Treatment and symptoms of synovitis of the knee

Synovitis is a common cause of joint pain not only among athletes and those associated with physical labor.

Synovial inflammation can occur in everyone, even in response to any other disease. Most often, the disease affects the knee and elbow joints. Without proper treatment, synovitis tends to become chronic, which can seriously affect the quality of life. Synovitis of the knee joint is a rather serious disease that can develop as a result of a huge number of causes. For its treatment, there is a whole arsenal of drug and adjunctive therapy, however, the disease is very difficult to treat.

Synovitis of the knee joint: symptoms and how to treat

The knee joint is one of the most complex joints in the structure of bones:

  • it is formed by one bone (tibial) - from below, one (femoral) - from above,
  • the third bone, the patella, is located in front and also participates in the movements of the joint,
  • only inside this joint there are two cartilaginous half rings - the meniscus, which play the role of a shock absorber of this joint,
  • there are many ligaments in the joint, the task of which is to ensure its strength and functionality,
  • the joint on top is covered by a “sleeve” - a joint bag. Outside, it consists of coarse fibrous tissue, and from the inside is penetrated by a large number of vessels, performing the function of feeding the mating surfaces.

Since it is in this joint that there are a large number of structures - bones, cartilage, ligaments and muscles - the synovial membrane (namely, the so-called inner part of the joint bag) forms a large number of depressions that wrap some of them.

They are called synovial bags and folds. With joint inflammation, inflammatory fluid can accumulate in them. It also appears there when the disease of this membrane itself is present, and this can occur both as an independent disease and as a general reaction of the body. Here we come close to the concept of “synovitis”.

This is a pathology in which, as a result of various causes, inflammation of the synovial membrane of the joint occurs. As a result, an inflammatory fluid is formed in it - exudate (effusion).

What is synovitis of the knee joint

Synovitis of the knee joint is an inflammation of the synovial membrane, which can occur in acute or chronic form. The causes of the disease can become:

  • knee injuries
  • endocrine diseases
  • arthritis,
  • allergy.

Primary synovitis occurs against the background of injuries and excessive loads. The secondary or reactive form is a complication of diseases of the joints or internal organs. As the disease develops, a person loses working capacity. There are restrictions on movement and constant aching pain.

Synovitis should be correctly diagnosed from similar diseases, for example, knee bursitis. For this, modern diagnostic devices (ultrasound, MRI, puncture) are used.

Signs and Symptoms

The disease, which developed acutely, which is not purulent, is manifested by the following symptoms:

  • an increase in the joint in volume, which occurs over several hours to a day
  • no high skin temperature over the joint,
  • symptom of balloting of the patella: if you press on it, it plunges into the joint, when released, it pops up,
  • movements in the joint are difficult, it is painful to commit them,
  • body temperature rises (optional)
  • weakness, malaise appear.

Acute purulent synovitis:

  • The joint increases in volume,
  • The skin above the joint turns red, it becomes hot to the touch,
  • To bend-unbend a leg is very painful, sometimes even impossible,
  • Body temperature rises, usually to high numbers,
  • The general condition suffers: weakness, nausea, fatigue,
  • There may even be confusion, delirium, hallucinosis.

Chronic synovitis occurs with unexpressed symptoms:

  • tiredness when walking
  • joint movement restriction
  • aching knee pain
  • general fatigue
  • with a long-standing process, you can notice a crunch,
  • frequent dislocation of the knee even with a slight increase in the range of motion in it.

An acute disease (especially purulent synovitis) is most often one-sided. But if it develops in response to another pathology (reactive, allergic synovitis), and not to injury, synovitis of the right and left knee joints is possible. Then the above symptoms will occur in two knees, against the background of another disease or immediately after it has passed.

Features of chronic and acute form

Chronic synovitis is rare. In most cases, it appears if, in the acute form of the disease, therapeutic measures have not been taken or if there is an allergy. With a sluggish course of synovitis, the symptoms are less pronounced. A person is concerned about a little pain and swelling, while there is no redness and temperature.

The acute form of the disease is characterized by severe pain and swelling. In acute course, synovitis is almost always considered primary. Often, acute inflammation of the synovial membrane occurs due to infection.


Diagnosis is an important part of treating synovitis. With its help, it is possible not only to identify inflammation of the synovial membrane, but also to determine the degree of damage and the type of disease. To obtain an accurate diagnosis, hardware and laboratory methods are used. First of all, the doctor examines the affected area. Based on the results of the initial examination, the necessary diagnostic methods are selected.

Hardware Methods

Among the hardware research methods distinguish:

  • Ultrasound
  • tomography (CT and MRI),
  • X-ray examination.

Hardware diagnostic methods help to exclude similar diseases and allow to determine the degree of damage. They are prescribed immediately after a visual inspection. There is no need to prepare for an examination using special diagnostic devices. If a person suffers from acute pain, the diagnosis is carried out in a hospital. In a regular clinic, you will need to take tests in turn.

Specific diagnostic methods are selected by the doctor. In some cases, an X-ray of the knee joint is sufficient.

Causes and triggers

Synovitis of the knee joint develops most often due to destructive changes in connective tissue structures. Thickening, roughening of the layers of the synovial bag leads to the accumulation of fluid inside it. It is more than enough to nourish hyaline cartilage and ensure smooth bone displacement relative to each other.

Therefore, the long-term finding of excess exudate soon becomes the cause of the development of the inflammatory process. Tissue destruction can occur as a result of knee damage - meniscus injuries, sprains, muscles, dislocations, joint and extra-articular fractures.

Such factors and pathological conditions can provoke inflammation of the synovial membrane:

  • excessive motor activity, weight lifting,
  • hematopoiesis disorders associated with impaired blood coagulation, leading to hemorrhage in the cavity of the knee joint,
  • the presence of severe systemic diseases, including autoimmune genesis - rheumatoid, reactive, infectious, psoriatic, gouty or deforming arthritis, gonarthrosis, rheumatism,
  • frequent monotonous movements in the process of sports training or performing professional duties, predisposing to microtrauma of connective tissues.

The most severe and dangerous form of synovitis with its complications is infectious.It occurs as a result of the introduction of pathogenic microorganisms, often pathogenic bacteria, into the synovial bag.

Infectious agents (golden, epidermal staphylococcus) penetrate the knee at the time of injury from the surface of the skin.

This scenario is possible with deep punctures, cuts, ruptures of ligaments and (or) tendons with a violation of the integrity of the skin.

Pathogenic bacteria penetrate the bursa cavity also from the primary inflammatory foci, usually formed in the organs of the respiratory, digestive or urogenital systems. After introduction, they multiply intensively, releasing toxic waste products into the surrounding space. This provokes not only an acute inflammatory process, but general intoxication of the body.

The form of the course of synovitis of the knee jointCharacteristics
SharpSerous or hemorrhagic exudate containing a large number of proteins or blood impurities accumulates in the knee cavity. The synovial bag is filled with liquid, which leads to the "swelling" of its walls. Painful sensations are constantly present, amplified by attempts to bend or extend the knee
ChronicIn the study of synovial fluid, a high concentration of fibrillar proteins is detected in it, which indicates an irreversible destruction of the membrane. Its structure undergoes changes - it thickens, coarsens, intraarticular bodies begin to form. The pains weaken, arise only after serious physical exertion

Clinical picture

Non-specific acute synovitis is characterized by severe swelling of the knee joint, visualized in an increase in its size compared to a healthy limb. The skin over it is smoothed, swollen, there is a feeling of fullness. Pain of mild or moderate severity occurs only during movement and disappears after a short rest.

On palpation of the joint, moderate pain, an increase in local temperature, fluctuation (a symptom of fluid in a closed cavity with elastic walls) are felt.

A specific feature of this form of synovitis is balloting of the patella. When pressed, it moves downward until it touches the bone, and after the cessation of mechanical stress returns to its original position. There is also a limitation of joint mobility, minor hyperthermia, weakness, and malaise.

The clinical manifestations of acute purulent pathology are more vivid, and the symptoms of general intoxication of the body prevail:

  • body temperature exceeds subfebrile indicators, rises to 40 ° C,
  • hyperthermia is accompanied by chills, fever, increased sweating, delirium is possible,
  • neurological disorders occur - apathy, fatigue, drowsiness,
  • nearby lymph nodes increase
  • in children and debilitated patients, digestion and peristalsis may be impaired.

The joint itself swells, hyperemia of the skin above it is noted. Any movement causes acute pain. Sometimes protective and compensatory mechanisms are triggered, provoking the development of restrictive contractures.

In the absence of medical intervention, the disease soon takes a chronic form of the course. The severity of uncomfortable sensations is significantly reduced, the range of movements in the knee joint increases. Pain arises after intense physical exertion, hypothermia, exacerbation of other chronic pathologies, during the flu or SARS.

A person often takes a weakening of symptoms for recovery. In fact, destructive fibrotic changes develop in the joint cavity. The growth of the villi of the synovial membrane occurs, a large amount of fibrin accumulates on it.

When creating a certain concentration, they begin to "sag" into the joint cavity. After separation, fibrinous deposits are transformed, appearing on diagnostic images in the form of a characteristic sign of synovitis - “rice bodies”.

They are not localized in one place, but circulate in the synovial fluid, constantly injuring the joint capsule.


Among the laboratory methods, the following procedures are distinguished:

  • blood analysis,
  • blood chemistry,
  • puncture

If there is a suspicion of the infectious nature of synovitis, puncture is performed. By examining the synovial fluid, you can accurately determine the infection and its treatment regimen. The reason for the puncture can be leukocytosis and temperature. Leukocytosis is detected after studying a blood test. Laboratory diagnostic methods help to get an overall picture of the state of the body.

