Synovial fluid and Synovial gas

Synovial fluid and Synovial gas are two important components related to joint health and function.

Synovial Fluid :
Synovial fluid is a thick, transparent liquid found in the cavities of synovial joints, such as the knee, hip, or shoulder joints. It acts as a lubricant and shock absorber for the joint. The synovial fluid is secreted by the synovial membrane, which lines the joint capsule.

Functions of Synovial Fluid :

Lubrication: Synovial fluid reduces friction between the joint surfaces during movement, allowing smooth and pain-free motion. Nutrient Supply: It delivers oxygen, nutrients, and other essential substances to the articular cartilage, which lacks its own blood supply.
Waste Removal: Synovial fluid helps remove metabolic waste products from the joint, maintaining a healthy environment.

Composition of Synovial Fluid :

Synovial fluid consists of water, hyaluronic acid, lubricin, proteins (such as albumin and globulin), glucose, electrolytes, and cells (mainly synovial fibroblasts and white blood cells). The composition may vary in different joint diseases or conditions.

Clinical Significance:

Examination of synovial fluid (through arthrocentesis) can help diagnose joint disorders like arthritis, infection, or crystal-related conditions. Changes in synovial fluid analysis, such as increased white blood cell count or presence of bacteria, may indicate joint inflammation or infection.

Synovial Gas :

Synovial gas refers to the presence of gas bubbles or pockets within the synovial fluid of a joint. It primarily consists of nitrogen and, to a lesser extent, carbon dioxide and oxygen. This gas is dissolved in the synovial fluid under normal conditions.

Formation of Synovial Gas: :

The exact mechanism of gas bubble formation within the synovial fluid is not fully understood. However, it is believed that gas can accumulate due to a decrease in joint pressure, rapid joint movement, or sudden changes in joint position.

Pop Sound during Joint Flexion :

When you flex or move a joint, such as bending your fingers or cracking your knuckles, the joint capsule expands. This expansion causes a sudden decrease in joint pressure, leading to the formation of gas bubbles within the synovial fluid. The rapid release or collapse of these bubbles creates a popping or cracking sound.

Functions of Gas in Joints:
Joint Stability: The gas helps maintain joint stability by balancing intra-articular pressures during movement. Nutrient Exchange: The gas allows for the exchange of gases and nutrients between the synovial fluid and the articular cartilage.

Clinical Significance:
Excessive gas accumulation within the joint may cause joint distension, discomfort, or pain. This can occur in conditions such as joint effusion or intra-articular fractures.

It's important to note that cracking your joints does not lead to long-term joint damage or arthritis, contrary to popular belief. However, intentionally cracking your joints excessively or forcefully may increase the risk of injury.
Understanding the phenomenon of synovial gas and the associated pop sound can help medical professionals differentiate between normal joint sounds and potentially problematic ones. If patients have concerns or experience persistent symptoms related to joint cracking, a thorough clinical examination and appropriate investigations can help determine the underlying cause.

Gangrene

Gangrene refers to the death of the tissue in any particular area of the body caused by the loss of blood supply. Though gangrene can occur in any part of the body, it normally affects toes, fingers, feet and hands. Infections, vascular disease, diabetes, injury and weakened immunity are some of the causes of gangrene.

Types of gangrene

Dry gangrene: Dry gangrene involves lack of blood supply due to cell death and necrosis. This condition is not associated with infection and develops gradually over a period of time. Patients with diabetes, atherosclerosis and other blood vessel diseases are most likely to develop dry gangrene. Those suffering from injuries, burns, frostbite and any other arterial trauma are also prone to dry gangrene.

Symptoms of dry gangrene

• Affected area feels numb and cold.
  
• Does not show any signs of healing due to interrupted blood supply and necrosis (un programmed cell death).
  
• Patients may or may not have pain.
  
• Color changes gradually from red to brownish red and eventually becomes black.
  
• Skin becomes dry, scaly, shriveled and finally falls off the body if not treated in time.
  
• On very rare occasions, the onset of dry gangrene may be sudden which may be caused by an immediate loss of arterial blood supply. In such a case, the affected area turns pale or bluish and then starts withering away.

Wet gangrene: Bacterial infection, loss of blood supply due to swollen tissues and gas production are some of the causes of wet gangrene. Wet gangrene spreads very quickly and in no time turns into sepsis. It restricts the white blood cells from reaching affected area, allowing the bacteria to feed on the surrounding muscles. Hence wet gangrene is a medical emergency and requires immediate treatment.

