Bursitis, Synovitis and Capsulitis

Joint Inflammatory Problems

Joint inflammatory problems
can be classified as:

Capsulitis

Inflammation of ligaments surrounding the joint i.e. inflammation of the joint capsule

Synovitis

Inflammation of the tissues that line the joint i.e inflammation of the synovial membranes

Bursitis

Inflammation of the bursa adjacent to the joint

These sound so similar. What’s the difference?
How do you know if you have one and not the other?

The Metatarsophalangeal joint (also known as the MTP joint) is a common site of these inflammatory processes.

Bursitis

Bursitis is inflammation and a painful swelling of a small sac of fluid called a bursa. Bursae (plural of bursa) are fluid filled cushions that help absorb shock and lubricate areas where tendons, ligaments, skin, muscles, or bones rub against each other.  People who repeat the same movement over and over or who put continued pressure on a joint in their jobs, sports, or daily activities have a greater chance of getting bursitis.

The anatomical location of MTP bursa is at the base of metatarsophalangeal joint. Any condition that causes over-riding of metatarsal bones can aggravate the risk of developing bursitis as a result of tissue compression in the region. Many cases of Morton’s neuroma present with adjacent bursitis and in some cases it can be very hard to differentiate the true cause of pain.  In most cases, painful MTP bursitis involves first MTP joint. A bunion together with pain around the MTP joint is suggestive of MTP bursitis.

Synovitis

Synovitis is inflammation of the tissues that line a joint causing increased fluid in the joint and even joint instability. In general Synovitis is commonly associated with specific diseases such as arthritis or gout but may also be the result of overuse or trauma. Symptoms of synovitis may include redness, swelling, warmth, and pain with joint motion.

Capsulitis

Ligaments surrounding the joint at the base of the joint form a “capsule,” which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed. Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis is due to abnormal foot mechanics combined with repetitive foot motion that exerts pressure on the ball of foot to cause connective tissue degeneration. Poor foot dynamics or chronic stress can cause MTP capsulitis.

Treatment

Regardless of the site of inflammatory process, the treatment protocols are similar. the key is to have a clinician experienced with diagnosing and treating these conditions. Inflammatory lesions of MTP joint (synovitis, capsulitis, bursitis) usually responds to conservative therapies and surgery is not usually required in most cases. Most common interventions are:

  • Rest and limitation of physical activities
 
  • Stretching is an ideal solution for individuals who develop MTP inflammation due to tight or stiff calf muscles
 
  • Use of cold compresses or ice-wraps
 
  • Use of splinting helps in preventing unnecessary drifting of toes.
  • If severe, you can use crutches or a cast in order to help heal the tissue in the short term
 
  • Over-the-counter anti-inflammatory medications are also helpful in reducing the intensity of inflammation and improving the quality of symptoms
 
 
  • Platelet Rich Plasma injections can be extremely helpful in the treatment of all joint inflammatory conditions

Although similar, there are subtle differences in the preferred treatment for these conditions. Specifically:

Synovitis can be treated with a viscosupplementation injection (such as Synvisc) into the joint or a Platelet Rich Plasma injection.

Bursitis can be optimally treated with a Platelet Rich Plasma injection.

Capsulitis can be treated with a Platelet Rich Plasma injection.

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