It develops due to the ingress of the microbe into the synovial membrane:

    • direct method (with penetrating wound),
    • contact method (if there is inflammation of the bones of the joint (osteomyelitis), articular bag (bursitis), and so on),
    • with blood flow, with lymph - from other foci of infection in the body.

Such a disease may be:

  • specific when microbes such as Koch's bacillus, treponema (a causative agent of syphilis), listeria and others get into the synovial membrane
  • non-specific: it is called "banal" cocci.


To get rid of synovitis of the knee joint, it is necessary to use a complex effect. Therapy consists of the following elements:

  • drug exposure
  • physiotherapy
  • special diet
  • therapeutic preventive physical education.

If the disease is not amenable to therapeutic effects or is extremely acute, surgery is performed. After surgery, conservative methods for recovery are used.

An orthopedist is involved in the preparation of a treatment regimen. Also, with a complicated course, other specialists may participate in therapy.


Drug treatment is aimed at relieving inflammation and pain. For this, local ointments and systemic anti-inflammatory are used. If a person suffers from infectious synovitis of the knee joint, antibiotics are prescribed. In the acute course of the disease, proteolysis inhibitors can be used. Each medication has a limited duration of use. The doctor must correctly draw up a treatment regimen and select the necessary dosages.

Nonsteroidal Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs are used for any type of synovitis. They help withstand pain and inflammation. Local ointments and gels are used. Among the most effective drugs are:

Ointments are applied to the affected area 2-3 times a day. The specific dose and duration of use is determined by the doctor. In the treatment of chronic synovitis, medications are used in courses. In no case should you prescribe ointments or tablets on your own. If used incorrectly, side effects occur, there is no therapeutic effect.


Hormonal drugs can quickly get rid of inflammation. Corticosteroids effectively suppress inflammation, but can be harmful to the body. That is why they are used only with a complicated course of the disease. To achieve maximum results, medicines are used as injections. Among the most preferred drugs are:

Simultaneously with the suppression of inflammation, it is necessary to eliminate the cause of the disease. In addition, it is important to ensure complete peace and not to give an extra load on the joint until the first remission.

Hormonal drugs can cause complex complications. It is very important to correctly observe the treatment regimen and dosage of the drug.


In the complicated chronic course of synovitis, proteolysis inhibitors are used. Medicines of this class can slow down the breakdown of proteins, as well as reduce the permeability of cells. Among the most popular drugs are:

Proteolysis inhibitors are used in the form of injections. Injections should be done by a specialist. To achieve lasting improvement, you must complete the full course of treatment. A second course can be carried out in a few months.


Antibiotics are used to detect a bacterial infection. Medications can be used in the form of tablets or injections. The acute course of the disease requires the use of powerful antibiotics. The choice of drug depends on the results of the puncture. Most often, doctors prescribe:

Most often, gonococci and streptococci penetrate the synovial membrane. With the improper use of antibacterial agents, the infection becomes resistant.

The type of bacteria is determined after obtaining the results of bacterial inoculation of the synovial fluid. During treatment, it is necessary to completely destroy the infection in order to avoid relapse of the disease.

Ointments and gels

Local remedies are used until the first results in therapy appear. With the help of ointments and gels, you can relieve inflammation and pain. Medications of the class of non-steroidal anti-inflammatory drugs are used. Among the most popular options are:

The advantage of local drugs is a low rate of absorption in the systemic circulation. Only gels and ointments can be applied for 4-8 weeks without any consequences. Local remedies can be combined with physiotherapy. For example, electrophoresis can provide deeper drug penetration.


After removing the acute inflammation of the synovial membrane, physiotherapy can begin. Only a doctor can determine the moment when it is more appropriate to use physiotherapy. Among the most popular methods are:

  • procedures in the physiotherapy room are numerous hardware methods based on physical effects on the body,
  • massage,
  • performing exercises from the exercise therapy complex.

Physiotherapy will not only help in the treatment, but also will prevent the recurrence of synovitis of the knee joint. Often they are prescribed in the fall or spring during the period of the next exacerbation of the disease.

Physiotherapeutic effects are not a substitute for drug treatment. Both treatments can be successfully combined.

Physical therapy allows you to restore the efficiency of the knee joint. It is worth noting that exercise therapy begins to be used last, when inflammation and pain are completely absent. The exercises are aimed at:

  • restoration of joint mobility,
  • prevention of muscle wasting,
  • return to health.

When performing exercises, a person should not be tired. The simplest movements are performed (rotation, extension and bending of the leg). After a long remission, you can switch to walking. The main thing in rehabilitation with the help of exercise therapy is regularity and a gradual increase in loads.

Reasons and development mechanism

It is worth noting that knee synovitis is not an independent disease. This is always a consequence of pathological processes. How does the nucleation of synovitis of the knee occur?

For normal mobility of the joint, the absence of friction and lubrication of the articular surfaces by the cells of the inner shell, a fluid is produced. Normally, it is produced a little, but with the development of the inflammatory process or the influence of other factors, its production is significantly enhanced. As a result of this, an articular effusion is formed. Joint inflammation arises, causes:

  • injuries (bumps, bruises, dislocations, fractures, sprain or damage to the meniscus, cartilage surface),
  • infections (streptococci, staphylococci, pneumococci, pale treponema, tuberculosis),
  • metabolic disease,
  • endocrine diseases
  • joint diseases (arthritis, arthrosis),
  • allergy,
  • autoimmune processes (rheumatism, rheumatoid arthritis),
  • neurological diseases (neuritis, nerve infringement).

Infections can penetrate in several ways: directly through damage, from nearby tissues (boils, abscesses), with blood and lymph flow.


Synovitis of the knee joint and other joints is an ailment based on a violation of the functions of the synovial membrane as a result of inflammation. The inner surface of the joint bag is covered with connective tissue, the surface of which has villi. Shell cells synthesize synovial (synovial fluid), which improves the sliding of articular surfaces during movement and delivers oxygen and nutrients to articular tissues.

For normal functioning, the joint contains 2-3 ml of articular secretion. In the process of synovitis, the knee is completely filled with fluid. This is due not only to increased production, but also to the loss of the ability to reabsorb excess effusion. In this case, the composition and consistency of the synovium changes. It becomes viscous and can acquire a different composition, the nature of which depends on the cause of the disease.

It develops not because of a microbe, but as a result of:

    • joint injuries
    • with metabolic disorders,
    • hemophilia
    • some endocrine disorders,
    • arthrosis, arthritis (reactive synovitis).

The fluid formed in the joint with this type of synovitis is sterile (in contrast to its infectious type).

3. Allergic

It develops in response to any infectious or non-infectious disease of the body. In this case, the synovial membrane becomes inflamed due to excessive "bombing" of its antibodies or other chemicals formed in the body. This type of synovitis develops in those people whose articular capsule cells are hypersensitive to certain endogenous chemicals.

Acute synovitis of the knee

For this form, pronounced symptoms are characteristic. The joint after exposure to a provoking factor may increase in size from a few hours to several days.

Symptoms largely depend on the volume of effusion. The more it is, the more severe the symptoms. Symptoms of acute form:

  • articulation increase in size,
  • feeling of fullness
  • severe pain while moving,
  • hyperemia and hyperthermia,
  • an increase in body temperature to febrile indicators.


This is a subspecies of allergic synovitis that occurs as a result of:

  • frequent mechanical irritation of the synovial membrane (for example, with damaged bones of the joint or its articular surfaces),
  • as a response to general intoxication resulting from an infectious or non-infectious pathology.

Chronic form of synovitis of the knee

This form is characterized by a wave-like course, periods of exacerbation and remission alternate. Symptoms of seizures are similar to those of acute knee synovitis.

More often, the cause of the chronic course of synovitis is the absence or inadequate treatment of the acute form, circulatory and nutritional disorders, pathological changes in the functioning of the joint.

The chronic form of knee synovitis is rarely diagnosed, but it often leads to complications.

The characteristic symptoms of a chronic form of synovitis of the knee are:

  • pain, often dull aching,
  • mobility restriction
  • fatigue when walking,
  • slight accumulation of effusion,
  • frequent dislocations and subluxations.

The severity of symptoms depends on the severity of pathological changes, as well as the frequency of attacks.

A type of chronic or moderate synovitis of the knee joint is villonodular. This is a rare pathology with severe symptoms. Villonodular synovitis of the knee joint is characterized by an overgrowth of the membrane with the formation of articular outgrowths, secondary injury of the membrane occurs. There is soreness and swelling of the joint. The villous synovitis is treated surgically.


In this case, the division of synovitis by the duration of its course is taken into account. The disease develops as a result of untreated or untreated acute synovitis, especially if it was caused by a traumatic factor that was not eliminated subsequently. The overall reactivity of the synovial membrane also plays a role in the development of the disease. To diagnose this disease at first is difficult due to the scarcity of its clinical manifestations. But its neglected course leads to a violation of blood and lymph circulation in the joint, which leads to a change in its function and a deterioration in the quality of life.


It takes into account the classification according to the severity of inflammatory changes in the synovial membrane.

Symptoms of the disease are not very pronounced:

  • the joint does not increase much in volume,
  • movements in it, although painful, but possible,
  • general condition suffers, but not significantly.

This type of disease should be treated especially carefully, as it has a tendency to relapse and chronicity.

