SYNOVIAL FLUID

EXAMINATION
Prepared by
Mr. Mohideen Sharfan S A Reviewed by
Assistant Professor PPT Review Committee
Medical Laboratory Technology

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SPECIFIC LEARNING OBJECTIVES

At the end of the session, students should be able to

 Introduction on Synovial fluid.
 List down the composition of synovial fluid.
 Discuss about the clinical significance.
 Explain physical, chemical & microbiological
examination.

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SYNOVIAL FLUID
 Viscous fluid found in the cavities of movable joints
such as:-
• Knee

• Ankle
• Hip

• Elbow
• Wrist
• Shoulder

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 With its yolk-like consistency, the principal role of
synovial is to reduce friction between the articular
cartilage of synovial joints during movement.
 The inner membrane of synovial joints is called the
synovial membrane and secretes synovial fluid into
the joint cavity.

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COMPOSITION
 Hyaluronic acid
 Synthesized by synovial membrane
 Increase the viscocity and elasticity of articular
cartilages
 lubricate the surface between synovium and
cartilage.

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 Lubricin secreated by synovial cells.

It is chiefly responsible for so called boundary layer

lubrication, which reduces friction between opposing

surfaces of cartilage.

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CLINICAL SIGNIFICANCE

 The laboratory examination of this fluid helps to

assist in the diagnosis of joint disorders.
o infective arthritis (septic arthritis, rheumatic)
o Gouty arthritis (metabolic disorder)
o Rheumatoid arthritis (autoimmune disorder).
o Degenerative arthritis.

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LABORATORY EXAMINATION

 Physical examination
 Microscopic examination
 Chemical examination
 Microbiological examination

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SPECIMEN COLLECTION

Tube - 1 Chemistry &

immunology

Tube - 2 microbiology

Tube - 3 Cytology and

hematology

Note : if the specimen cannot be examined immediately fluid should be frozen and
stored at -70○c until examined
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 PHYSICAL EXAMINATION

 Volume
 Color and appearance
 Inclusions
 Viscosity
 Mucin clot

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 VOLUME

 Normal up to < 3.5 ml of fluid

 Can reach up to 25 ml (inflammation)

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COLOR AND APPEARANCE
Appearance Condition
Normal Clear, straw colored and
viscous.it does not clot
Turbid & yellow Infection and
inflammation of the joint
space, due to the
presence of crystals.

purulent Septic arthritis

Red or brown Hemarthrosis or in a
supernatant traumatic tap
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INCLUSIONS

 Rice bodies
Free floating aggregates of tissue appear as rice
bodies
(RA, Degenerated synovium enriched with fibrin)
 Orchronotic shards
Debris from joint prosthesis
Look like ground pepper
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VISCOSITY

 Synovial fluid is viscous due to the presence of

hyaluronic acid.
 The viscosity of the synovial fluid decreases in
inflammatory joint disorders.
 It is due to breakdown of hyaluronic acid by the
enzyme hyaluronidase.

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MUCIN CLOT TEST

 Hyaluronic acid forms a compact clot when mixed

with the acetic acid
 Low concentartion of hyaluronic acid does not allow
the formation of a firm clot.
Procedure :- Add few drops of synovial fluid to 20 ml of
5% acetic acid in a small beaker.
A good clot is formed if the synovial fluid is normal.
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MICROSCOPIC EXAMINATION

 Total leukocyte count - <200 cells/Ul

 Differential leukocyte count
 if polymorphs more than 70%, it indicates
bacterial arthritis
Non inflammatory arthropathies
(osteoarthritis) are associated with
lymphocytes and macrophages. 18
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 WET SMEAR
 Centrifuge the S.fluid and take the sediment on a
glass slide and cover it with a coverslip.
 Observe under the microscope
 Urate crystals are needle shaped, highly seen in
gouty arthritis.

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 Rhomboid calcium pyrophosphate crystals are seen in
pseudo-gout.
 Cholesterol crystals are seen in rheumatoid arthritis .
 Crystal can be confirmed using polarized microscopy.

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CHEMICAL EXAMINATION

 Glucose estimation:- Typically a bit lower than blood

glucose levels. May be significantly lower with joint
inflammation and infection.
 Protein – increased with bacterial infection.
 LDH – Increased LDH level may be seen in
rheumatoid arthritis, infectious arthritis or gout.
 Uric acid - increased with gout.
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MICROBIOLOGICAL EXAMINATION
 Staining
 Smear prepared by centrifugation or
cytocentrifugation
 Saline dilution reduces clustering of cells

 Gram’s stain most common

 AFB stain
 Culture
 Aerobic

 Anaerobic

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SUMMARY

 Synovial fluid analysis is helpful for determining the

underlying cause of arthritis, particularly for septic
or crystal-induced arthritis.
 The white cell count, differential count, cultures,
Gram stain, and crystal search using polarized light
microscopy are the most useful studies.

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REFERENCE

 Nayak R, Rai S. Essentials in Hematology and clinical

pathology.2nded.India:Jaypee the health science
publisher;2017.
 Textbook of medical laboratory technology – Praful B
Godkar, Darshan P Godkar.

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