis
As noted above, synovitis rarely occurs as an independent pathology.
Usually, synovitis appears in the background:
- Infections. In such cases, we are talking about both a non-specific flora (coccal) and a specific one (Koch’s bacillus in tuberculosis, pale syphilitic spirochete, etc.). Infectious agents usually spread along with penetrating wounds (punctured, cut wounds or open fractures) in the ankle or spread from distant foci in the patient’s body. In the latter case, the infection “spreads” with blood or lymph flow. In this case, a predisposing factor is a weakening of the immune system or exhaustion of the patient.
- Injuries (intraarticular fractures, bruises, damage to the ligament and tendon apparatus). Fragments of bones or cartilage usually irritate the synovial membrane, causing increased formation of joint fluid and the development of inflammation.
- Joint pathologies (arthritis, arthrosis). The mechanism of the occurrence of the inflammatory reaction is similar to traumatic synovitis, however, the “starting push” is the destruction of the cartilage surface of the joints.
- Systemic and allergic ailments (gout, diabetes, etc.). A separate option is considered synovitis with hemophilia, caused by frequent hemorrhages in the joint cavity – hemarthrosis. The cause of such conditions is congenital bleeding disorders, due to which the patient is prone to bleeding.
Inflammation often covers one joint, while when the body is weakened, multiple lesions are possible.
There are three options for a clinic of synovitis of the ankle joint:
In acute non-infectious inflammation of synovitis, patients note an increase in the volume of the joint cavity due to the accumulation of flu >
How to diagnose an ailment?
The diagnosis of synovitis of the ankle is made on the basis of a survey of the patient (clarification of the circumstances of the ailment and predisposing factors), as well as examination. The latter includes palpation of the affected area with the definition of a characteristic symptom of fluctuations: the doctor puts one hand on the ankle, and the second taps on the joint. If a specialist feels characteristic “tremors” with an immovable hand, this indicates accumulation of fluid in the synovial membrane – i.e. about synovite.
Among the additional research methods, the “gold standard” is puncture – a puncture of the articular membrane with a fence of the contents of the joint. The resulting liquid is examined for the presence of characteristic microflora, protein and enzymes. And when infectious agents are detected, their sensitivity to antibiotics is determined.
In some cases, arthroscopy may be necessary – a minimally invasive procedure consisting of the introduction of video equipment into the joint cavity for the purpose of diagnosis or treatment. Often the manipulation is accompanied by a tissue sampling of the articular membrane for further research – biopsy.
To exclude concomitant pathologies (injuries, arthrosis, etc.), ultrasound and x-ray studies are prescribed. Sometimes, computed or magnetic resonance imaging data may be required to study synovitis. A clinical blood test and determination of acute-phase indicators are also carried out in general order (indicate the activity of the inflammatory process). It is not excluded that an allergy test is prescribed for suspected immune mechanisms of the development of the disease.
Treatment of ankle synovitis
Therapy of synovitis of the ankle joint begins with the rest of the affected limb. The ankle is tightly bandaged (with periodic weakening once every 3-4 hours), the leg is given an elevated position. With severe pain in the first two days, you can apply a cold compress for 20 minutes every 5 hours.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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Further assistance depends on the nature of the synovitis:
- In a non-infectious process, the main treatment is physiotherapy: ultraviolet irradiation, as well as UHF with anesthetics (Lidocaine) for pain relief. If the amount of effusion in the joint bag is sharply increased, it is possible to conduct a medical puncture with the removal of fluid. Only a doctor can prescribe drugs. With a prolonged course, phonophoresis with hydrocorticosteroids (Cortisol) is indicated.
- With purulent inflammation, a course of antibiotic therapy is required (Amoxicillin, Cefotaxime), as well as therapeutic puncture. The latter consists in removing pus, but in some cases it may be necessary to rinse the joint cavity with antiseptics or antibiotics. If the infectious process is specific (tuberculous or syphilitic), the use of etiotropic drugs (Rifampicin or Benzylpenicillin, respectively) is indicated. In severe purulent inflammation, an opening of the joint bag and its drainage are used.
- Treatment of chronic synovitis of the ankle consists in stabilizing the primary disease (arthrosis, hemophilia, etc.). Typically, patients are prescribed anti-inflammatory drugs (Nimesil, Voltaren) in tablet or gel forms. Physiotherapeutic procedures are also effective: electrophoresis, UHF, paraffin baths. With frequent exacerbations, the introduction of the antenzyme drug Aprotinin into the articular bag is possible.
With prolonged synovitis with persistent relapses or irreversible rearrangements in the articular membrane, surgical treatment is performed. The latter consists in complete or partial excision of the synovial sac – synovectomy. At the rehabilitation stage, patients are prescribed broad-spectrum antibiotics (Cefuroxime, Cefotaxime), as well as anti-inflammatory drugs (Diclofenac, Nimesil) and physiotherapy (ozokerite, electrophoresis, etc.).
In the absence of proper treatment of purulent synovitis of the ankle joint, the spread of infectious agents through the surrounding tissues (purulent arthritis, phlegmon) or the whole body with the development of sepsis is a serious condition that requires intensive care in intensive care.
With a prolonged course of synovitis, an ankle dropsy may develop. In this case, there is a “looseness” of the ankle, sprain of the ligamentous apparatus and subsequent destabilization of the articular surfaces.
In order to prevent synovitis of the ankle joint, it is necessary:
- lifestyle modification: rational nutrition and dosed physical activity;
- normalization of body weight in the presence of its excess;
- timely treatment of bacterial and viral diseases, including the rehabilitation of foci of chronic infection (tonsillitis, caries, etc.);
- prevention of injuries, as well as proper assistance in fractures or dislocations of the feet;
- diagnosis and control of articular pathologies (arthritis and arthrosis);
- therapy of allergic and systemic ailments (gout, diabetes, hemophilia, etc.).
High-quality diagnosis and timely assistance can completely eliminate the inflammation of synovitis, while maintaining the full range of movements in the ankle. However, in some cases, the development of stiffness or restriction of passive movements – contracture. In this case, the occurrence of life-threatening conditions – sepsis – is not excluded. In view of this, synovitis of the ankle joint requires specialist advice and subsequent treatment under medical supervision.