When diagnosis is early, conservative treatment
such as exercises that extend the spine (bend the
body forward) and medications such as NON-
STEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS) may
reduce the causes of the stenosis enough to relieve
the compression of the nerves. Heat, cold, and
weight loss also help. Physical exercise that
stretches and strengthens the muscles without
compressing the spine, such as bicycling and
swimming, improves the ability of the muscles to
support the body and further relieves pressure on
the spine.
When these measures do not relieve symptoms,
surgery to widen the vertebral channel may be
necessary to prevent permanent loss of function in
the legs. Because the outcome of back surgery is
less predictable than many other kinds of surgery,
it is important to discuss and understand the
expected benefits and potential risks of any OPERA-
TIONthe doctor proposes.
See also BONE SPURS; CERVICAL SPONDYLOSIS;
OSTEOARTHRITIS; SCIATICA; SPINAL NERVES; SURGERY BEN-
EFIT AND RISK ASSESSMENT.
syndactyly Fingers or toes that are fused
together by connective tissue. Sometimes the
fusion is only SKIN(simple syndactyly) and other
times the fusion involves MUSCLE, ligaments, and
BONE(complex syndactyly). Syndactyly is present
at birth and often indicates a genetic disorder with
additional symptoms. Most commonly the fusion
involves the third and fourth fingers or toes,
though sometimes affects multiple fingers or toes.
Treatment is typically to separate the fused digits
surgically to allow full use of the hand or foot.
See also GENETIC DISORDERS; LIGAMENT; POLY-
DACTYLY; SURGERY BENEFIT AND RISK ASSESSMENT.synovitis INFLAMMATION of the synovial mem-
brane that lines the JOINTcapsule of joints such as
the hip and knee. Synovitis is common in RHEUMA-
TOID ARTHRITIS, GOUT,SYSTEMIC LUPUS ERYTHEMATOSUS
(SLE), and INFECTION. Generally there is PAIN, often
severe, and swelling due to fluid accumulation.
The SKINover the joint is often hot to the touch
and red. The doctor may aspirate (withdraw with
a fine needle) some fluid from within the joint to
rule out INFECTION.
Most synovitis improves with NONSTEROIDAL
ANTI-INFLAMMATORY DRUGS(NSAIDS); severe or recur-
rent synovitis may require injected CORTICOSTEROID
MEDICATIONSalong with a local anesthetic to relieve
PAIN and reduce inflammation. The extent of
improvement depends on the underlying cause.
Unfortunately synovitis often becomes a chronic
presence with rheumatoid arthritis. DISEASE-MODI-
FYING ANTIRHEUMATIC DRUGS(DMARDS), which slow
the progression of rheumatoid arthritis, may
lessen the symptoms of synovitis as well. When
BACTERIAare present in the synovial fluid, treat-
ment requires ANTIBIOTIC MEDICATIONS.
See also BURSITIS; TENDONITIS.synovitis 357