| ICD-9-CM: |
| 727 - | Other Disorders of Synovium, Tendon, and Bursa |
| 727.0 - | Synovitis and Tenosynovitis |
| 727.00 - | Synovitis and Tenosynovitis, Unspecified; Synovitis NOS; Tenosynovitis NOS |
| 727.01 - | Synovitis and Tenosynovitis in Diseases Classified Elsewhere |
| 727.09 - | Other Synovitis and Tenosynovitis |
| 727.2 - | Specific Bursitides Often of Occupational Origin; Beat: Elbow, Hand, Knee; Chronic Crepitant Synovitis of Wrist; Miners Elbow, Knee |
| 727.8 - | Other Disorders of Synovium, Tendon, and Bursa |
| 727.9 - | Unspecified Disorder of Synovium, Tendon, and Bursa |
| | | |  | | © Reed Group | | |
Each joint is enclosed in a capsule lined with membrane tissue known as synovium, also referred to as synovial membrane. When viewed under the microscope, the synovium reveals folds that are filled with nerves, blood and lymph vessels. The synovium secretes a lubricating fluid called synovial fluid and is able to adapt to different motions of a joint by expanding and contracting. Synovitis is a condition which develops when the joint lining (synovial lining) becomes irritated and inflamed. The result is warmth, tenderness and swelling in and around the joint, which is caused by increased fluid production and swelling of the lining.
Synovitis has many causes, including infection, direct joint trauma, allergic reaction, gout, overuse syndromes, and inflammatory diseases such as rheumatoid arthritis. Synovitis can be an acute episode, limited to one joint, or it can be a chronic symptom of a general disease process such as rheumatoid arthritis. Synovitis is a common finding on arthroscopic exam of the temporomandibular (TM) joints, which are found where the lower jaw joins the skull. TM disorders commonly have a finding of synovitis.
Uric acid overproduction, as seen in gout, places individuals at an increased risk for synovitis. People at risk of uric acid overproduction include those with a history of leukemia, lymphoma, psoriasis, and those receiving chemotherapy for cancer. Alcohol consumption, chronic renal failure, and hypertension can lead to a decreased excretion of uric acid which, in turn, can lead to an increased risk of gout and associated synovitis.
Risk: Individuals exposed to prolonged, repetitive motions of the hand, wrist, elbow, and shoulder, such as those who perform assembly line or keyboarding work, are at risk for synovitis. This condition can also affect any joints of the lower extremities, placing at risk individuals performing repetitive movements of the hip, knee, foot, and ankle (during activities such as running, climbing, and jumping).
Synovitis is not sex-specific. Incidence and Prevalence: Synovitis causing joint stiffness is found in 98% of individuals with rheumatoid arthritis (Goodman). |
Source: Medical Disability Advisor
| History: Symptoms of synovitis are often activity-related, with the individual describing extended periods of repetitive movements or a history of physical forces sufficient to strain the involved joint(s). If the symptoms are not activity-related, individuals must be questioned about known underlying conditions as there is often a medical history of infection, allergic reaction, or inflammatory disease. One joint or several may be involved. Individuals will complain of joint pain, swelling, warmth, and stiffness and may experience relief of symptoms with the use of heat or cold therapy. Physical exam: Passive and active range of motion is observed for indications of pain, stiffness and/or crepitus. Muscles surrounding the joint are tested for weakness and pain to resistance. Joint-play movements are evaluated for mobility and irritability, are typically limited and painful. However, if the synovitis is the result of a more traumatic joint injury, joint-play may be excessive. Joints will appear swollen, red, and warm to touch, and have a "boggy" feel to palpation. Tests: Laboratory tests include rheumatoid panel, complete blood count (CBC), urinalysis, joint fluid analysis (following joint aspiration) with Gram stain, ESR. Routine x-rays may be indicated to evaluate the joint surface looking for erosion of the articular surface. Nuclear medicine scans may also be valuable. |
Source: Medical Disability Advisor
| Synovitis is most often treated with anti-inflammatory medications, cold or heat therapy, corticosteroid injections, and rest from aggravating activity. Medication for pain control may be needed as well as splinting for part of the day or night to immobilize and support the joint over a period of time. Once symptoms are stabilized, general exercises of the joint are initiated to restore strength to surrounding muscles, helping to decrease degenerative processes of the joint.