Types and symptoms

According to the etiology of origin, 3 types of synovitis are distinguished:

  • aseptic - not associated with an infection, occurs against a background of trauma, impaired metabolism, etc.,
  • infectious - caused by specific or non-specific infectious agents,
  • allergic.

Infectious forms are accompanied by a vivid clinical picture. Body temperature rises to febrile indicators, inguinal lymph nodes increase, mobility is limited up to the impossibility of performing flexion-extensor movements, and the pain is acute. Symptoms of general intoxication appear (weakness, headache, nausea, and vomiting). Moderately pronounced synovitis of the knee joint with aseptic inflammation. Symptoms in this case are erased, the symptoms increase within a few weeks. Pain, as a rule, appears only with movement.

Also, synovitis is serous (effusion changes color from clear to cloudy), serous-fibrous (has a yellow tint), hemorrhagic (liquid with an admixture of blood) and purulent (contains an admixture of pus).

Varieties according to the cause of occurrence:

  • Reactive synovitis of the knee joint.This is an allergic form, which can also occur with diseases of the knee (arthritis, arthrosis). Symptoms develop amid exposure to a mechanical or toxic irritant. Treatment of reactive synovitis of the knee should be aimed at eliminating the allergen.
  • Post-traumatic synovitis of the knee joint. Caused by mechanical damage to the knee. Therapy of post-traumatic synovitis of the knee joint should begin with the elimination of the inflammatory process and the cause that caused it.
  • Exudative synovitis of the knee joint.It is also a consequence of a knee injury. Exudative synovitis of the knee joint is characterized by the accumulation of a huge amount of exudate, which leads to the development of inflammation. The consequence is the stretching of the joint bag, the severity of pain even at rest.

Depending on the number of joints involved in the pathological process, there is bilateral and unilateral synovitis of the knee joint.

Regardless of the origin of the inflammatory process, common symptoms are:

  • aching dull pains that appear mainly during movement,
  • an increase in the size of the knee joint,
  • swelling, redness of the skin,
  • decreased mobility of the joint, and in some cases even its immobility,
  • fever.

For suprapatellar synovitis of the knee joint, a defeat of the suprapatellar sac (upper knee) is characteristic. A feature of the disease is swelling and swelling over the joint.


In orthopedic practice, several varieties of synovitis of the knee joint are distinguished, which differ in reasons, duration, and morphological signs.

Given the period of time during which the disease accompanies the patient:

  • Acute - until 21 days
  • chronic - more than 1 month.

By the composition of the fluid that accumulates in the joint:

  1. Serous - with a transparent exudate, which subsequently acquires a yellowish tint. Appears without the influence of an infectious factor.
  2. Fibrinous - A tight secret with a lot of fibrinogen. Most often appears with viral and fungal infections.
  3. Purulent - green exudate with a fetid odor, signals the penetration of pyogenic bacteria into the joint cavity.
  4. Mixed - combined forms are found: serous-fibrinous, purulent-fibrinous.
  5. Hemorrhagic - with a large number of red blood cells that stain blue in pink.

According to the etiological origin there is the following division:

  • Aseptic - without the presence of pathogenic bacteria.
  • Infectious - caused by microbes.
  • Post-traumatic - develops as a result of joint injury.
  • Autoimmune - when immune aggression occurs, it is directed against its own cells.
  • Metabolic - in violation of metabolic reactions.

In addition, the ailment is primary, the cause of which cannot be established. This type is called idiopathic. Another variety is the result of damage to articular tissues or a pathological process, - secondary synovitis of the knee joint.

Which doctor should I contact for synovitis of the knee joint?

Regardless of slight synovitis or severe, you need to go to the hospital. The treatment is carried out by an arthrologist, rheumatologist, orthopedic surgeon. If the disease is caused by an injury, then it is worth visiting a traumatologist, arose against the background of an allergic reaction - an allergist, due to an impaired metabolism - an endocrinologist. You may also need to consult an infectious disease specialist, a hematologist. Therapist will help determine the choice of a specialist by listening to complaints.


When synovitis of the knee joint appears, the symptoms have different severity and variety. Any of the forms of the disease is accompanied by signs characteristic of inflammation. The clinical picture of each species has a number of distinctive symptoms.

Synovitis of the knee joint in a child and an adult is accompanied by the following manifestations:

  • Pain symptom occurs in response to irritation of the receptors and the pressure of a large amount of fluid on the surrounding tissue. With serous forms, the pain syndrome is moderate aching in nature, purulent synovitis leads to severe throbbing pain.
  • Swelling is the result of accumulation of excess fluid in the soft periarticular tissues. In mild forms of inflammation, the knee swells slightly, in severe cases severe swelling develops.
  • Local fever over the joint is a characteristic symptom of inflammation. The hotter the joint to the touch, the more actively the pathological reaction develops.
  • Hyperemia indicates internal articulation abnormalities. The skin can change color and becomes pale pink, and in some cases - dark purple.
  • Knee deformity manifested in an increase in articulation and the acquisition of the shape of a ball. This phenomenon is explained by the filling of the cavity of the joint bag with liquid, which creates pressure on the walls of the capsule and stretches them, smoothing the edges.

General condition, as a rule, does not change. An increase in body temperature to subfebrile values ​​may accompany fibrinous synovitis. When a secondary infection joins or pyogenic bacteria enter the bag cavity, the clinic of the disease changes:

  1. The pain intensifies and acquires a pulsating character,
  2. the knee is very swollen and hot
  3. mild hyperemia gives way to severe redness,
  4. symptoms of general intoxication are observed - fever, headache, weakness,
  5. movements in the knee joint are very limited, extension of the joint is almost impossible.

Possible complications

If adequate treatment for synovitis of the knee joint is not carried out or unsuccessful attempts of independent therapy are made, secondary conditions develop that can cause significant damage to health:

  • Deforming arthrosis (gonarthrosis) - secondary degeneration of the articular cartilage and bone tissue,
  • sepsis - general infection of the blood, develops when microorganisms enter the vascular bed,
  • contracture - limitation of joint mobility due to shortening of the ligaments of the knee,
  • ankylosis - immobility of the knee joint.

In addition, in some patients, limb shortening occurs, due to which the gait changes, lameness appears. Therefore, in order to prevent irreversible phenomena, it is necessary to properly treat synovitis of the knee joint.


The synovial membrane, covering the joint cavity from the inside, is the place where the normal articular (it is called synovial) fluid that nourishes the articular cartilage is synthesized. With inflammation or irritation of this membrane, the cells react by synthesizing more fluid - an effusion appears in the joint (there may be a different amount of it).

Exudative synovitis is usually a variant of an acute illness, as in a chronically ongoing process, cells are depleted, resulting in less synovial fluid than is needed.


It develops as a result of the bacterial flora entering the synovial cavity. This can happen as a result of an injury, or with another infectious disease (gonorrhea, tuberculosis, pneumonia, sepsis). This is the most difficult process. It requires the use of antibiotic therapy:

  • at the beginning - of a wide spectrum, after diagnosis and taking pus for bacteriological examination,
  • continues - according to the results of the tank. seeding and sensitivity of a microorganism to a certain type of antibiotic.


One of the subspecies of chronic synovitis. Diagnosis is by arthroscopy (insertion of video equipment into the joint). In this case, you can note:

  • thickening of the outer shell of the joint capsule,
  • cicatricial changes appear in it,
  • the villi of the synovial membrane grow
  • fibrin is deposited on the synovial membrane, which hangs, like cysts, in the joint cavity.


It develops mainly with untreated acute synovitis. If such a disease recurs often, then:

  • fluid accumulates in the joint (hydrarthrosis, dropsy),
  • as a result - increased pressure on the synovial membrane,
  • as a result, the membrane becomes thinner, cicatricial changes appear in it, its ability to absorb joint fluid decreases sharply.

There is a "vicious circle."

Treatment tactics

Therapy of synovitis is carried out simultaneously with the treatment of the pathology that has caused its development. Therefore, consultation with a traumatologist, venereologist, infectious disease specialist, neuropathologist, gastroenterologist, endocrinologist may be required.

In acute aseptic or infectious synovitis, the patient is hospitalized. The doctor with a puncture removes the accumulated exudate, and then rinses the joint cavity with solutions of antiseptics, glucocorticosteroids or antibiotics.

After applying a tight dressing, treatment is carried out in the department under the supervision of medical personnel.

Therapy of chronic sluggish synovitis is to eliminate the factors that provoked it. The patient is shown taking medications at home.

Recurrent chronic synovitis, accompanied by degeneration of the tissues of the joint capsule, is practically not amenable to conservative therapy.

During the surgery, the doctor completely or partially excised the inflamed synovial membrane.

Non-drug therapy

To reduce the severity of pain and prevent excessive loads on the injured knee, patients are recommended to wear orthopedic appliances. With severe inflammation, semi-rigid orthoses, bandages and kneecaps with metal or plastic inserts are used.

Knee pad for fixing the joint.

To alleviate the symptoms of synovitis at the initial stage, wearing a soft elastic bandage that only slightly restricts movement is enough. Physiotherapeutic measures are necessarily included in treatment schemes:

Immediately after stopping the inflammatory process, the patient is recommended to perform special exercises to improve joint functioning. The complex is compiled by a physical therapy doctor, and the first classes are held under his supervision.

Pharmacological preparations

Severe pain arising from the acute form of synovitis is eliminated by the parenteral administration of glucocorticosteroids - Diprospan, Triamcinolone, Phlosterone, Dexamethasone. These hormonal drugs have not only an analgesic effect, but also exhibit pronounced antiexudative, anti-inflammatory activity.

