Synovitis was in the news recently – though you could be forgiven for missing it. (Unless you happen to be a Chelsea fan.)
“Enzo Fernandez withdraws from Argentina squad with synovitis in right knee,” read one article, in The Athletic. The piece went on to explain how the 24–year–old defender had suffered “a swelling of the synovial membrane” and would undergo checks to “determine the severity of the issue.”
Six weeks later, Fernandez was off the treatment table and playing again. But his injury prompts the question – what is synovitis? And what are the treatment options for it? Happily, most synovitis cases are very resolvable (see below). But getting a proper diagnosis and treatment plan is important, because ongoing swelling from synovitis can potentially cause permanent damage to your joint tissue.
With that said, let’s look into the detail…
What is synovitis?
Synovitis is an inflammation that happens to the friction–reducing tissue that protects many of your joints, including your knees. Inflammation or swelling occurs when this tissue, or the synovial fluid inside it, becomes irritated or damaged. Beyond swelling, synovitis can also cause stiffness or trouble with movement. In some cases it can cause the knee to feel warm, hot or tender.
What causes synovitis?
This is the critical question. Synovitis is actually more of a description than a condition. It’s a symptom of something that has happened somewhere inside your knee joint. In Fernandez’s case (we’re speculating here) that was likely trauma – a heavy fall or an impact tackle, for instance. But there are plenty of other potential triggers for synovitis:
- Overuse – such as in running, or through a repetitive stress injury
- Wear and tear – irritation or damage that happens over a longer period of time
- Osteoarthritis (cartilage wear) – studies suggest two-thirds of arthritis patients may experience synovitis at some stage
- Autoimmune disorders (such as rheumatoid arthritis or gout) – when the immune system attacks its own tissues
- Infection – from a virus or bacteria which, though rare, is important to rule out.
Step 1: diagnosis, diagnosis
So the first step in tackling synovitis is to find what triggered it, so we can focus on treating that underlying cause (see Step 3, below). This starts with a physical examination, to check your range of motion and look for the classic signs of an inflamed synovium (swelling, tenderness, warmth, and thickened tissue) and rule out other issues like tendonitis, which is quite similar to synovitis. We would follow this up with some tests, which may include:
Blood tests – to rule out an infection
Scans – an X-ray, MRI or ultrasound, to look at the synovium in more detail, and to see if the problem is deeper inside the joint (for instance, if you have cartilage loss through osteoarthritis).
Step 2: conservative treatment
Whatever the underlying cause, conservative treatment is the first line of defence for synovitis. The goal is to reduce the swelling and give your joint time to heal while you wait for any further treatment. The best way to do that is with rest, to let the tissues recover. It may also be helpful to think about a brace or splint to reduce the stresses on your knee. Applying ice packs is another simple and effective way to reduce swelling. In the short term, you can also think about some simple painkillers. If you’re able to take them, NSAIDs (nonsteroidal anti–inflammatory drugs) like Ibuprofen can help to tackle the pain and inflammation of synovitis. Depending on what’s happening in your knee, we might also recommend some physiotherapy to help you improve the range of movement and build strength in supporting muscles (this reduces the pressure on the inflamed joint).
Step 3: medical options
Many cases respond well to the conservative approach. But if your synovitis is persisting, there are some other things we can do to help you along:
Corticosteroids (such as hydrocortisone) – These are delivered by injection; they target swelling and pain by releasing a steroid slowly into the knee joint to reduce inflammation. The benefits can last for several months
Hyaluronic acid – This is a lubricating chemical, naturally present in our bodies, that we can inject into the knee to compensate for the synovial fluid lost to arthritis. While they don’t work for everyone, the benefits can last for six to 12 months.
Other medicines – If the synovitis is primarily due to an autoimmune problem, we may refer you to a rheumatologist; they can look at your case in detail and if necessary, prescribe medication to manage the underlying condition. These are commonly known as Disease-Modifying Antirheumatic Drugs (DMARDs).
When to intervene with surgery
In rarer cases, the synovitis continues and doesn’t respond to the other options we’ve discussed. When this happens, particularly if your symptoms are severe and persistent, we may consider surgery to address the problem. The type of procedure very much depends on the underlying cause of your synovitis. One option is arthroscopy (keyhole surgery) for loose bodies – this is when tiny fragments of cartilage break away and settle into joint, causing irritation and mechanical issues for your knee. We can use this operation to remove the obstructions and smooth any frayed cartilage. A bigger surgical option is a synovectomy, which involves removing the inflamed synovium itself. Practically, however, these procedures are becoming much less common and are generally not recommended.
The final word
The good news about synovitis is that, while frustrating and potentially painful, it’s a condition that usually improves with time and the right treatment. It’s generally temporary and the symptoms should subside once you begin your management and treatment plan, which could take anywhere from a few days to a few weeks, depending on the root cause. And that root cause is the big takeaway. With synovitis, the important thing is to get a proper medical diagnosis and move on from there.
Ready to read on?
You may find these articles helpful…
- What is synovitis? (blog article)
- What is a synovectomy? (blog article)
- A brief guide to injections for knees (blog article)
- Do hyaluronic acid injections work for knees? (blog article)
