Synovium
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The synovium (plural: synoviums, not synovia) or synovial membrane is a soft tissue lining of joints bursae and tendon sheaths and seems to be responsible for the secretion and absorption of synovial fluid components, whereby the synovial fluid arises from leakage of the intimal capillaries 1-4.
Gross anatomy
The synovial membrane consists of an intimal layer and a thicker layer of loose connective tissue, the subintima, which contains fewer cells and is composed of fatty, fibrous or loose areolar tissue. The intima is well innervated and vascularizedvascularised containing different types of cells including fibroblasts, macrophages, adipocytes, nerve fibres, vascular endothelial cells as well as lymphocytes 1-4.
The synovium forms the inner layer of the joint capsule in diarthrodial joints and faces the tendon within the tendon sheath. It forms the inner lining in bursae.
Histology
The synovial intima features two types of synoviocytes: macrophagic (type A) and fibroblastic (type B) cells. The macrophagic type is mobile being able to remove and degrade waste and cell debris. The fibroblast-like type possesses dendritic processes forming a network within the surface of the synovial membrane and are involved in the production of matrix components such as hyaluronan, fibronectin and collagen 3.
Radiographic features
The synovium will be mostly imaged and assessed with MRI and ultrasound in the setting of inflammatory conditions such as arthritis, tenosynovitis and bursitis in which it becomes thickened and increased amounts of synovial fluid will be present.
Ultrasound
The normal synovium should neither show hypoechoic synovial hyperplasia nor vascularity on colour and power Doppler, not even in the presence of effusion 5.
Conversely, ultrasound will show hypoechoic synovial hyperplasia and increased vascularity on colour or power Doppler in the setting of synovitis 5.
MRI
Suggested MR imaging for assessment of synovial disease include T1 weighted images before and after intravenous contrast as well as T2 weighted fat saturated or STIR images in at least two different planes.
Signal characteristics of normal synovium are 4:
T1: intermediate
T2: hyperintense
T2FS/PDFS: hyperintense
Contrast administration facilitates the differentiation between the synovial fluid and the synovium, which thickens and enhances avidly in case of inflammation or synovitis.
Development
Within the joints, the synovial membrane is last fully differentiated and the least specializedspecialised if compared by the skeletal elements and capsular structures.
History and etymology
The word synovium is derived from ‘synovia’, which is thought to have been coined by Paracelsus ref.
Related pathology
The following pathologies and diseases are related to the synovial membrane 4:
rheumatoid arthritis, juvenile idiopathic arthritis, septic arthritis
-
pigmented villonodular synovitis,
See also
-<p>The <strong>synovium</strong> (plural: synoviums, not synovia) or <strong>synovial membrane</strong> is a soft tissue lining of joints bursae and tendon sheaths and seems to be responsible for the secretion and absorption of synovial fluid components, whereby the synovial fluid arises from leakage of the intimal capillaries <sup>1-4</sup>.</p><h4>Gross anatomy</h4><p>The synovial membrane consists of an intimal layer and a thicker layer of loose connective tissue, the subintima, which contains fewer cells and is composed of fatty, fibrous or loose areolar tissue. The intima is well innervated and vascularized containing different types of cells including fibroblasts, macrophages, adipocytes, nerve fibres, vascular endothelial cells as well as lymphocytes <sup>1-4</sup>.</p><p>The synovium forms the inner layer of the joint capsule in diarthrodial joints and faces the tendon within the tendon sheath. It forms the inner lining in <a href="/articles/bursae">bursae</a>.</p><h4>Histology</h4><p>The synovial intima features two types of synoviocytes: macrophagic (type A) and fibroblastic (type B) cells. The macrophagic type is mobile being able to remove and degrade waste and cell debris. The fibroblast-like type possesses dendritic processes forming a network within the surface of the synovial membrane and are involved in the production of matrix components such as hyaluronan, fibronectin and collagen <sup>3</sup>.