Often they can not be used due to toxic effects on the human body, therefore, after the pain is weakened, glucocorticosteroids are replaced by non-steroidal anti-inflammatory drugs:

  • ointments, gels - Indomethacin, Arthrosilen, Voltaren, Fastum, Nimesulide,
  • tablets - Ibuprofen, Nise, Ketorol, Nurofen, Ketoprofen, Meloxicam,
  • injection solutions - Ortofen, Voltaren, Movalis, Diclofenac.
  • Approximately 3-4 days after treatment after stopping inflammation, patients are recommended to use ointments with a warming effect (Finalgon, Kapsikam, Apizartron) to improve blood circulation in the knee.
  • If destructive changes have occurred in the articular structures, then chondroprotectors (Structum, Arthra, Teraflex) that stimulate the regeneration of damaged tissues are included in therapeutic schemes.

Compliance with all medical recommendations allows you to quickly get rid of all the symptoms of synovitis. The prognosis for a full recovery is favorable. Complications in the form of contractures arise only with a severe course of purulent synovitis. Timely seeking medical help will help to avoid such a negative development of events.

Synovitis of the knee joint what is this photo treatment

Synovitis is an inflammatory process of the synovial membrane. Inflammation is only within the membrane and is expressed by the concentration of inflammatory effusion in the cavity of the membrane.

The lined membranes of the cavities involved in the inflammatory process can be:

  • Synovial bag. This is a small cavity, which is lined with the synovial membrane, and delimited by the capsule.
  • Joint cavities
  • The synovial sheath of the tendon.

As a rule, there is chronic synovitis of the elbow joint, as well as the wrist, ankle, joint and knee joints. Inflammations differentiate depending on the clinical course, into acute and chronic.

Chronic synovitis occurs against a background of thickening of the fibrous membrane of the joint capsule. This condition forms fibrosis - a seal of connective tissue with scarring.

Chronic synovitis is rarely diagnosed, its symptoms can be different.It is formed in one joint, but when it develops into polyarthritis, both joints are affected. Chronic type, most often affects:

  1. knee,
  2. ankle
  3. wrist band
  4. carpal joint.

Post-traumatic synovitis of the knee joint is a reaction of the body to deformation of joint tissues or damage to the joint. In this case, the synovial membrane forms an effusion in the joint. Additional reasons:

  • joint body movement
  • damage to the meniscus or cartilage.

Exudative synovitis is similar to post-traumatic synovitis. This form develops when the joint is injured. Distinctive feature: a greater amount of precipitation in the joint fluid, due to which the joint hurts and greatly increases in size.

Depending on the specifics of the inflammatory process and effusion, modern medicine distinguishes between these types:

  1. purulent,
  2. hemorrhagic,
  3. serous,
  4. serous fibrinous.

Synovitis can be moderate, that is, do not have pronounced symptoms. Moderate synovitis is characterized by:

  • a slight increase in the joint,
  • the possibility of joint movements.


Most often occurs in response to a mechanical injury to the joint. In this case, the synovial membrane produces a lot of inflammatory, rich in proteins and various cells, fluid (exudate). By the nature of this fluid emit:

  • serous synovitis,
  • serous fibrinous (also called adhesive),
  • purulent synovitis,
  • hemorrhagic.


This characterizes the severity of inflammatory changes in the joint according to additional studies: MRI, ultrasound, arthroscopy. In this case, usually the symptoms are pronounced:

  • the joint is swollen
  • the skin is taut over him
  • the skin may be reddened,
  • the movements are significantly hindered.

Non-drug therapy

To reduce the severity of pain and prevent excessive loads on the injured knee, patients are recommended to wear orthopedic appliances. With severe inflammation, semi-rigid orthoses, bandages and kneecaps with metal or plastic inserts are used.

To alleviate the symptoms of synovitis at the initial stage, wearing a soft elastic bandage that only slightly restricts movement is enough. Physiotherapeutic measures are necessarily included in treatment schemes:

  • magnetotherapy
  • electrophoresis, phonophoresis using solutions of anesthetics, analgesics, chondroprotectors,
  • laser therapy
  • UHF therapy
  • sinusoidal modulated currents
  • applications with ozokerite, paraffin, therapeutic mud.

Immediately after stopping the inflammatory process, the patient is recommended to perform special exercises to improve joint functioning. The complex is compiled by a physical therapy doctor, and the first classes are held under his supervision.

Causes of synovitis

Synovitis groups are divided due to the appearance of:

Causes of infectious synovitis: the entry of pathogens into the synovial membrane. Microorganisms enter there from the outside, as well as by the lymphogenous and hematogenous route:

  • non-specific synovitis occurs due to pathogenic microorganisms that cause non-specific inflammation in the synovial membrane: pneumococci, staphylococci, streptococci,
  • specific synovitis occurs due to pathogenic microorganisms that cause inflammation in the synovial membrane.

Causes of aseptic synovitis:

  1. mechanical injuries of the joint,
  2. hemophilia
  3. metabolic disorders
  4. endocrine disorders.

Allergic synovitis, for example, reactive synovitis, appears due to exposure of the synovial membrane to infectious and non-infectious allergens. Reactive synovitis is an allergic form of the disease. Most often, in this case, the knee joint suffers. Reactive synovitis affects people, both young and old.

What it is?

Synovitis of the knee joint is a process of inflammation of the synovial membrane of the joint, which is accompanied by an increase in the production of synovial fluid. Inflammation can be different for its reasons, course, complications and methods of flow. Sometimes synovitis comes without a trace, but in some cases it takes a long treatment, surgery and subsequent rehabilitation.

Symptoms of synovitis

Exudation begins to accumulate in the joint cavity, this is especially evident in the knee joint, as it manifests itself as a symptom of balloting of the patella.

This symptom is characterized by the fact that with a straightened leg, pressure on the patella leads to its entry into the joint cavity, and all the way into the bone. After the pressure is stopped, the patella pops up.


Can provoke inflammation of the synovial membrane:

  1. Injuries resulting in constant irritation of the inner lining of the joint with pieces of cartilage or a damaged meniscus.
  2. Infections that penetrate the joint cavity from the external environment (when injured) or from neighboring tissues (in the presence of phlegmon, abscesses, wounds, abrasions, boils, etc.). Also, pathogens can enter the joint from remote foci of infection with the flow of lymph or blood.
  3. Congenital and acquired pathologies of the joint and periarticular tissues. They lead to the development of synovitis for various reasons. For example, with rheumatoid arthritis or rheumatism, the disease develops under the action of antibodies that affect the synovial membrane, and with arthrosis - due to irritation of the membrane by cartilage, which has lost its smooth surface, or by bone growths.
  4. Autoimmune diseases (lupus erythematosus, rheumatoid arthritis). The immune system perceives the inner shell of the joint as a foreign agent, and antibodies gradually begin to destroy it.
  5. Metabolic disease. This cause causes synovitis, because metabolic products that irritate the membrane accumulate in the joint cavity.
  6. Allergic reactions. When penetrated into the joint capsule, allergens are perceived as dangerous antigens, and the immune system begins to produce antibodies, resulting in inflammation, accompanied by excessive formation of synovial fluid.
  7. Endocrine diseases. Hormonal disruptions lead to the fact that the synovial fluid begins to be produced in large quantities. Because of this, inflammation of the inner lining of the joint develops.
  8. Hemophilia. With this disease, constant hemorrhages occur in the joint cavity, which causes inflammation.
  9. Diseases of the nervous system. Severe stresses, pinching or damage to nerves during scoliosis, neoplasms or fractures, as well as peripheral nerve neuritis lead to the occurrence.

There are 2 stages observed during the course of the disease:

  1. Sharp. Symptoms are progressive: swelling, pain, redness intensifies during the first few days.
  2. Chronic (recurrent). It is observed in the absence of an adequate and timely treatment of the disease, the main symptom of chronic synovitis is dropsy and periodic mild pain.

Symptoms of acute form

Acute synovitis of the knee joints may be accompanied by severe pain. Therefore, if there is a suspicion of an infectious form of the disease, it is extremely important to consult a doctor as soon as possible, who will identify the causative agent of the infection and prescribe the necessary therapy.

Symptoms that accompany an acute purulent form:

  • the joint is enlarged
  • fever
  • general condition is characterized by weakness and nausea,
  • there is pain during flexion-extension of the leg,
  • there is redness in the knee area, which is hot on palpation.

The disease with pyogenic infection is especially acute.Pathogenic bacteria often penetrate into the joint cavity along with blood flow or through open wounds. The accumulated blood, pus and joint fluid become the cause of the stretching of the joint bag, which causes pain.

Signs of a non-infectious form of the disease

The main symptoms of an aseptic type of disease are an increase in the volume of the knee joint and the absence of pain. This phenomenon is caused by the fact that the synovial fluid located in the joint bag during irritation of the synovial membrane increases dramatically in literally a few hours. The resulting swelling in the knee joint prevents free movement.

Symptoms of aseptic type have the following form:

  • an increase in volume occurs from several hours to 1-2 days,
  • the affected area does not have a high temperature,
  • when pressing on the patella, it sinks into the joint, after which it reappears,
  • general weakness.

Synovitis of the right knee joint

In acute purulent synovitis, there is a rather vivid manifestation of the symptoms of the disease. We can say that in this case the symptoms are more indicative than with serous synovitis.

Purulent synovitis is characterized by the following conditions:

  • general unsatisfactory condition of the patient,
  • sharp leaps of weakness,
  • chills
  • high body temperature,
  • in some cases, the appearance of delirium.

