Synovitis: Causes, Symptoms & Treatment

Synovitis is a painful phenomenon that can occur especially at an advanced age or in the case of prolonged stress. Above all, synovitis becomes noticeable when tendons, joints or the musculature are impaired or permanently stressed without regeneration phases.

What is synovitis?

The medical profession refers to synovitis (or synovialitis) as an inflammation of the mucous membranes that line the tendon sheaths, joints and bursa from the inside. In the process, the mucous membrane produces a certain amount of fluid, which ensures, for example, that there is friction-free movement between the bony structures. Inflammation of the mucous membrane can develop as a result of constant pressure, for example during work or sporting activities (kneeling positions are beneficial). The inflammation may also spread to the connective tissue and bony structures; as part of that expansion, acute synovitis may mutate into chronic synovitis.

Causes

Individuals who perform predominantly kneeling activities (such as cleaners or tile setters) are primarily affected by synovitis. Occasionally, athletes also complain of corresponding complaints, although here synovitis often takes a chronic course. The chronic course of synovitis occurs when there is no recovery from acute forms and training continues, or the joints that cause pain are not spared. Older people, whose regenerative abilities are already limited and sometimes already have a higher degree of wear of their joints, usually suffer from synovitis. In this case, the painful synovitis also occurs with other inflammatory diseases, so that sometimes the synovitis and an arthritis are diagnosed, which are sometimes responsible for the discomfort.

Symptoms, complaints and signs

The affected person complains mainly of an increasingly intense pain after an excessive load (for example, if he has overexerted himself in the course of a physical activity or participated in a sports competition). The pain occurs in combination with restricted movement. Sometimes the affected limb may swell; subsequently, redness appears in the region causing the pain. These symptoms are due to the inflamed mucous membrane, as increased blood flow is activated here. In the context of synovitis, fluid accumulations occur in the affected joints or joint capsules (for example, in the knee joint), which are subsequently responsible for restricting movement.

Diagnosis and course of the disease

The physician makes the diagnosis of synovitis when other inflammatory diseases, such as arthritis, can be ruled out entirely. For this reason, different examinations are usually performed to confirm the diagnosis of synovitis on the one hand and to exclude diagnoses such as arthritis on the other. The problem is that – especially in older age – several diseases can trigger the classic symptoms of synovitis. Thus, of course, there is also the possibility that synovitis remains undiagnosed. Still at the beginning, synovitis manifests itself by means of a “rubbing sensation”; the patient “waits” for relief, but notices that the joint continues to “rub”. Subsequently, pain, redness and swelling increase. The physician examines the affected joint. To do this, he uses an ultrasound scanner. By means of ultrasound, the doctor can determine whether synovitis is suspected. The course of the disease is mainly influenced by the occupation of the affected person. Especially tilers or even cleaners who work mainly in a squatting position or on their knees are at risk of synovitis becoming so bad that even the joint cartilage is destroyed and subsequently the bone is attacked.

Complications

Synovitis usually occurs in combination with restricted movement. This can be accompanied by swelling of the affected limb and redness and further pain. Due to the accumulation of fluid in the affected joints, normal movement is usually no longer possible. Further complications can occur if arthritis has been diagnosed concomitantly.Bone density then continues to decrease as the disease progresses, and the prospects of curing synovitis worsen. Chronic pain may develop, associated with a decrease in the quality of life and performance of the affected person. This may develop into depressive moods and other psychological distress that must be treated separately. Surgical intervention can lead to bleeding, secondary bleeding and infection at the affected site. Rarely, nerve injury occurs, which may be associated with temporary movement restrictions and sensory disturbances. There may also be further irritation of the affected region due to surgery, which may worsen the synovitis. Prescribed painkillers can cause side effects and interactions and trigger allergies. If the condition is prolonged, addictive behavior may develop, resulting in addiction.

When should you see a doctor?