</p><h4>Radiographic features</h4><p>The synovium will be mostly imaged and assessed with MRI and ultrasound in the setting of inflammatory conditions such as arthritis, <a href="/articles/tenosynovitis">tenosynovitis</a> and <a href="/articles/bursitis">bursitis</a> in which it becomes thickened and increased amounts of synovial fluid will be present.</p><h5>Ultrasound</h5><p>The normal synovium should neither show hypoechoic synovial hyperplasia nor vascularity on <a href="/articles/color-flow-doppler-ultrasound">colour</a> and <a href="/articles/power-doppler-1">power Doppler</a>, not even in the presence of effusion <sup>5</sup>.</p><p>Conversely, ultrasound will show hypoechoic <a href="/articles/synovial-hyperplasia">synovial hyperplasia</a> and increased vascularity on colour or power Doppler in the setting of <a href="/articles/synovitis">synovitis</a> <sup>5</sup>.</p><h5>MRI</h5><p>Suggested MR imaging for assessment of synovial disease include <a href="/articles/t1-weighted-image">T1 weighted</a> images before and after intravenous contrast as well as <a href="/articles/t2-weighted-image">T2 weighted</a> fat saturated or <a href="/articles/short-tau-inversion-recovery">STIR</a> images in at least two different planes.</p><p>Signal characteristics of normal synovium are <sup>4</sup>:</p><ul>-<li>-<strong>T1:</strong> intermediate</li>-<li>-<strong>T2:</strong> hyperintense</li>-<li>-<strong>T2FS/PDFS: </strong>hyperintense</li>-</ul><p>Contrast administration facilitates the differentiation between the synovial fluid and the synovium, which thickens and enhances avidly in case of inflammation or synovitis.</p><h4>Development</h4><p>Within the joints, the synovial membrane is last fully differentiated and the least specialized if compared by the skeletal elements and capsular structures.</p><h4>History and etymology</h4><p>The word synovium is derived from ‘synovia’, which is thought to have been coined by Paracelsus <sup>ref</sup>.</p><h4>Related pathology</h4><p>The following pathologies and diseases are related to the synovial membrane <sup>4</sup>:</p><ul>-<li><a href="/articles/synovitis">synovitis</a></li>-<li><a href="/articles/osteoarthritis">osteoarthritis</a></li>-<li>-<a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a>, <a href="/articles/juvenile-idiopathic-arthritis">juvenile idiopathic arthritis</a>, <a href="/articles/septic-arthritis">septic arthritis</a>-</li>-<li><a href="/articles/crystal-arthropathy">crystal deposition disease</a></li>-<li>-<a href="/articles/pigmented-villonodular-synovitis">pigmented villonodular synovitis</a>, <a href="/articles/siderotic-synovitis">siderotic synovitis</a>-</li>-<li><a href="/articles/synovial-sarcoma">synovial sarcoma</a></li>-<li><a href="/articles/synovial-hyperplasia">synovial hyperplasia</a></li>-</ul><h4>See also</h4><ul><li><a href="/articles/synovitis">synovitis</a></li></ul>- +<p>The <strong>synovium</strong> (plural: synoviums, not synovia) or <strong>synovial membrane</strong> is a soft tissue lining of joints bursae and tendon sheaths and seems to be responsible for the secretion and absorption of synovial fluid components, whereby the synovial fluid arises from leakage of the intimal capillaries <sup>1-4</sup>.</p><h4>Gross anatomy</h4><p>The synovial membrane consists of an intimal layer and a thicker layer of loose connective tissue, the subintima, which contains fewer cells and is composed of fatty, fibrous or loose areolar tissue. The intima is well innervated and vascularised containing different types of cells including fibroblasts, macrophages, adipocytes, nerve fibres, vascular endothelial cells as well as lymphocytes <sup>1-4</sup>.</p><p>The synovium forms the inner layer of the joint capsule in diarthrodial joints and faces the tendon within the tendon sheath. It forms the inner lining in <a href="/articles/bursae">bursae</a>.