This document discusses synovial fluid, its composition and functions, as well as how and why synovial fluid analysis is performed. It contains the following key points: - Synovial fluid is a viscous fluid found in joints that lubricates and nourishes cartilage. It is composed of proteins, glucose, and cells. - Synovial fluid analysis can help differentiate between infectious, inflammatory, bleeding, and crystal-related joint disorders by examining the fluid's viscosity, color, contents under microscopy. - Abnormal synovial fluid is obtained through arthrocentesis, and is then analyzed macroscopically, microscopically, and through microbiological testing to identify the cause of joint

1. SYNOVIAL FLUID
EXAMINATION AND IT’S
CLINICAL APPLICATIONS
DR ADITYA P. APTE
RAJAWADI HOSPITAL

2. WHAT IS SYNOVIAL FLUID??
• Viscous fluid found in cavities of joints.
• SYN(like) + OVIA(egg)= egg like joint fluid
• Mixture of protein rich ultrafilterate of plasma and hyluronan secreted by
synoviocytes.
• Forms a thin layer at the surface of cartilage and also seeps into the
microcavities in the articular surface
• During movement the fluid is redistributed mechanically so that a thin
layer always persists on the cartilage surface thus reducing friction.

3. FUNCTIONS
• Lubricates the joint thus reducing FRICTION
• As the shearing forces increase the fluid viscosity increases and it acts as
an effective SHOCK ABSORBER while loading.
• NUTRIENT and WASTE TRANSPORTATION from the surrounding
cartilage by supyling o2 and nutrients and removing co2 from the
surrounding tissue
• Contains PHAGOCYTIC CELLS that remove debris that result from the
normal wear and tear of the joint

4. NORMAL COMPOSITION
• Mucin containing hyaluronic protein complex(lubrication of joint)
• Glucose and uric acid are equivalent to plasma
• Proteins are lower than plasma

5. WHY????
• To differentiate between the following disorders-
• 1.infectious disorders
• 2.inflammatory disorders
• 3.bleeding tendencies
• 4.crystal precipitation disoders

6. WHEN???
• Synovial fluid analysis is ordered when a condition involving the joints is
suspected
• Patients presents with-
• 1.joint pain +/- history of trauma
• 2.swelling
• 3.positive bulge test
• 4.positive patellar tap

7. BULGE TEST
• Used to determine if there is an abnormal amount of fluid surrounding the
joint
• Indications-
• Suspected effusion
• Inflammed knee.
• Procedure-one hand superior to the patella and push inferiorly –other hand
stroke lateral side of the knee – fluid thrill on medial side aspect of knee
• Positive patellar tap is also indicative of abnormal fluid collection

8. HOW???
SPECIMEN COLLECTION-ARTHROCENTESIS
• Aseptic precautions to be maintained.
• After skin preparation inject a local anaesthetic to minimize pain
• Parapatellar approach is usually the preferred approach
• Flexing the knee to 10-15 deg. May facilitate entry into the joint space

9. LABORATORY TESTING
1.MACROSCOPIC ANALYSIS
• Viscosity-non inflammatory conditions..normal viscosity
• Low viscosity-inflammatory conditions (as reduced content of hylarunon
thus reduced polymerization)
• String test - normally..fluid drips from the pipette in the form of a long
string
• In inflammatory conditions fluid falls freely.( indicates de polymerization)

10. • Mucin clot test-when 2-5% acetic acid is added normal synovial fluid will
form a clot surrounded by thin rim of fluid
• Absence of clot formation indicated denaturation of hyaluronic acid.

11. • COLOR- normally deep yellow (yolk yellow)
• In R.A-GREENISH
• Pigmented villonodular synovitis-inflammation and overgrowth of joint
lining leading to tissue damage-blood stained synovial fluid
• RICE BODIES- T.B; R.A

12. • Eosinophilia-seen in hemearthrosis
• Following an arthrogram(contrast induced)
• LYMES disease

13. MICROSCOPIC ANALYSIS
• Hemosiderin deposits-PVNS
• RICE BODIES-collagen and fibrin accumulation..macroscopically resemble
rice
• RA cells(ragocytes)-neutrophils with dark nuceli containing precipitated
R.A factor.

14. MICROBIOLOGY TESTING
• Gram staining
• Culture sensitivity – for isolating organisms and their susceptibility to
antibiotics.

15. • GLUCOSE-typically a bit lower than plasma glucose normally
• Reduced in inflammatory states and infections
• PROTEINS-increased in bacterial infections
• LDH- increased in infective states.

16. EVALUATION UNDER POLARIZED LIGHT
• Monosodium urate crystals needle shaped-gout
• Rhomboid crystals-calcium pyrophosphate dihydrate crystals(CPPD)-
pseudogout
• Hydroxyapetite crystals-milwakee arthritis.
• These cant be seen under polarized light and require to be seen under
electron microscope

17. RECENT ADVANCES
• MMP3(matrix metalloproteinase 3) levels are more sensitive markers of
inflammation than deranged glucose and protein values
• Increased MMP3- potent marker of erosive rheumatoid arthritis

18. THANK YOU.