A doctor is needed insofar as the sufferer suffers from persistent pain. Irregularities of the tendons, joints or muscles should be examined and treated. If relief of symptoms and recovery is achieved after a restful night’s sleep or adequate rest and sparing, in most cases a doctor does not need to be consulted. In these situations, it is an overload of the body, which heals on its own through the natural regeneration processes. In the case of recurring, persistent or increasing health impairments, a doctor is needed. If there is only a slight improvement in well-being after a regeneration phase, this is not sufficient. Further examinations are necessary so that a diagnosis can be made by investigating the cause. Restrictions of the general movement processes, a decrease of the usual physical performance as well as irregularities of the joint activity are to be presented to a physician. Irritability, accumulation of fluids or swelling are considered signs of a health disorder. A sensation of warmth near the joints, an increase in cardiac activity, or redness of the skin are symptoms that indicate synovitis. Since the affected person is threatened with a chronic disease if the disease progresses unfavorably, a reaction to the complaints should be taken at an early stage. In cooperation with a physician, changes in the usual movement sequences as well as optimizations of the resilience can take place.

Treatment and therapy

At the beginning of treatment, it is advisable that the inflamed area of the body be immobilized and relieved. This is the only way to reduce the swelling and relieve the pressure exerted on the tissue. The patient should regularly cool the affected region with cold packs or ice; this process also ensures a reduction in swelling and a decrease in pain. Analgesic and also anti-inflammatory medications can help relieve the acute phase of synovitis. It is important to discuss the use of the tablets with the family doctor and to have regular check-ups to see whether the medication is having the desired effect. If the symptoms do not improve or worsen so that medication or cooling measures no longer help, the patient must undergo surgery. In this case, the physician opts for the keyhole technique. The doctor makes a few small incisions in the affected area; the incisions are just large enough for the necessary instruments or the camera to be inserted. With this method it is possible that any outgrowths of the mucosa can be treated. As a rule, surgery is the only way that synovitis can be permanently cured. In a few cases, however, a worsening of synovitis has been noted, as the already affected regions – due to the surgery – became even more irritated.

Prevention

Synovitis can very well be prevented. Athletes, for example, can prevent synovitis by warming up; sometimes people who are at risk for synovitis because of their occupations can take precautions by swimming. Of course, it is important that sufficient regeneration phases are also observed. Therefore, if the first signs of synovitis have already been noticed, one should take care of the affected joints.

Aftercare

Aftercare is advisable for synovitis, or inflammation of the synovial membrane, until it is completely healed. There is acute synovitis and chronic synovitis. The aftercare treatment is adapted to the respective form of the disease. In the acute course, aftercare ends when the symptoms subside. In the case of chronic synovitis, it is long-term. The symptoms should be alleviated in both courses, and completely eliminated in the acute form. Another goal is to prevent a secondary disease. The affected person can also counteract the symptoms by taking painkillers, taking it easy on the inflamed joint and protecting it from overloading. Additional cooling can accelerate the reduction of swelling. If the patient’s job requires him to kneel a lot and the inflammation keeps returning, he should consider changing jobs. In cases of severe disease progression, the only remaining option is surgery. The excess mucosa is removed during surgery using a keyhole procedure. Aftercare depends on the postoperative condition: If the joint was able to heal afterwards, no further follow-up is necessary. The inflammation has been eliminated. If the symptoms worsen, further healing methods must be discussed. The development of chronic synovitis should be prevented, and the mobility of the joint must be restored.

This is what you can do yourself

In case of acute synovitis, a doctor should be consulted immediately. Self-help measures are limited to rest and taking medication as prescribed by the doctor. In chronic synovitis, the affected joints should not be subjected to further stress. If the condition occurs in conjunction with rheumatoid arthritis, further measures must be taken. The patient needs a walking aid and special care by a physiotherapist. Accompanying conservative medicines, synovitis can be treated with various natural remedies. In particular, analgesic and anti-inflammatory agents such as aloe vera or nettle extract are useful to relieve joint discomfort. A tight bandage must be worn while the joint is immobilized. Physiotherapy includes warming compresses, electrophoresis and electromagnetic wave therapy. After joint surgery, the leg should not be moved at all for three to four days. For the first few weeks, any stress should be avoided until the doctor gives the okay. Synovitis is a serious disease that can take very different forms. Therefore, self-care must also be closely monitored.