Synovial fluid

It is fluid which is viscous found in the cavity of movable joints,
b/w Sub-intima n Intima synovium.

1. Synovial FLUID EXAMINATION Ms Ankita R Bhatiya Assistant Professor Shree P.M.Patel COLLEGE OF PARAMEDICAL SCIENCE N TECHNOLOGY

2. Synovial FLUID EXAMINATION It include: 1.What is Synovial Fluid? 2.Function of Synovial Fluid. 3.Collection of Synovial Fluid . 4. Examination of Synovial Fluid.

3. Synovial FLUID Introduction: It is fluid which is viscous found in the cavity of movable joints, b/w Sub-intima n I ntima synovium. The synovial cavity is a potential space lined by connective tissue of the Sub-intima n Intima pleura. Synovial fluid Formation: Synovial Fluid is a selective ultrafiltrate of plasma. Small amount of the synovial fluid is also formed from the tissue lining the sub-intima and other by capillaries. There is about 30-40 ml of synovial fluid at any one time and about 60 ml is generated every day.

4. Synovial FLUID Composition of Synovial fluid fluid: Volume: 30-40 ml Hyluronic acid:Secreted by synovium membrane. Lubricin secreted by synovial cell. Type A CELL:Macrophage : remove the debries from the fluid Type B Cell: Fibroblast: secrate hyaluronic acid n proteins Proteinases C ollagenases

5. Synovial FLUID Function of Synovial fluid: Reduction of friction — synovial fluid lubricates the articulating joints. Shock absorption — as a dilatant fluid, that possesses rheopectic properties,becoming more viscous under applied pressure; the synovial fluid in diarthrotic joints becomes thick the moment shear is applied in order to protect the joint and subsequently, thins to normal viscosity instantaneously to resume its lubricating function between shocks. Nutrient and waste transportation — the fluid supplies oxygen and nutrients and removes carbon dioxide and metabolic wastes from the chondrocytes in the surrounding cartilage Molecular sieving - pressure within the joint forces hyaluronan in the fluid against the synovial membrane forming a barrier against cells migrating into, or fluid migrating out of, the joint space. This function is dependent on the molecular weight of the hyaluronan .

6. SYNOVIAL FLUID Collection of Synovial fluid: Arthrocentesis is a process by which Synovial fluid is collected. A needle is placed through the skin in to joint cavity.

7. Synovial fluid

8. Synovial FLUID Indication of Synovial fluid : 1.Infections: Tuberculous Arthritis, Infectious Arthritis. 2 . Pyogenic infection. 3. Rheumatoid Effusion 4.Gout 5.Viral Arthritis 6.SLE 7.Serum sickness 8.Pseudogout

9. Synovial FLUID Procedure: 1.Take consent of a patient. 2.Position of patient: The patient is supine position. 3.Proper aseptic precautions are taken with the help of spirit –iodine-spirit. 4.Before puncture give injection of atrophin intramuscularly to prevent vasovagal shock. 5.Give xylocane injection as local anesthesia before puncture.

10. Synovial fluid FLUID 6.Then insert the needle synovial cavity space & allow the fluid to flow in container. 7. Pleural fluid is collected in 3 tubes: 1. EDTA Bulb: Cell count n differential count. 2. Flouride Bulb: For glucose examination. 3. Plain Bulb: Chemical n immunology study

11. Synovial FLUID Examination of Synovial fluid: Physical examination: Chemical examination: Microscopic examination:

12. Synovial FLUID Physical examination of Synovial fluid : 1.Volume: Normally: 30 to 40 ml Abnormally– above 100 ml Condition:Tuberculous Arthritis, Infectious Arthritis. Pyogenic infection. Rheumatoid Effusion Gout Viral Arthritis SLE Serum sickness Pseudogout

13. Synovial FLUID 2. color : Normally: colorless Abnormally: Pale yellow or straw clr : septic arthritis, I nflamateroty n non- I nflamatery condition Reddish: Presence of blood (Bacterial iNFECTION , Cancer.) Traumatic tap: due to collection time blood is mix. Green; Pseudmonas effusion.

14. Synovial FLUID 3.Appreance: Normally: Clear or transparent Abnormally: Turbid: Bacterial n viral arthritis, Tuberculosis arthritis. Oily: presence of crystal- gout.arthritis .

