Articular effusion is the pathological accumulation of a fluid within a joint. Depending on the type of fluid involved, different types of articular effusion are distinguished: If the fluid is bloody, it is called haemarthros, if it is purulent, it is called pyarthros or joint empyema. If only the amount of synovial fluid is increased, but the composition is the same as always, a hydarthros is present.
Causes
There are various causes that can be considered as triggers for joint effusion. The most common ones are trauma (then often as a bloody joint effusion) and inflammation of the inner joint skin (then often with pus). Degenerative diseases such as osteoarthritis or permanent incorrect loading can also lead to joint effusion. In addition, there are some diseases that can be associated with joint effusion in some cases and which must be clarified in order to be able to treat them adequately. These include tumor diseases, rheumatoid arthritis, gout and blood coagulation disorders such as hemophilia.
Symptoms
The main symptoms of a joint effusion are swelling, which is usually both visible and palpable, and pain in the affected joint. These are mainly present during movement and stress, but are usually already noticeable at rest. The above-mentioned complaints often result in limited mobility of the fluid-filled joint. If the joint effusion is caused by an inflammation, the two other classic signs of inflammation, namely overheating and redness, are often added.
Diagnosis
In order to make a diagnosis of a joint effusion, it is first of all of great importance to take a detailed medical history (anamnesis), as this can already be very indicative of a possible cause. In addition, the joint should be thoroughly examined by a doctor. In addition, a puncture of the joint effusion (arthrocentesis) is usually performed.
This has two advantages: On the one hand, the fluid can be sent to the laboratory and the puncture can be examined there (for example, for bacteria or blood). If the cause of the effusion is still unclear, imaging (ultrasound, magnetic resonance imaging, computed tomography, X-ray) or arthroscopy can be used as a supplementary diagnostic procedure. The therapy of joint effusion depends on the cause of the joint effusion and its underlying disease.
At first, of course, one tries to alleviate the situation by conservative therapy. In the beginning, the joint should be relieved and, if necessary, the affected area should be splinted. If possible, exercises of the musculature can lead to a better drainage of the effusion.
In addition, further pain relief can be achieved with painkillers. The analgesics can be taken orally or injected. The class of analgesics that is frequently used and has an anti-inflammatory effect is called non-steroidal anti-rheumatic drugs NSAIDs.
Ibuprofen and Diclofenac also belong to the non-steroidal anti-inflammatory drugs. In addition, the use of antibiotics is also common. Another conservative measure is to cool the affected region with compresses, which can alleviate the inflammatory reaction and pain.
Elevating the affected region can also be helpful to better resorb the effusion. It is possible that the effusion may disappear by itself through conservative measures by resorption, but the unexplained cause of the effusion remains, which may lead to a recurrence of effusions. Acute therapy is a puncture of the joint.
This can be particularly useful in cases where the cause of the effusion is unknown, in order to better diagnose the cause. However, it should not be forgotten that in most cases a relief of the knee joint is not the solution to the problem, as the cause of the disease remains and the effusion is often only a side effect of another disease. The puncture is followed by an elastic wrapping with a felt ring.
Relief through puncture usually provides rapid pain reduction by relieving pressure on the joint. In addition, if necessary, a drug can be injected into the joint immediately after the puncture. When puncturing with a hollow needle, high standards of sterility should be observed, as otherwise an infection triggered by the puncture may occur.The puncture is usually performed after a local anesthetic of the area.
If the suspicion of a knee joint infection is confirmed, surgical treatment should be initiated immediately. This is because an infection of the knee joint represents an emergency situation where surgery should be performed and a broad antibiotic treatment initiated. Otherwise, the specific cause can be searched for further.
During the operation, fractures, cruciate ligament ruptures or a part of the inner skin of the joint can be removed. The appropriate treatment of a joint effusion therefore depends on its cause. In any case, a puncture is recommended to relieve the pressure on the joint, as well as cooling, protection and immobilization of the affected joint (possibly elevation), followed by gradual mobilization.
Non-steroidal anti-inflammatory drugs are recommended against the pain. Whether further drug treatment or even surgery is necessary depends on the trigger of the effusion. In the case of an underlying disease, this should of course also be treated. In summary, it is important to provide for a fast treatment, since long-term persistent joint effusions can lead to further consequential damage such as damage to the joint cartilage.
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