</p><h4>Histology</h4><p>The synovial intima features two types of synoviocytes: macrophagic (type A) and fibroblastic (type B) cells. The macrophagic type is mobile being able to remove and degrade waste and cell debris. The fibroblast-like type possesses dendritic processes forming a network within the surface of the synovial membrane and are involved in the production of matrix components such as hyaluronan, fibronectin and collagen <sup>3</sup>.</p><h4>Radiographic features</h4><p>The synovium will be mostly imaged and assessed with MRI and ultrasound in the setting of inflammatory conditions such as arthritis, <a href="/articles/tenosynovitis">tenosynovitis</a> and <a href="/articles/bursitis">bursitis</a> in which it becomes thickened and increased amounts of synovial fluid will be present.</p><h5>Ultrasound</h5><p>The normal synovium should neither show hypoechoic synovial hyperplasia nor vascularity on <a href="/articles/color-flow-doppler-ultrasound">colour</a> and <a href="/articles/power-doppler-1">power Doppler</a>, not even in the presence of effusion <sup>5</sup>.</p><p>Conversely, ultrasound will show hypoechoic <a href="/articles/synovial-hyperplasia">synovial hyperplasia</a> and increased vascularity on colour or power Doppler in the setting of <a href="/articles/synovitis">synovitis</a> <sup>5</sup>.</p><h5>MRI</h5><p>Suggested MR imaging for assessment of synovial disease include <a href="/articles/t1-weighted-image">T1 weighted</a> images before and after intravenous contrast as well as <a href="/articles/t2-weighted-image">T2 weighted</a> fat saturated or <a href="/articles/short-tau-inversion-recovery">STIR</a> images in at least two different planes.</p><p>Signal characteristics of normal synovium are <sup>4</sup>:</p><ul>
- +<li><p><strong>T1:</strong> intermediate</p></li>
- +<li><p><strong>T2:</strong> hyperintense</p></li>
- +<li><p><strong>T2FS/PDFS: </strong>hyperintense</p></li>
- +</ul><p>Contrast administration facilitates the differentiation between the synovial fluid and the synovium, which thickens and enhances avidly in case of inflammation or synovitis.</p><h4>Development</h4><p>Within the joints, the synovial membrane is last fully differentiated and the least specialised if compared by the skeletal elements and capsular structures.</p><h4>History and etymology</h4><p>The word synovium is derived from ‘synovia’, which is thought to have been coined by Paracelsus <sup>ref</sup>.</p><h4>Related pathology</h4><p>The following pathologies and diseases are related to the synovial membrane <sup>4</sup>:</p><ul>
- +<li><p><a href="/articles/synovitis">synovitis</a></p></li>
- +<li><p><a href="/articles/osteoarthritis">osteoarthritis</a></p></li>
- +<li><p><a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a>, <a href="/articles/juvenile-idiopathic-arthritis">juvenile idiopathic arthritis</a>, <a href="/articles/septic-arthritis">septic arthritis</a></p></li>
- +<li><p><a href="/articles/crystal-arthropathy">crystal deposition disease</a></p></li>
- +<li><p><a href="/articles/siderotic-synovitis">siderotic synovitis</a></p></li>
- +<li><p><a href="/articles/synovial-sarcoma">synovial sarcoma</a></p></li>
- +<li><p><a href="/articles/synovial-hyperplasia">synovial hyperplasia</a></p></li>
- +<li><p><a href="/articles/tenosynovial-giant-cell-tumour-2" title="Tenosynovial giant cell tumour">tenosynovial giant cell tumour</a></p></li>
- +</ul><h4>See also</h4><ul><li><p><a href="/articles/synovitis">synovitis</a></p></li></ul>
References changed:
- 5. D'Agostino M, Terslev L, Aegerter P et al. Scoring Ultrasound Synovitis in Rheumatoid Arthritis: A EULAR-OMERACT Ultrasound Taskforce Part 1: Definition and Development of a Standardised, Consensus-Based Scoring System. RMD Open. 2017;3(1):e000428. <a href="https://doi.org/10.1136/rmdopen-2016-000428">doi:10.1136/rmdopen-2016-000428</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28948983">Pubmed</a>
- 5. D’Agostino M, Terslev L, Aegerter P et al. Scoring Ultrasound Synovitis in Rheumatoid Arthritis: A EULAR-OMERACT Ultrasound Taskforce — Part 1: Definition and Development of a Standardised, Consensus-Based Scoring System. RMD Open. 2017;3(1):e000428. <a href="https://doi.org/10.1136/rmdopen-2016-000428">doi:10.1136/rmdopen-2016-000428</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28948983">Pubmed</a>
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