Synovitis of the wrist

definition

Synovitis (also called synovitis) is an inflammation in the joint. In particular, it is an inflammation of the joint capsule, i.e. the connective tissue that surrounds the joint. The innermost layer of the joint capsule is affected by the inflammation. In the hand, the wrist is usually affected. However, it can also cause problems in the small joints (metacarpal, finger joints). A distinction is also made between acute and chronic synovitis of the hand.

causes

When it comes to the causes of synovitis of the hand or wrist, a distinction must be made between acute and chronic causes.
Acute synovitis can be caused by trauma or accident. Bacterial inflammation is also possible. The bacteria can get into the wrist, for example through an injection. In addition, febrile infections caused by viruses or bacteria can attack the wrists and lead to acute inflammatory reactions in the joint capsules.
In chronic synovitis, excessive stress is often the cause of the disease. Especially people who work a lot with their hands (craftsmen, competitive athletes, office workers who work a lot on the computer) are affected by these symptoms of overload. Systemic inflammatory diseases such as rheumatism can also trigger synovitis in the hand or wrist.

rheumatism

Rheumatism is a disease that can manifest itself in many different symptoms. The mechanism of the disease is that the immune system attacks the body's own cells and thus triggers chronic inflammatory processes. The fingers and wrists are often affected by rheumatic complaints.
The result is what is known as rheumatoid arthritis, in which the joints are swollen, overheated and reddened. There may also be severe pain in the joints. These inflammatory processes, which are fueled by the body again and again, can cause chronic inflammation of the synovia and thus synovitis in the wrist.

Concomitant symptoms

With acute synovitis in the hand or wrist, there are usually other inflammatory symptoms in addition. These include the five classic signs of inflammation: redness, pain, overheating, swelling and restricted functionality.

Acute synovitis is usually triggered by acute overuse of the hand or by trauma, so often only one side is affected by the disease.
Chronic synovitis, on the other hand, is often an expression of permanent or repeated overloading of the hand. Therefore, it occurs relatively often on both sides at about the same time (unless someone has long-term, very one-sided strain on one hand). In addition, it is very persistent and makes itself felt again even after repeated therapeutic attempts. If chronic synovitis is caused by systemic diseases such as rheumatism, the inflammatory processes usually do not only occur in the hands. Other joints such as the knee, hip, and finger joints can also be affected. This also causes pain, swelling and reddening of the joints. In later stages, destruction of the joints is not uncommon, leading to misalignments and severe restrictions on movement. Chronic synovitis becomes noticeable in the late stages in many fine motor movements in everyday life, especially in the hand.

diagnosis

The diagnosis of synovitis is first made on the basis of the anamnesis, i.e. the questioning of the person concerned by the doctor. In particular, the chronic causes of the synovitis should be asked in detail. Restrictions of movement and pain points can be recorded in the physical examination. This is usually followed by an ultrasound examination of the wrist. In particular, an inflammatory thickening of the synovia can be assessed. Chronic damage to ligaments, tendons, cartilage and bones can also be revealed in the ultrasound. In order to differentiate synovitis from the symptoms caused by rheumatism, a blood sample with determination of the blood values ​​in the laboratory is often useful.

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therapy

The acute treatment of synovitis is initially only symptom-related. The affected wrist should be relieved. Regular cooling of the wrist and raising the arm can also improve the symptoms. In addition, anti-inflammatory agents can be taken, they also have an analgesic effect. However, taking the medication should be discussed with the attending physician.

In acute synovitis, the disease can often be treated with these conservative measures. But especially with chronic synovitis on the wrist, surgery is usually the only way to completely cure the disease.
This does not apply to people who suffer from synovitis due to other diseases. The most classic example of this is rheumatoid arthritis. Therapy for the underlying disease consists of a mixture of different components: drug therapy elements are painkillers, anti-inflammatory drugs and cortisone preparations. Synovitis caused by rheumatism can also be operated on.An alternative therapy is radiation treatment of the wrists.

When is an operation necessary?

An operation is especially necessary if the synovitis of the hand or wrist is chronic and can no longer be treated satisfactorily with conservative treatment methods. Synovitis caused by an underlying disease can also require surgery. First of all, one tries to alleviate the discomfort on the wrist by treating the underlying disease. If this is not successful or if the symptoms are severely limiting, an operation on the affected hand or wrist is recommended.

Course of the operation

The operation for synovitis on the wrist can usually be carried out using a minimally invasive technique (keyhole technique). To do this, several very small incisions are made on the wrist, which provide various instruments with access to the inside of the wrist capsule. A camera and instruments are inserted through these cuts. The operation can be performed under local or general anesthesia. As a rule, the entire synovium is removed after the joint capsule has been opened. In order to minimize bleeding and the influence of wound secretions, a drainage system is often inserted through which the fluids can drain. The small incisions are then sewn and the wrist bandaged.

Irradiation

Radiation is a good alternative to hand surgery for wrist synovitis. In the so-called radiosynoviorthesis, the wrists are irradiated. This is to stop the inflammatory process at the synovia. So far, radiation has been shown to be a good therapeutic option, especially for rheumatoid arthritis. However, radiation therapy should be avoided if possible in pregnant and breastfeeding mothers as well as children and adolescents.

Duration

Synovitis of the hand or wrist can last very differently.
The acute synovitis has often completely subsided after a few weeks.
Chronic synovitis can last for several months to years. Often the only chance of recovery is surgery. But even this does not necessarily prevent the symptoms from occurring again. The clinical picture can make itself felt again and again over several years.