There is a smoothness of the contours of the diseased joint, redness of the skin above the joint, as well as soreness and apparent limited movement.

In some cases, contracture may appear, that is, a restriction in the joint of passive movements. Purulent synovitis, among other things, may be accompanied by regional lymphadenitis. This is an increase in lymph nodes due to the inflammatory process.

Please note: if acute purulent synovitis is not completely cured, then its relapse is likely.

At the first stage of the chronic form of serous synovitis, pronounced clinical manifestations are observed. Patients complain of:

  • fatigue
  • tiredness when walking,
  • restriction of movements in a sore joint,
  • the appearance of aching pain.

In the joint cavity, the accumulation of large volumes of effusion begins, which turns into a dropsy of the joint - hydrarthrosis. With the prolonged existence of dropsy, the ligaments of the joint are stretched, this leads to its looseness, subluxation, and, sometimes, dislocation.

Signs of a chronic form

Chronic synovitis is the result of the treatment of an acute form of pathology and is characterized by blunt symptoms. Painful manifestations are of little concern to the patient. The knee has a slight swelling, there is no redness, there is a slight soreness when bending and walking.

The chronic form of synovitis can be recognized by the following signs:

  • The joint often crunches, regular micro-dislocations are observed.
  • Long walks are impossible, as there is increased fatigue of the legs.
  • The joint has limited mobility.

In the chronic form, there are no symptoms such as fever or fever. Unhealed rheumatism, allergic reactions, gout can lead to inflammation.

Every year, accumulations of effusion inside the knee joint gradually accelerate the development of the inflammatory process. The patient has signs of hydrarthrosis (dropsy) and pathological changes in the ligamentous apparatus itself are observed.

Synovitis Complications

  • Purulent expressed arthritis develops during the formation of an active purulent process, which is caused by acute purulent synovitis.
  • Soft tissue phlegmon and periarthritis appear when the purulent process passes from the synovial cavity to the tissues surrounding the joint, with acute purulent synovitis.
  • Phlegmon, purulent arthritis and periarthritis have local manifestations:
  • joint area increases significantly,
  • tissue swelling is observed,
  • the skin over the joint quickly turns red.

Panarthritis is formed when the purulent process affects the cartilage, ligaments of the joint and bone.

How to treat reactive synovitis

Treatment of acute serous synovitis must be carried out with the initial immobilization of the limb with a plaster tire. How to treat synovitis in the initial stage:

  • UHF therapy
  • UV irradiation
  • electrophoresis with novocaine,
  • warming compresses with a solution of dimexide.

If the synovitis is severely leaking, then the doctor prescribes:

  1. electrophoresis with lidase,
  2. electrophoresis with potassium iodide,
  3. phonophoresis with glucocorticosteroids.

If the disease proceeds easily and the symptoms are not striking, then treatment of synovitis involves only immobilization of the limb and tight bandaging of the joint, up to the complete disappearance of the effusion in the joint cavity and the disappearance of inflammatory changes in the soft tissues near the joint.

Treatment of synovitis can not do without physiotherapy. For example, physiotherapy for arthrosis of the knee joint has proven itself well.

Puncture of the knee

Acute purulent synovitis needs such treatment, where special attention is paid to ensuring the best immobilization of the affected limb with a plaster tire or bandage.

It is also important to conduct serious general and local antibiotic therapy. Pus is removed from the joint cavity by puncture, after which antibiotics of a general spectrum of action, novocaine and hydrocortisone are injected into the cavity, this is the treatment of synovitis of this type.

In addition, it is important to use continuous continuous flow-aspiration rinses of the joint cavity with non-concentrated antibiotic solutions. These actions are performed using two thin drains.

In severe course of purulent synovitis, opening and drainage of the joint cavity is indicated.

Treatment of serous-fibrinous or serous synovitis consists in the following steps:

  1. providing rest of the affected limb,
  2. joint puncture
  3. physiotherapeutic procedures: paraffin applications, electrification.

It is important to identify and treat the underlying disorder that triggered the onset and symptoms of chronic synovitis.

In advanced cases, it is necessary to carry out surgical intervention using synovectomy. The operation may consist in complete or partial excision of the synovial membrane of the joint capsule.


Massage is performed to eliminate effusion as soon as possible. It is almost impossible to independently carry out the necessary actions. It is necessary that the massage is performed by a specialist. The duration of the procedure is 10-15 minutes. The course of treatment is 7-10 days. Massage is prescribed during remission to maintain and improve treatment results. People note that after proper massage, the edema is relieved and pain disappears. Procedures should be carried out in the office of a qualified masseur. When contacting a private specialist, you must first be interested in his qualifications.


After achieving remission or with a sluggish course of synovitis, hirudotherapy can be used. Exposure to leeches allows you to achieve the following results:

  • pain relief
  • immunomodulatory effect
  • relieve inflammation.

Hirudin, which is injected with leeches, can help, even when the drugs are powerless. To maximize the effect of the procedure, you must use it together with medications.

Before hirudotherapy, it is necessary to carefully read the contraindications of the procedure. You can use leeches only with a sluggish course of synovitis of the knee joint.

Synovitis treatment prognosis

The prognosis for synovitis largely depends on the characteristics of the pathogen and the state of the body.

Complete recovery involves maintaining movement in the joint.Doctors give such a positive prognosis for allergic and serous synovitis. In relation to other forms of the disease, stiffness or complete immobility of the joint may appear.

If acute purulent synovitis develops in a severe form, then the likelihood of sepsis is high, in the aggregate all this often creates a threat of death for the patient.


Diet is not the basis for treating synovitis of the knee, but it can complement it. With any disease, the body begins to need more vitamins and minerals. In order for the joint to recover as soon as possible, it is necessary:

  • eat fractionally (at least 4 times a day),
  • use vitamin supplements
  • eliminate bad habits.

It is enough to eat healthy food. Counting calories is not required. A balanced diet will allow the immune system to suppress inflammation. In order not to worsen the situation, it is necessary to exclude all bad habits, at least for the duration of treatment of synovitis.

Surgical intervention

Surgical treatment is an extreme measure in the treatment of synovitis. It is used in the chronic course of the disease when it is not amenable to therapy. Also, surgery is used in case of irreversible processes in the synovial membrane. After surgical treatment, conservative therapy using medications continues. To get rid of synovitis of the knee, doctors use minimally invasive methods of intervention, so recovery takes place as soon as possible, often without prolonged rehabilitation.


The classic operation is aimed at the complete or partial removal of the synovial membrane. Doctors try to keep the affected area to the maximum. The knee joint is opened through a small incision. After that, the necessary manipulations are performed. After surgery, rehabilitation will take about 7 days. Next, you will need to continue to be observed by your doctor. Surgery ends with a complete cure if a person follows all the recommendations of a specialist.

Before surgery, you must try to get rid of the disease in a conservative way.


The endoprosthetics method is a complete replacement of the affected parts of the joint with prostheses. This allows you to permanently get rid of synovitis. Implantation is carried out if the inflammation of the synovial membrane has led to irreversible consequences and caused serious damage to the joint. A joint prosthesis is made from materials that are not repelled by the body. Modern methods of arthroplasty allow you to forget about the problem for a long period of time. The service life of an artificial joint is 15-30 years.

Folk methods

In the treatment of synovitis, alternative methods of treatment can be used. Among the most effective recipes are:

  1. Salt compress - add 1 tablespoon of salt in 1 liter of boiled hot water. After this, the liquid will need to be moistened in a towel and applied to the affected joint.
  2. Infusion of bay leaf - purchase a bay leaf in a store or pharmacy, add 10-15 leaves in 200 ml of water. Boil for 5 minutes, then let it brew for 3 hours. Infusion is used once a day. The course of treatment is 3 days. Every time you need to prepare a new infusion. Bay leaf contains a lot of beneficial substances, and also stimulates the immune system to fight infection.

Also during the treatment of the disease, you can make cold and hot compresses on the affected area, if there is no purulent exudate.

In the acute course of the disease, it is better to make a choice in favor of medical methods of treatment. Alternative methods work well during remission and between courses of pharmacy drugs.

Rehabilitation Features

After getting rid of inflammation and pain, it is necessary to undergo rehabilitation.The most important thing is not to rush to return to your usual way of life. With improper rehabilitation, a relapse of synovitis may occur. Among the features of the recovery period are:

  • elimination of static and heavy loads,
  • restoration of joint mobility,
  • adding exercises from the exercise therapy complex.

Synovitis often leads to a decrease in the flexibility of ligaments and muscle atrophy. You need to start recovering slowly. During the rehabilitation period, massage and physiotherapy procedures will help. A disease is considered cured only in the absence of complaints in a person and deviations during a hardware examination.

Main symptoms

If we talk about synovitis as a consequence of an injury or external impact on the knee, then the first symptoms can appear only after a few hours, days or even a week. You should pay attention to this when determining the cause of synovitis.

The first sign of the disease is an increase in the volume of the joint due to the accumulation of fluid in the joint bag. There is a smoothing of the contours of the knee, its rounding and, as a result, deformation. With synovitis, the knee joint increases slightly in volume, which makes it possible to distinguish it from hemarthrosis (a childhood disease consisting in the accumulation of blood in the joint).

The second symptom is limited mobility. Fluid builds up in the knee, increasing its volume and making normal work difficult. In this case, pain may occur. However, this does not happen in all cases. The nature of the pain is dull, aching, low and medium intensity. The color of the knee remains unchanged, no increase in temperature is observed.

