Ask the Doctors February 2006 Issue

Ask the Doctors: 02/06

I was recently diagnosed with synovitis of the knee. How is it treated, and is there anything I can do to prevent a reoccurrence?

 The normal knee joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid). This synovial fluid helps to nourish the cartilage and keep it slippery. Inflammation triggers an excess of fluid production and accumulation in the knee.

Synovitis with swelling is often caused by a minor knee injury or overuse of the knee. It can also be caused by diseases such as gout or rheumatoid arthritis. Using a RICE (rest, ice, compression, elevation) treatment plan usually is effective within a few days. Over-the-counter analgesics or anti-inflammatory medications can help reduce acute pain and swelling. If these simple measures fail, steroid injection into the knee joint can be helpful. For long-standing synovitis that does not respond to nonoperative treatment, arthroscopic synovectomy may be necessary.

The chance of recurrence can be reduced by physical therapy to strengthen the muscles about the knee joint, by the use of an elastic bandage during activity, the use of knee pads if you spend time on your knees such as in gardening, and avoiding activities that put large stresses on the knee joints, such as deep knee bends. If you’re a runner, choosing alternative activities such as bicycling, walking, or swimming will put much less stress on your knees.

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I have rheumatoid arthritis in my wrist and have completely lost range-of-motion. What can you tell me about wrist arthrodesis surgery—how is it done, and what are the advantages?

The wrist is actually a collection of many bones and many small joints that can become arthritic, making the wrist stiff and painful. Moving the wrist or gripping objects in your hand may become difficult because of the pain and stiffness. This happens because the muscles running from the forearm to the hand contract, tightening the wrist bones together.

An arthrodesis or fusion of the wrist eliminates pain by making all the bones grow together into one solid bone. When the bone ends can no longer rub together, there is no more pain.

Several techniques are used for wrist fusion, but all involve removing the articular cartilage from between the bones so that they can grow together. A metal plate may be used to hold the bones together while they heal, and an arm cast will probably be required for about six weeks.

A wrist fusion is a tradeoff. You will lose some motion, but you will regain a strong and pain-free wrist. You should still be able to rotate your hand, but you will not be able to bend your wrist.  Occupational and physical therapy after surgery will help you learn ways to perform activities of daily living with limited wrist motion.

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After lifting a heavy carton, I experienced severe chest pain. After X-rays, my doctor concluded that I had costochondritis. I’m told that it’s a form of arthritis. Can you explain?

Costochondritis is an irritation and swelling of the joints that connect the ribs to the breastbone.  It is a form of arthritis—inflammation of a joint—but it is not caused by normal wear and tear, as is osteoarthritis, or an underlying disease process, as is rheumatoid arthritis. Costochondritis usually results from some unaccustomed activity, such as lifting a heavy object, and results in chest pain of varying intensity that typically worsens with straining or motion of the rib cage. The condition usually is self-limiting and requires no specific treatment. Nonprescription medications (aspirin, acetaminophen, ibuprofen) and applying heat to the area may ease the pain. If possible, avoid any movements that aggravate the symptoms. Symptoms generally subside within a few weeks.