There are few variations to wet gangrene and one of them is gas gangrene. The bacterial organism called Clostridium perfringens causes gas gangrene. The bacteria present in the site releases toxins and produces gas bubbles in the dead tissues affecting not only the local site, but adjoining tissues and muscles. Though gangrene normally occurs on external parts of the body like hands, toes and legs, it can also attack internal organs like gallbladder, intestines and appendix. This condition is called internal gangrene. Internal organs may develop hernia, get strangulated and as a result do not receive sufficient blood supply causing gangrene.

Fournier gangrene is the gangrene that occurs in the male genital area due to an infection or urinary tract infection. Red skin, swelling, tenderness associated with pain are some of the symptoms of Fournier gangrene.

Necrotizing fasciitis is a type of wet gangrene that is caused by bacterial infection, affecting the deep layers of skin. It progresses rapidly and starts eating up the flesh in the body.

Symptoms of wet gangrene

• The site at which gangrene has occurred becomes swollen and painful. The skin in that area gets discolored.
  
• Pus, oozing of fluid and foul smell in the affected area.
  
• Fever indicating sepsis.
  
• If it is a gas gangrene, along with above mentioned symptoms, patient may experience increased heartbeat and vigorous breathing as toxins enter the blood stream. When the wound is pressed, there will be a slight crackling noise as there is a gas beneath the skin.

Causes of gangrene

The first and the primary cause of gangrene is complete loss or insufficient supply of blood to the tissue. When there is no blood supply, the required oxygen does not reach the cells allowing them to decay and die. Bacterial infections, trauma, damaged blood vessels, and blood vessel disease like atherosclerosis are some of the causes that restrict the blood supply leading to gangrene. Surgery wounds, frost bites, severe burns are typical breeding sites for bacteria causing infection and gangrene.

Diagnosing gangrene

Doctor will conduct a thorough physical examination and look for the symptoms like discoloration, pus, shrinking of skin, odor to determine the type of gangrene. If it is a wet gangrene, further tests like blood test, blood culture and tissue cultures are carried on to find out about the white blood cell count and the kind of bacteria causing the issue. This helps the doctors to decide on the right course of antibiotics. Imaging studies like X-ray, MRI and CT scan are done to determine the spread of gangrene.

Gangrene Treatment

Treatment approach varies depending upon the type of gangrene. However, whatever be the type of gangrene; it should be brought to the notice of the medical practitioner at the earliest to prevent it from spreading. In case of dry gangrene, firstly, doctor will remove the dead tissues from the affected area surgically. Next, he will try to correct the destroyed blood vessels to smoothen the blood flow. Patient will be administered antibiotics to curtail the spread and will also be given some anti blood clotting drugs.

Wet gangrene is a medical emergency and once diagnosed, treatment should start as quickly as possible. Debridement procedure is normally adopted to treat wet gangrene. Debridement refers to the removal of dead and decaying tissues from the affected site. Antibiotics are administered to control the infection and pain killers are given to relieve the patient from pain. In worst cases surgeon may have to amputate, where the affected limb will be separated from the body to prevent further deterioration. Gas gangrene is a deadly disease. Though it is treated in the same way as mentioned above, it necessitates swift action when compared to all other gangrenes. The infection can spread and enter the blood stream very quickly causing organ failures.

There is also an alternate therapy called hyperbaric oxygen therapy that is gaining momentum to treat gas gangrene. This process involves exposing the patient to 100% oxygen at inflated pressure for 90 to 120 minutes, three times a day for 2 days. Then the frequency will be brought down as per the patient's requirements. This therapy stimulates the cell growth, enhances the white blood cell count thereby regulating the infection and increasing the blood flow to areas affected by the arterial blocks.

Preventing gangrene

• Seek prompt treatment for any kind of external wound, cut or injury before the site is attacked by infection.
  
• Diabetics should keep their sugar levels under control as they are at higher risk. Those with vascular diseases and low immunity levels should be extremely cautious and vigilant about the signs of infection like pus, oozing, discoloration, swelling and pain. They should take good care of their fingers, toes and feet and go for frequent health checkups to rule out any adverse health condition.

Dry gangrene is easily treatable provided there is no infection associated with it. Chances of recurrence are higher in diabetes patients. The outlook for wet gangrene is poor and patients with severe infection and sepsis may also lose their life, if treatment is not initiated in time. It requires an aggressive treatment and patients with wet gangrene may end up with amputation.

Antiflatulent

Flatulence is caused by substances that are indigestible. Antiflatulent agents ensure that small gas bubbles merge into larger bubbles and ease out of the gastrointestinal tract. Antiflatulents alleviate intestinal gas. They are usually enzyme-based and break down the indigestible elements and expel them by burping or flatulence.