15. Synovial FLUID Chemical examination of Synovial fluid: 1.Glucose: Normal range: same as blood glucose Serum to fluid ration 10mg/dl consider as normal If it is increase upto20-60 mg/dl ,suggestive septic arthritis. Method : 2.Colorimetric method GOD-POD Condition for decrease glucose: Bacterial arthritis Viral arthritis Fungal arthritis Tuberculous arthritis Rheumatoid arthritis Cancer

16. SYNOVIAL FLUID 2. Protein: Normal range: 1-3gm/dl Abnormally: Above 3 gm/d Method: 1 .Colorimetric method Biuret Condition for Increase protein: Arthritis(Bacterial, fungal,viral ) Tuberculous arthritis septic arthritis Gouty arthritis

17. SYNOVIAL FLUID 3. Enzyme 1.LDH: Normal range: 140-280U/L aBNORMALLY : Above 280U/L Method: 1.Colorimetric method 2. U.V.Kinetic method Condition for Increase LDH: ARTHRITIS(Bacterial, fungal,viral ) TuberculoUS ARTHRITIS Gouty arthritis, Infectoious arthritis

18. SYNOVIAL FLUID 2. Acid Phosphatase: Condition for Increase Acid phosphatase: RA 3.Lactate: Normally: up to 250mg/dl Abnormally: above 250 mg/dl Condition for increase lactate: septic arthritis RA

19. SYNOVIAL FLUID 4 . Uric Acid: Normal range: 3.5-7 mg/dl Exudate: Above 7 mg/L Method: 1.Colorimetric method Condition for Increase Uric acid: Gouty arthritis

20. SYNOVIAL FLUID 5.Lipids: Increase cholesterol level Condition for present cholesterol: Lung carcinoma chronic rheumatoid arthritis 4.Mucin clot test: Method: 1-2 ml of synovial fluid+ acetic acid. synovial fluid gets precipitate. OBSERVATION: The clot may be graded as; good fair poor

21. SYNOVIAL FLUID Microscopic examination of synovial fluid: 1.TLC (Total leukocyte count): Normally: 0-50 cell/ cumm Transudate : 0-50 cell/ cumm Exudate : 50-500 cell Method: Same as Blood Condition in increase TLC count: Bacterial ARTHRITIS Viral ARTHRITIS Fungal ARTHRITIS TuberculoUS ARTHRITIS Malignancy SLE SEPTIC ARTHRITIS

22. synovial FLUID 2. DC: Method: Same as Blood Neutrophilia : Bacterial arthritis Tuberculous arthritis Rheumatoid arthritis Acute pyogenic arthritis Lymphocytosis : Viral arthritis Tuberculosis arthritis Malignancy chronic disorder SLE Leukemia Eosinophilia : Rheumatoid arthritis Rheumatioid infection Matastatis carcinoma Parasitic infection

23. Synovial FLUID 5 : Lipid bodies Normally: absent Abnormally: present Clinical Condition: Trauma,Aseptic necrosis Rheumatoid Arthritis 4.Synovial cell: Normally: Presenr Abnormally : present

24. Synovial fluid Crystal Examination: 1.Monosodium Urate Crystal ( MSU): Needle Shape rods. 5-20 um long Condition: Gouty Arthritis 2.Calcium Pyrophosphate dehydrate crystal: Rhombic rods or rectangles. 1-20 um in length Condition: Pseudo gout, Degaerative Arthritis Hypothyroidism, Hyperthyroidism Hemochromatosis, Hypo magnesemia .

25. Synovial fluid 3.Hydroxyapatite Crystal: Spherical shape Find in microaggregates 1-50 um in size No pathological importance 4.Calcium oxalate Dehydrate: Envelop shape 5-30um diameter Condition: Chronic renal dialysis

26. Synovial fluid 5.Lipid crystal: 1-20 um in diameter,spherical in shape Condition: Acute arthritis 6.Cholesterol crystal: Irregular notched crystal Condition: Tuberculosis arthritis Rheumatoid arthritis 7.Artifacts: Glove powder Corticosteroid injection sometimes look in artifacys .