Separately, it is necessary to highlight the signs of purulent synovitis. They are fundamentally different from other types of disease.

In the knee there is an acute pain of a pulsating nature. The knee seems to be bursting with an abundance of effusion. The color of the knee joint becomes bright red, an increase in temperature is observed.

The volume of the joint increases significantly, the skin becomes stretched and shiny. Perhaps even the appearance of cyanosis.

The movements are extremely painful, there are signs of fever and general infectious poisoning of the body.

To clarify the diagnosis, it is necessary to take periarticular fluid for analysis. It is examined for infections, checked for transparency, the presence of protein and red blood cells. After the puncture, the specialist can make an accurate diagnosis, focusing on the indications of effusion.

Orthopedic constructions

The initial stage of recovery can take place using bandages and knee pads. Orthopedic designs are selected individually. You need to purchase them in specialized stores. They will help reduce the load on the joint. A person rarely can afford to be without movement for a long time. When synovitis loads on the knee at a certain stage may be undesirable. In order not to harm the body, it is required to use orthopedic structures. After completely getting rid of inflammation, the need for bandages is practically absent.

Minimal synovitis of the knee

It can be painless. There is no pronounced inflammation, discomfort manifests itself in the form of pulling sensations. The temperature is within normal limits. Painful sensations appear only upon palpation of the affected joint. Determining the disease on your own is quite difficult, and this is one of the dangers - minimal synovitis can flow into chronic.

General recommendations

During rehabilitation, you must adhere to the following rules:

  • use fortifying additives,
  • lead a healthy lifestyle,
  • try to avoid overloading the knee joint,
  • treat infectious diseases and injuries on time
  • monitor your own health.

It is necessary to avoid factors that can trigger a relapse of synovitis.If there are chronic diseases that can cause inflammation of the synovial membrane, it is necessary to carry out their treatment. After a successful cure, you must regularly undergo a routine examination in the hospital.

The recovery period for each person passes individually. The younger the person, the faster the joint will recover.


During rehabilitation, exercises are taken from a complex of therapeutic exercises. A specific complex is a doctor. Usually, the following exercises are present in it:

  • flexion of the affected leg while lying down,
  • lifting a bent leg with fixation in the air.

All actions must be performed smoothly and technically correctly. If there is pain, you must stop the exercise. The doctor should not only choose the appropriate complex of therapeutic exercises, but also show how to correctly perform all the actions. The first classes should be carried out exclusively under the supervision of the attending physician.

General principles for treating synovitis

Knee joint treatment is prescribed after a full examination and diagnosis. The method of therapy depends on the type of inflammation, the stage of development of synovitis of the knee joint and the individual characteristics of the body.

Most often, an integrated approach is used, which implies:

  • puncture
  • immobilization of a damaged joint,
  • taking medications
  • physiotherapy,
  • use of traditional medicine.

If conservative methods of treating synovitis of the knee joint do not bring the proper result, surgery is used.

Acute synovitis of the knee

The acute form of the disease of the knee joint is accompanied by severe pain and difficulty in the normal functioning of the limb. In acute synovitis, the occurrence of a purulent infection is often observed, accompanied by severe inflammation of the joint and fever.

If you suspect an infection, you must urgently consult a specialist who will prescribe the necessary treatment.

Secondary synovitis of the knee

This type of synovitis is observed in people with diagnoses of arthritis, arthrosis, osteoarthritis. With these diseases, a particular load falls on the joint, which leads to its deformation and the accumulation of effusion.

A feature of secondary synovitis of the knee joint is its repeatability. Knee deformation, pulling pain, difficulty in moving and swelling - all symptoms occur and disappear within 3-7 days. Then all the signs of the disease disappear, and return again after 2-3 months.

How to treat rheumatoid and psoriatic synovitis

This synovitis develops against the background of rheumatoid arthritis. Therefore, in order to eliminate its symptoms, it is necessary to treat the underlying disease. Therapy should be carried out comprehensively and include the following elements:

  1. Chondroprotective agents - used to preserve the tissues of the knee joint. An effective and inexpensive drug in this group is chondroitin.
  2. Anti-inflammatory treatment - if there is a good effect of NSAIDs, you can limit yourself to the regular use of these drugs, in combination with omeprazole. If ineffective, the doctor prescribes hormones (prednisone, hydrocortisone, and so on), calculating the dose individually.
  3. Reducing the load on the affected joint - also reduces pain. Unloading of the knee joint can be done by recommending the patient to use a cane when walking.
  4. Physiotherapy - analgesic procedures aimed at the affected area. Allowed the use of any methodology: UHF therapy, photo and magnetotherapy, galvanization.

The treatment should be performed by a rheumatologist. It is not recommended to independently treat this form of synovitis.

The specifics of treatment of knee synovitis in children

Treatment of knee synovitis in children is carried out using the same principles as in adults.There are some nuances that need to be taken into account. Firstly, you can not let the disease go into a chronic condition. The longer the inflammation of the synovial membrane lasts, the higher the chance of irreversible consequences. Secondly, you need to correctly diagnose the disease. Synovitis in childhood is extremely rare. It is necessary to find the reason for such a deviation and get rid of it. For children, the dosage of all medicines should be reduced. In childhood, it is advisable to avoid the use of hormones.

Prognosis for recovery

The prognosis depends on the individual characteristics of the person and the time when he asked for help. If prolonged swelling of the knee and pain is detected, you should immediately contact a general practitioner or orthopedist. Proper diagnosis will determine the disease and choose the right treatment regimen. Acute aseptic synovitis is almost always immediately eliminated with the help of medications, after which usually no consequences remain from the pathology. Infectious disease requires a more serious approach. To eliminate chronic damage, you will need to use a whole range of actions. In the absence of results in treatment, you need to go to extreme measures and carry out the operation.

Do not delay with a visit to a doctor. Infectious synovitis can lead to general sepsis and death.

Therapy for villous-nodular synovitis

This form of synovitis is inherently a benign tumor. The most effective treatment option will be the removal of education. For this, arthroscopic operations are currently underway:

  • make two small incisions of 1-2 cm,
  • they remove the tumor,
  • after the procedure, the incisions are sutured,
  • inject tools into the joint. One of them is a camera with a flashlight, and the second is an electric knife or tweezers.

Complications after such manipulations are very rare. They do not require long hospitalization - on average, a patient stays in a hospital for 4-7 days.

Therapy of non-infectious synovitis (with osteoarthrosis)

Synovitis that occurs against the background of osteoarthritis requires a special approach to treatment. NSAIDs are used as the main therapy. However, this is not enough. To prevent the re-development of synovitis, it is necessary to improve the blood supply to the joint. The easiest way to do this is with physiotherapy, which can be started from the first day of the illness.


In the case of ineffective drug treatment, arthroscopy is done to obtain more complete information about the pathology - a surgical procedure with minimal intervention in the body. Using an arthroscope, the doctor clarifies the condition of the tissues of the articular bag and clarifies the diagnosis (excluding or confirming other diseases: gouty arthritis, deforming arthrosis and others). If necessary, a biopsy of the altered tissue of the synovial membrane is performed.

Arthroscopy can also be used to treat synovitis: after treatment with medications of the joint cavity from the inside, edema decreases, and then the use of conventional medications is possible.

Chronic synovitis of the knee joint with frequent relapses and lasting symptoms, as well as pronounced changes in the synovial membrane (with tumor-like growths) are indications for a synovectomy (complete or partial removal of altered tissue). In the postoperative period, antibiotics and analgesics are prescribed, physiotherapy (from the first day). Joint immobility is provided for a week, but walking is allowed from the second day after surgery.

After arthroscopy, joint surgery or conservative treatment, a set of exercises is recommended to restore limb function as soon as possible (start classes at the time indicated by the doctor):

  1. Lie on your back, after which produce incomplete flexion and extension of the knee (10 times).
  2. In the prone position, squeeze under the knee any flat object up to 10 cm thick. (10 times).
  3. In any position, strain the muscles of the thigh and lower leg (5-6 times).
  4. Lie on your back, slowly raise your straight leg 40 cm from the floor and lower it (10 times).
  5. Lie on your side, opposite the side of the affected leg, and then take the affected leg up (5 times).
  6. Sit on a chair and slightly raise a sore leg with a tied 1 kg load (5 times) above the floor surface.
  7. Standing on the affected leg, sit down and rotate with the second leg (1 minute).

After stabilization, it is recommended to take walks up to 500-600 m. Several times a week at a slow speed, as well as exercise on a stationary bike.

Complications and prognosis

The prognosis is serious with purulent and secondary septic synovitis. Complications can be purulent panarthritis, phlegmon with lesions of cartilage and bones. In the case of reactive synovitis, the prognosis is favorable.

Synovitis of the knee joint, the symptoms and treatment of which we examined, is a relatively common disease. Often it is a secondary process, a complication of arthritis. Therefore, any pain, discomfort during movement or swelling should be controlled.

If within a few days the symptoms do not go away - you need to see a doctor.


When prescribing pharmacological preparations, symptoms are taken into account, and treatment is drawn up to alleviate the patient's condition:

  1. Nonsteroidal anti-inflammatory drugsas an analgesic and anti-inflammatory agent - Indomethacin, Diclofenac,
  2. antibiotics for synovitis of the knee joint to destroy the pathogen - Erythromycin, Ampicillin,
  3. diuretic drugs with severe swelling - Furosemide, Diuver,
  4. in the absence of an analgesic effect from NSAIDsglucocorticosteroids are prescribed - Dexamethasone, Prednisone,
  5. chondroprotectorsto stop reactions that destroy the joint - Don, Structum.


