Swollen joints (joint effusion) are usually a clearly visible enlargement of the joint with swelling often caused by fluid accumulation. A joint swelling may affect the small joints of the hands and fingers or that of the foot and legs or the larger joints like the wrist, elbow, shoulder, knee and ankle. Most noticeable joint swellings affect the hinged joints and ball and socket joints.
Joints are the junction where two or more bones meet usually to allow for some degree of movement. The ends of the bones are lined with cartilage which is resistant to wear and tear. The joint is lined by a synovial membrane which secretes synovial fluid within an enclosed sac. This fluid helps to reduce friction as the bones articulate. However, sometimes the fluid within the joint may increase. This is not always due to excess synovial fluid.
Swelling is a sign of inflammation along with pain and other symptoms. As a result of the inflammatory process, fluid seeps out of the blood vessels and into the joint space. Another possible source of fluid in the joint space is a broken blood vessel. This leads to blood collection within the joint space which is known as hemoarthrosis. Any fluid accumulation in the joint is most visible in the superficial joints.
Visible swelling of a joint is most visible when fluid accumulates in the joints of the upper and lower limbs. These joints lie just underneat the skin and swelling cause enlargement and stretching of the skin over the joint. Swelling of joints of the vertebral column and hip are usually less evident due to the location but in some cases, like ankylosing spondylitis, it may be barely visible.
Causes of Swollen Joints
Some of the common causes of joint swelling may be due to acute or chronic factors. Most of the time this is due to joint inflammation (arthritis). However, sometimes the joint may appear enlarged and this is not due to swelling (fluid accumulation). Other masses can also cause joint enlargement.
- Injury or overexertion of the joint can lead to inflammation of the joint (arthritis). This may occur with a blow to the joint, repetitive stress or excessive force on the joint.
- Synovitis ins inflammation of the joint lining (synovial membrane) and typically affects the larger joints like elbow, shoulder, hip or knee.
- Adhesive capsulitis is inflammation and scarring of the joint capsule of the shoulder joint. It is commonly known as frozen shoulder although joint swelling is usually not present.
- Rheumatoid arthritis (RA) is joint inflammation due to the body’s immune system attacking the joint lining (autoimmune). It usually affects the small joints on both sides of the body with morning stiffness and pain being prominent features. Stiffness usually eases with movement.
- Osteoarthritis (OA) is not an inflammatory joint condition but due to degeneration of the joint cartilage. It is the most common type of arthritis and usually affects the larger joints of the body. OA is due to wear and tear on the joint and tends to affect older people.
- Gout or gouty arthritis is inflammation of the joint due to the presence of uric acid crystals that form in the joint space. Pseudogout is a similar joint condition that occurs due to calcium pyrophosphate crystals.
- Joint infections is usually due to bacteria that enter the joint space. It is known as septic arthritis. Viruses can also cause joint infections but are usually self-limitig. .
- Fractures of the bone near the joint especially of the smaller bones of the fingers, wrist, toes or patella of the knee.
Tennis elbow, golfer’s elbow and carpal tunnel syndrome do not usually cause joint swellings. Swollen ankles is often a symptom of a systemic condition associated with lymphedema or other pathologies that may cause a swelling of the leg.
Apart from the obvious swelling of the joint, other symptoms may also be present. These symptoms may vary depending on the underlying cause of the joint swelling. However, sometimes joint swelling may occur on its own with no other signs and symptoms, such as:
- Pain may or may not be present. Joint pain is known as arthralgia.
- Heat or coldness of the joint to the touch.
- Redness of the skin over the joint.
- Immobility or difficulty moving of the joint.
- Popping or clicking sound may be present upon movement. This may occur in any joint but is more common in TMJ dysfunction, fingers and knee.
Treatment of Joint Swelling
A swollen joint is a symptom of underlying pathology and treatment should be directed at the cause of the joint swelling. (1)
- Anti-inflammatory drugs assist with joint swelling and pain. Oral or topical applications.
- Corticosteroids may be useful in reducing and preventing joint swelling in chronic conditions like rheumatoid arthritis. Oral or joint injection although the latter is not advised as a first course of therapy. (2)
- Antibiotics may be necessary for joint infections.
- Joint aspiration (arthrocentesis) can relieve joint swelling and reduce pain due to the pressure of the swelling. Arthrocentesis involves the drainage of joint fluid and is useful for diagnostic investigation in joint swellings of unknown causes or in joint infections.
- Joint replacement surgery may be required for degenerative bone and joint disorders.
Management of Swollen Joints
A swollen joint should be treated with appropriate therapeutic options once investigations identify causative factors. Conservative management may vary depending on the cause of the joint swelling.
- Applying hot or cold compresses may not always be advisable as it can cause an aggravation of the joint swelling and other symptoms.
- Resting the limb or joint may reduce swelling and pain.
- A joint brace may be useful for reducing strain and providing added support to the joint. Tight bandaging of the joint is not advisable as this may aggravate the swelling further.
- Certain topical applications for muscle pain like massage oils may aggravate a joint swelling. Do not massage a swollen joint deeply as this can exacerbate the pain and swelling.