In destructive synovitis, as found in conditions such as rheumatoid arthritis, surgical removal of the synovium may be required (synovectomy). Destruction of the synovium can also be accomplished with laser therapy/surgery and injections of selectively destructive chemicals (ablation). |
Source: Medical Disability Advisor
| Acute, isolated episodes usually respond well to conservative treatment. In chronic states, the course of the underlying disease will predict the outcome. Synovitis can recur if the synovium regrows after surgical removal of the inflamed synovium (synovectomy) or chemical or laser destruction (ablation). The underlying disease process may start the inflammatory process and swelling of the synovium all over again. |
Source: Medical Disability Advisor
| The goal of rehabilitation for synovitis is to decrease the inflammation and pain to the inflamed synovial membrane and fluid (synovium) of the affected joint. This allows the physical therapist to focus the rehabilitation on restoring motion and strength to the involved joint(s). Early in the course of synovitis, the physical therapist instructs the individual to elevate the affected joint to help reduce swelling. The therapist also educates the individual on how to avoid pressure from the inflamed bursa by applying an elastic bandage, sling, or soft foam pad to protect the involved area until the swelling decreases.
Rehabilitation offers several possible treatments to control the inflammation resulting from synovitis. At the initial flare-up of synovitis, the physical therapist uses cold treatments to control swelling and pain. This is often in the form of ice packs for 20 minutes several times a day during the first 2 days or for as long as the joint area is warm to the touch. Electrostimulation combined with a cold treatment is another technique used in physical therapy to relax muscles around the inflamed joint and help to decrease pain and inflammation.
Once the initial pain and inflammation of the acute stage of synovitis have lessened, heat is applied during the rehabilitation process. Heat treatments are used to help relieve muscle and joint pain and stiffness along with increasing blood flow to help reduce inflammation of the synovial membrane. Moist heat packs are one form of heat the physical therapist utilizes. The pack is used over multiple layers of toweling to achieve a comfortable warming effect for 20 minutes. Another form of heat treatment used in physical therapy includes ultrasound that uses high frequency sound waves producing heat that penetrates deep into the involved synovial membrane and surrounding joint and muscles. Iontophoresis is another popular treatment used in the rehabilitation of synovitis. This technique uses a small electric current to drive anti-inflammatory medication of the same electrical charge into the inflamed tissues. Depending upon the medication used in this method, iontophoresis is often performed for 15 to 20 minutes each session on an every-other-day basis for 1 to 2 weeks.
Once pain and swelling have been greatly reduced, the physical therapist will perform stretching exercises to help restore full motion to an affected joint and/or limb. Stretching exercises consist of the therapist moving the affected limb with no effort initiated by the individual. The muscles are placed upon a mild stretch and held for at least 20 seconds. The physical therapist instructs this to be repeated 5 to 10 times and performed twice daily. Modifications may need to be made by the physical therapist depending on the location of the affected joint, the stage of the inflammation (i.e., recent flare-up or ongoing pain) and whether surgery was required. However, this condition rarely requires surgical intervention. |
Source: Medical Disability Advisor
| Any chronic inflammatory disease, such as allergies, diabetes, infection, over-use syndromes and tendinitis or bursitis, may complicate synovitis. When the synovitis is chronic, the lining can grow over the articular surface of a joint (pannus) and become destructive to the cartilage. |
Source: Medical Disability Advisor
| Limited work (loading) of an affected joint would be an appropriate restriction. Periods of rest and time for rehabilitation would be necessary. Use of prescribed medication for control of pain and inflammation will require review of drug policies. Altering job requirements to reduce repetitive activities is helpful. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did the individual present with pain, swelling, and redness of one or more joints?
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Were diagnostic x-rays and blood tests done to confirm the diagnosis?
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Has cause of synovitis been identified?
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Is more than one joint involved?
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Would individual benefit from evaluation by a specialist (rheumatologist, sports medicine specialist)?
Regarding treatment:
- Was the underlying cause addressed?
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Has enough time passed to allow for conservative measures to resolve symptoms?
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If symptoms persist despite conservative therapy, is more aggressive intervention with laser or surgical treatment now warranted?
Regarding prognosis:
- Has the underlying condition been identified? Is it responding well to treatment?
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Has individual participated in a comprehensive rehabilitation program?
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Does the individual have any existing conditions (chronic inflammatory disease, allergies, diabetes, infection, over-use syndromes and tendinitis or bursitis) that could impact recovery and prognosis?
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Would accommodations allow individual to return to present duties?
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Would individual benefit from temporary transfer to a different position?
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Source: Medical Disability Advisor
| Goodman, Catherine C., and William G. Boissonnault, eds. Pathology: Implications for the Physical Therapist. Philadelphia: W.B. Saunders, 1998. |
Source: Medical Disability Advisor
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