When there is an acute period of synovitis of the knee joint, rehabilitation treatment is carried out, which according to reviews contributes to a speedy recovery.

With synovitis, the following methods are effective:

  • Magnetotherapy
  • electrophoresis
  • UHF
  • laser therapy
  • ultrasound exposure.

Each of the methods is carried out in courses, during which there is an improvement in blood microcirculation, tissue nutrition, as well as the regeneration of damaged areas.

Orthopedic mode

In the early days of the onset of the disease, it is recommended to observe bed rest, how to treat is determined according to the symptoms, and treatment is carried out by limiting the load on the diseased joint. If necessary, independent movement on a sore joint put on an orthosis of rigid fixation. The knee pad holds the joint securely and relieves during movement. If a person is lying, he does not need a knee brace.

In addition to the orthopedic product, crutches or walkers are used to move. The synovitis of the knee should not be exerted during the treatment period, with rash physical activity, the therapeutic actions performed can be reduced to zero, which is confirmed by the reviews.


Inflammatory pathology is a multifactorial condition that develops for a variety of reasons. In most cases, synovitis of the knee joint responds well to treatment, and has a favorable prognosis of complete recovery, as evidenced by numerous reviews. Therefore, when the first symptoms appear, it is advisable to immediately consult a doctor in order to achieve recovery in the shortest possible time.

Post-traumatic synovitis of the knee

As the name implies, this is a form of synovitis resulting from joint injury.Shock, bruise, fall - the most common picture of the occurrence of post-traumatic synovitis. This also includes meniscus damage, tears and sprains, dislocations, fractures.

For post-traumatic synovitis, pronounced signs of joint disease are characteristic. There is swelling, acute pain and fever. The contours of the knee are smoothed, movements cause sharp pain.

Particular attention in the treatment should be given to restoring the integrity of joint damage. Post-traumatic synovitis can also occur due to chronic injuries. In this case, it proceeds as a moderate synovitis.


More common in children 1.5-15 years old. It is characterized by rapid development of symptoms, passes within two weeks. If the disease is not started to be treated on time, the child will be limp. Likely reasons:

  • bacterial diseases of the respiratory tract and oral cavity (tonsillitis, pharyngitis),
  • with joint injury,
  • with prolonged walking.

Possible consequences and complications

Complications develop mainly with purulent synovitis. Complications include:

  • Periarthritis and phlegmon - purulent impregnation of the tissues surrounding the joint (muscles, tendons, subcutaneous tissue and skin).
  • Purulent arthritis occurs if pus begins to melt the outer shell of the joint capsule.
  • Panarthritis - bones, cartilage, and ligaments of the joint are involved in the purulent process.

The consequences of synovitis are the development of a chronic relapsing process, which leads to a disruption in the normal functioning of the joint (contracture develops). They can develop even with the timely provision of competent medical care.

Diagnostic Methods

Synovitis of the knee joint - a diagnosis that is not made only on the basis of anamnesis, complaints and results of examination of the joint, but requires instrumental confirmation. This is because many of the symptoms (pain and impaired movement), as well as objective data (swelling of the joint, redness and swelling of the skin above it) are nonspecific, that is, they can appear in various diseases. Therefore, in the diagnosis, the doctor focuses on the data of some instrumental diagnostic methods.

This study is very informative in detecting effusion in the joint cavity. So, if the amount of exudate exceeds 1 ml, it will already be visible. Also, with this diagnosis, a thickening of the joint capsule is visualized.

This type of diagnosis is widely used to visualize intraarticular structures. It is according to his data that the diagnosis “Sinovit” is made. In the case of the development of this disease, there is a change in the signal intensity in the joint cavity due to the accumulation of exudate: it is hyperintensive in the T2VI mode, reduced by T1VI. In MRI with contrast, the signal from the inflamed synovial membrane is amplified, its growths are visible, which hang in the lumen of the inversion of the joint capsule.

How to treat synovitis of the knee joint?

Treatment of this disease should begin on time and continue for a sufficient amount of time, which is determined not only by the absence of pain and a decrease in the circumference of the joint, but also by other clinical signs that the doctor determines during the examination.

In the treatment of synovitis, the following groups of drugs are used:

  • Nonsteroidal anti-inflammatory drugs
  • Proteolytic enzyme inhibitors
  • Corticosteroids
  • Microcirculation regulators
  • Antibiotics


Exercise therapy for synovitis should be very gentle so that movements do not create increased pressure in the diseased joint, which will further increase tissue ischemia. You need to carry out exercises lying on your back, starting from 5 minutes a day - from the seventh day of illness:

  • At the beginning, you simply lift the straightened leg 15 cm from the floor, holding it in this position for several minutes.
  • Bend and unbend the foot very carefully from the exact same starting position.
  • Raise-lower the straight leg with low intensity, starting from 5 times, bringing the number of max to 15 to 10 occupation.

You can not squat, unbend and bend the leg in the knee, wave it very actively, and also perform such movements that will cause pain in the joint.


Depends on the severity of the process. So, moderate or minimal synovitis is treated with:

  • electromagnetic therapy
  • ultrasound with anti-inflammatory drugs,
  • microwave therapy
  • electrophoresis with hydrocortisone, dimexide, diclofenac.

After the inflammation subsides, heat therapy is used (applications of paraffin, mud, ozokerite), balneotherapy (various therapeutic baths).

Exercise therapy for synovitis of the knee joint

Exercise therapy in the treatment of synovitis of the knee joint plays an important role. Gymnastics is aimed at restoring blood circulation and strengthening the musculo-ligamentous apparatus.

Exercises should be performed daily, but they should be gentle, not lead to acute pain. Initially, the lesson lasts 10-15 minutes., As you recover, its duration is increased to 30-40 minutes.

Approximate complex:

  • lying on your back, bend your knees, holding them for up to 5 seconds, then straighten,
  • lie on your stomach, rest against the wall with your feet, try to strain and straighten the limb as much as possible,
  • standing, holding on to a support, take your foot to the side, and then back and forth at an angle of no more than 45˚, linger for 5 seconds.,
  • lying on your back, raise your sore leg up, trying not to bend at the knee.

Villonodular synovitis of the knee

This type of disease is currently studied poorly enough. It was determined that the characteristic symptoms for villonodular synovitis are severe pain, difficulty in moving, arthritis and arthrosis of the knee joint.

Villonodular synovitis is classified as an autoimmune disease, due to which free cavities form in the knee joint. Neoplasms are detected in the cavity, and synovitis itself is characterized as a benign tumor disease.

Treatment methods

There are several ways to treat synovitis. In most cases, a complex of puncture and further medication is necessary. If medications do not give sufficient effect, specialists can resort to surgical intervention.

It must be remembered that when the first signs of synovitis occur, the knee must be fixed with a tight bandage in a straightened form and consult a specialist as soon as possible to prescribe treatment.

Terms of treatment

The period of joint immobilization lasts about 7 days, which is determined by the causes and severity of the process. Further treatment, in which there is a gradual rejection of medical methods in favor of physiotherapy, exercise therapy and additional methods, lasts an average of about 3 months.

Prevention is to avoid joint damage. If gonarthrosis of the knee joint or arthritis occurs, synovitis can be avoided by timely and correct execution of the prescribed therapy. With synovitis that has arisen once, in the future, it is necessary to strictly monitor in order to give minimal chances of relapse. To do this, you must:

  • exercise regularly, but watch for proper knee flexion,
  • Avoid increased physical activity
  • do not overeat,
  • monitor the maintenance of body weight within the limits of individually acceptable values,
  • If you feel pain, crunching, or impaired knee mobility, consult your doctor. published by

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Alternative treatment of synovitis of the knee

Treatment of synovitis of the knee joint with folk remedies should be carried out only with the approval of a doctor.

Traditional medicine does not replace the main treatment, but only are auxiliary.

You can make lotions and compresses of decoctions of medicinal herbs:

  • comfrey
  • mistletoe
  • tansy,
  • echinacea
  • thyme
  • yarrow
  • birch leaves.

For the preparation of broths you need 1 tbsp. l raw materials brewed in 200 ml of boiling water. Lotions are made 2-3 times a day for 20-30 minutes.

Forecast and possible complications

The prognosis depends on what caused the exudative synovitis and how quickly treatment was started. If it is unexpressed, then the therapy is short, it is possible in a short time to restore the mobility of the knee joint and return to the usual way of life.

Upon transition to the chronic stage, it is quite difficult to get rid of the disease. The likelihood of complications and surgical intervention is high.

Treatment of synovitis of the knee should be timely, since it significantly complicates the course of the underlying disease, and, accordingly, the quality of life of the patient.

The greatest likelihood of complications with an infectious and often recurring non-infectious form. The following consequences may occur:

  • scarring, thickening, sclerotherapy,
  • dislocations, subluxations,
  • soft tissue phlegmon,
  • the formation of hypertrophic areas,
  • purulent arthritis,
  • periarthritis
  • hydrarthrosis (dropsy of the joint),
  • arthritis (acute purulent inflammation),
  • sepsis.

All intraarticular changes lead to dysfunction of the joint, are resolved by surgery.


Secondary synovitis can be prevented if all predisposing factors are excluded. It is important to maintain healthy knee joints.

