Mohyla O. O.

ULTRASOUND SCANNING METHOD FOR DETERMINING OF A KNEE JOINT SYNOVITIS MANIFESTATION ON THE MUSCULO-TONIC SYNDROME RANGE OF SEMIMEMBRANOSUS AND THE MEDIAL GASTROCNEMIUS MUSCLES

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About the author:	Mohyla O. O.
Heading	CLINICAL MEDICINE
Type of article	Scentific article
Annotation	Abstract. Synovitis, in particular nonspecific, has traditionally refers to pathology of the knee joint (KJ), which is accompanied by inflammation of the synovial membrane and appears of effusion or exudate. In most cases, there are lesions of the support function, which lead to considerable discomfort and loss of ability to work of the patient, and with significant damage to disability. It is also known that synoviitis plays a leading role in the progression of the destruction of articular cartilage, the development of osteoarthritis (OA) and other pathologies. The degree of expression of synovitis plays an important role, since it causes the severity of the clinical picture, the degree of pain syndrome and, accordingly, the degree of impairment of function. In case of trauma, the degree of synoviitis (hemarthrosis) determines the order and speed of trauma care. The aim of the work is to analyse ultrasound evidence the degree of muscle-tonic syndrome muscles of Semi group and gastrocnemius muscles with the severity of the knee joints synoviitis of the knee joint by the ultrasound method. Methods. There were studied the ultrasonographic data of 461 patients aged from 13 to 80 years with complaints of pain in the KJ and in the popliteal fossa, with restriction of movements during the period of 08-09.2016. All the patients had US of both knee joints by standard methods on the device by “BK Medical” company with linear sensor with the frequency of 12, 0 MGz. The front, back and side areas of the knee joint were scanned in direct and lateral projection. Complaints about pain location in suprapatellar zone, on back sides of thigh and shin were taken into consideration. The following US evidence was considered: in the front projection: patellar bursa, the patella contours; the condition of adipose bodies and meniscus, joint areas of femoral bone and tibia; in the back projection: the structure of semitendinosus, semimembranous and gracilis muscles; the contours of hyaline cartilage. There are three groups of patients with US image. The 1st group was patients with US symptoms of muscle-tonic syndrome muscles of Semi group and gastrocnemius muscles till –1/3 from muscles area. The 2nd group was patients with spastic changes till – ½, 3th group – >1/2 of diameter. Results. There aren't enlargement suprapattelar bursa in 87,8% cases in patient 1st group. There are small enlargement suprapattelar bursa due to liquid in 65% cases in 2 group. It was impressed synoviitis from 3 group patient. Muscle-tonic syndrome muscles of Semi group and gastrocnemius characterize all 3 groups. The first phase of knee joint synovitis is muscular tonic syndrome of semimembranous muscle, or exudateless phase. The first phase development starts with muscle overload. The first changes in muscle structure by muscular-tonic syndrome are clearly visible at US, as hyperechogenic linea along outer edge of muscle at the background of normal homogeneous hypoechoic muscular structure. Clinically, the muscles pain appears at the site of spasm. When the download continues, the process goes to the second stage. At the first stage, muscle spasm doesn't exceed 1/3. Second stage of synoviitis is unexpressed synovitis. Enlargement of the muscular-tonic syndrome of the semimembranous and medial gastrocnemius muscles, leads to increased spasm zone to ½ of the width and small suprapatellar effusion is appearing. Patients complains note of pain in the area of the four-head femur muscle. Clinically, there is instability in the knee joint due to a decrease in the flexion-extension and support functions. When the load continues, the process goes to the third stage. Third stage, or exrpessed synoviitis knee joint. At this stage spasm of muscles increases more 1/2 of the muscies diameter, accompanied by expressed synovitis of KJ. T Such patients have expressed clinical manefestation. The patient can't stand on a sick leg, due to weakening of the muscular support function. Conclusion. As a result of this work, it can be noted that for the first time a mechanism has been established for the development of synoviitis of the knee joint, based on the muscle-tonic syndrome or muscle spasm of the Semi group, the medial gastrocnemius and quadriceps muscles of the thigh. The muscular-tonic syndrome can be amplified with a continuing load on the knee joint and reaching a spasm ½ of the diameter of the muscle and more, accompanied by a synoviitis, which becomes more expressed with the continuing load to the KJ. We can actively and effectively treat synovitis, as well as develop methods of prevention knowing this mechanism.
Tags	Non-specific synovitis, knee joint, ultrasonography, muscular-tonic syndrome
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Publication of the article	«World of Medicine and Biology» №2(60), 2017 year, 092-097 pages, index UDK 616.728.3-002-073.48