Recommendations for the prevention of synovitis of the knee joint:

  • maintain physical activity, moderate knees (cycling, hiking, swimming),
  • when doing sports, be sure to do a warm-up,
  • do not lift weights
  • avoid injuries
  • treat inflammatory and other joint diseases on time,
  • eat right, vitamins A, C, E must be present in the diet, gelatin, meat and bone broths are useful.

A healthy diet and rational exercise will help prevent the onset of a serious illness.

Do not delay with a visit to a doctor with synovitis, since the condition of the knee joint depends on the timeliness of therapy.

Arthroscopy Recovery

For the speedy return of joint mobility and comfort of movement, a set of exercises is recommended. Dates for different types of classes are set by the attending physician. It must be understood that competent rehabilitation prevents the recurrence of the disease and the development of complications.

Acceleration of the recovery procedure without the consent of the attending physician can be fatal and lead to new fluid formation, infection, hemarthrosis.

Often, to enhance the effect, the patient is prescribed a course of physiotherapy. However, with synovitis, physiotherapy is more of an additional method and does not replace physiotherapy exercises. Here are some examples of exercises:

  • Incomplete flexion and extension of the knee while lying on your back,
  • Slowly raising and lowering the straight leg while lying on your back,
  • Tension of the muscles of the thigh and lower leg (in any position),
  • Compression of a flat object under the knee while lying on your back.

Synovitis of the knee joint is one of the most common leg diseases. Regardless of the type and form of the course of the disease, it is necessary to immediately contact a specialist and prescribe treatment.

Synovitis can turn into a chronic form, the treatment of which may require surgical intervention, which will entail a long recovery period.

Synovitis of the knee joint - symptoms and treatment

Synovitis of the knee joint is a pathological condition caused by a number of predisposing factors or causes, accompanied by accumulation of fluid in the synovial membrane. Depending on the nature of the occurrence and course of the disease, this disease is divided into various types and severities.

Medical portals and magazines, as well as Wikipedia about synovitis of the knee joint, contain a lot of useful information, among which it is possible to find the symptoms and causes of the disease, as well as ways to treat this disease.

Almost all information sources contain a description of the disease in a language that is scientific and incomprehensible to a simple person, which is hard to perceive and does not provide the opportunity to obtain the necessary information.

That is why I would like to provide a description and methods of treating this disease is available for ordinary people.


  1. Synovitis of the knee joint can occur in acute and chronic form. Often an untreated illness can occur throughout life.
  2. Diagnosis plays a crucial role in the treatment of the disease. For this purpose, hardware and laboratory methods are used.
  3. The treatment regimen is selected individually, but part of the medication is used for any type of synovitis.
  4. Rehabilitation should take place under the supervision of an orthopedist. It includes not only therapeutic procedures, but also the wearing of special constructions.
  5. If you start knee synovitis, there is a risk of complications. The most dangerous are sepsis and the development of phlegmon.

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Etiology of the disease

Given the etiology, specialists distinguish the following groups of the disease in question:

  • Infectious synovitis occurs when microorganisms enter the synovial membrane. The microorganism is penetrated by this area from the environment, with the flow of blood or lymph,
  • nonspecific synovitis develops against the background of pathogenic microbes that cause a nonspecific inflammatory process in the synovial membrane. These microbes include streptococci, staphylococci,
  • specific - provoked by pathogenic microbes, including tubercle bacillus and pale treponema. Such microbes provoke specific inflammation in this membrane.

A separate group includes aseptic synovitis that occurs under the following conditions:

  • repeated mechanical joint injuries - reactive synovitis,
  • hemophilia,
  • disturbed metabolic process,
  • problems in the endocrine system.

Allergic forms of pathology develop against the background of exposure to the tissue of the membrane of allergens of an infectious and non-infectious nature. For the development of synovitis, there must be a condition for increased sensitivity of the membrane to the above allergens.

Synovitis is infectious and aseptic, the first type of disease can be attributed to an ailment that occurs when pathological microorganisms affecting the knee joint penetrate it. Aseptic synovitis of the knee joint, depending on the severity and the factors that influenced its occurrence, can be of several types:

  • Reactive - an allergic type of disease caused by toxic or mechanical effects on the area of ​​the knee joint. It may appear due to the presence in the body of any kind of allergic reaction. Reactive synovitis of the knee joint treatment, which is aimed at eliminating the allergic factor, occurs with general intoxication of a non-infectious or infectious nature, as well as under the influence of mechanical irritation in the synovial membrane.This type of disease can occur with arthritis, arthrosis and other pathologies localized in the knee joint, exerting constant pressure on the cavity of the synovial bag,
  • Exudative - is formed during mechanical injury of the knee and is accompanied by the development of a large amount of exudate with the synovial membrane. The produced fluid is rich in various cells and proteins, and is accompanied by the presence of an inflammatory nature,
  • Post-traumatic - treatment, which is based on the elimination of the inflammatory process in the joint area caused by mechanical stress. Irritation of the joint by fragments of cartilage or bone, as well as damage to the meniscus can affect the appearance of this type of disease,
  • Chronic - the symptoms of which are impaired blood circulation in the articular region, as well as a change in its functioning, arises from an untreated acute synovitis in the presence of a traumatic factor of its occurrence. This form of the disease is rarely diagnosed, as it develops only with prolonged absence of treatment.

The disease can occur with impaired endocrine or neurogenic functions, which is fraught with the combination of types of synovitis and the difficulty in carrying out diagnostic measures.

Synovitis of the right knee joint, with the advanced stage of the disease, spreads to the joint of the left leg, which provokes the allergic (autoimmune) cellular antibodies present in the body.

Characteristic common symptoms

Signs of synovitis of the knee joint differ depending on the degree and type of the disease, but, despite this, are general in nature and are expressed by the following symptoms:

  • Aching pain that occurs periodically or is constantly present in the affected joint,
  • A significant increase in the size of the joint caused by swelling caused by the formation of an inflammatory process,
  • Violation of the functioning of the knee joints, making it difficult to complete motor activity or completely blocking it.

With this disease, a microscopically serous inflammation of the synovial membrane occurs, characterized by a pronounced vascular reaction. In the photo of synovitis of the knee joint obtained by X-ray or ultrasound examination, it is possible to determine the thickening of the synovial membrane or fibrous capsule of the joint.

Disease complications

Acute and chronic aseptic synovitis can lead to infection of effusions, followed by the development of severe infectious synovitis. If the infection spreads to neighboring tissues, affecting the fibrous membrane, purulent arthritis develops.

Subsequent spread of the process contributes to the occurrence of soft tissue phlegmon or periarthritis. The severe course of infectious synovitis provokes panarthritis. In this case, the purulent process spreads to the bones, ligaments and cartilage. Under the influence of additional factors, sepsis develops.

A prolonged chronic aseptic form of the disease provokes the following complications:

  • gradual joint enlargement in volume, since excess water is not absorbed into the shell,
  • development of dropsy of the joint, if there is no therapy,
  • a long course of the above clinic provokes looseness of the joint. In this case, the ligaments weaken, a dislocation occurs.

Effective treatment

For an accurate diagnosis of knee synovitis, a puncture should be performed from the affected joint, and only after the results of the study have been obtained, treatment should begin, which will allow an effective course of physical and medical therapy to be completed.

This procedure is performed without anesthesia, as it is not accompanied by pain. For its implementation, a joint is punctured to suck the synovial fluid from its cavity.

After removal, the exudate is subjected to laboratory research, which allows you to determine the cause of the formation of pathology and prescribe the necessary treatment.


  • First of all, a tight bandage or knee cut is applied to the affected joint, fixing it and reducing mobility. During this period, physical activity is prohibited, but it is still necessary to develop a joint. To do this, you can use specially designed light gymnastic exercises or undergo a course of manual therapy,
  • With any form of synovitis, non-steroidal drugs are prescribed that reduce pain symptoms. With infectious forms of the disease, it becomes necessary to use antibiotics that suppress infections. The treatment of the chronic form of the disease is carried out with the help of corticosteroid medications,
  • If drug treatment does not lead to the desired result, then there is a need for surgical intervention.

Medication helps to cope with pain and reduce the inflammatory process in the joint. To do this, you can use various dosage forms recommended by your doctor, taking them inside, applying to the skin or injecting them into the affected area.

There is also the possibility of administering drugs in the form of rectal suppositories, which reduces the load on the stomach and intestines and increases the effectiveness of the components included in the preparation.

To effectively eliminate the disease, one should fight not only with its symptoms, but also with the causes of the appearance, which can be determined by a qualified rheumatologist or orthopedist. Self-medication with this disease can cause undesirable consequences, therefore it is not recommended to carry it out under any form of the disease.

Disease prognosis

For acute aseptic and allergic synovitis, the prognosis is positive. After adequate treatment, the inflammation is completely eliminated, the effusion disappears, and the movement persists. With a purulent course of the disease, contractures can sometimes appear.

In severe cases, the development of complications that are dangerous to the patient's life is not excluded. With this diagnosis, the prognosis is negative. Chronic aseptic synovitis can lead to stiffness. After surgery, relapse may occur. Sometimes contracture develops.

Useful video about synovitis

List of sources:

  • Traumatology and orthopedics / ed. Kornilova N.V. - 2011.
  • Traumatology and orthopedics / Kotelnikov G.P., Mironov S.P., Miroshnichenko V.F. - 2008.
  • Gerasimenko, M.A. Diagnosis and treatment of injuries and orthopedic diseases of the knee joint / M. A. Gerasimenko, A. V. Beletsky. - Minsk: Tekhnalogіya, 2010 .-- 167 p.

Watch the video: Joint effusions (April 2020).