ABNORMAL CONDITION OF THE ELBOW-JOINT. 



the sigmoid cavity of the ulna was the result of 

 a natural elloit to compensate for the loss of 

 Mrri;L;(h the j. mil suffered from the dislocation 

 of the raiiius. Still, supposing it possible that 

 the Miil'arr ill' the rapitiiluin of tin 1 Ililtuenis 

 could he so completely removed, under sucli 

 circumstances, as we find it was in the cases of 

 which jigf. 44 and 45 are delineations, we may 

 ask, is it likely, from accident or disease, 

 that Ivith elbow-joint! should be similarly 

 alle led, as they were in Dupuylren's cases. 

 Another circumstance in our mind cannot be 

 accounted f r, unless by supposing the-e 

 Congenital, namely, the alteration and urcat 

 elongation of the neck of the radius. " L'ex- 

 trciiiilc su|>crieurc de chai|iie radius avail 

 ahandonnr sa situation naturelle, se trouvait 

 place derriere 1'extremitc infcrieure dc I'hu- 

 merus, et dcpassait cette exlremilc d'nn 

 pouce au moins. Cette disposition flail ab- 

 solunicnl la mrine lie cliao,ue cote du corps." 

 \\ e know of no process which could take 

 place in the head and neck of the radius after 

 it had been dislocated, which could satis- 

 factorily account for the elongation of the 

 radius, which has been remarked in the^e 

 CMet. \\liilelooking on Ihem as congenital, 

 we need not be surprised at il ; for we have 

 known the neck of the femur elongated and 

 atrophied, in the case of congenital luxation 

 of the. femur, and have very frequently seen 

 the lower extremity of the ulna exceed in length 

 by half an inch ihe corresponding extremity 

 of the radius ; and ihese were cases in which 

 no doubl could be enterlained that they were 

 congenital. 



Disi'tisi: Acute and chronic inflammation 

 produces effects on the membranes, cartilages, 

 and bones entering into the composition of the 

 elbow-joint, which will be found nearly analo- 

 gous to those which the same morbid action pro- 

 duces on similar structures in other arliculalions. 

 A few local peculiarities, if we may so call them, 

 wl:en the elbow is ihe seat of the acute or 

 chronic disease, should alone occupy our atten- 

 tion here. 



Synovitil of the elbow-joint, uncombined 

 with any affection of the other structures, is 

 raie; it may, however, present itself either in 

 the acute or subacute form. Increased effusion 

 of fluid into the joint, accompanied wkh the 

 usual local and sympathetic phenomena of in- 

 flammation, is ihe result. Two well-marked 

 oblong swellings at each side of the olecranon 

 process in these cases first present themselves, 

 which after a lime, if the disease proceeds, 

 join and form one swelling, which extends up 

 (! hack of the arm, occupying ihe cellular in- 

 terval existing lietween the back part of ihe 

 huineriis and the from of the triceps muscle, 

 opposite to the outer condyle of the humerus 

 and head of ihe radius; the supinators arising 

 line are, in severe cases, occasionally elevated 

 and iluoun out from the bones by a soft tumour, 

 which, upon examination, conveys to the fingers 

 a .lisuncl feeling of a fluid contained beneath. 

 The nature of the accumulated fluid will, when 

 the joint is cut into, be found to vary. When 

 the effusion has followed an acute attack of in- 



flammation of the membrane, il will be cene- 

 rally found lo be purulent, lliough soim-tnnes 

 we have observed the quality of the synovia 

 but little altered, except that it was more or 

 less turbid. When iheconlenls of ihe synovia! 

 sac have been washed away, the membrane will 

 be seen to be highly vascular, and the ves- 

 sels of the subsynovial tissue congested 

 with blood, and its cells infiltrated with se- 

 rum ; while, if fine injection, coloured wiih 

 vermillion, is ihrown inlo the vascular system 

 of these parts, the unusual redness ihe mem- 

 branes assume can only be compared in height 

 of colouring lo ihe membrane of ihe eye in 

 acute conjunctivitis. With ibis inlense red- 

 ness of the surrounding membranes is strongly 

 contrasted the appearance of the cartilages of 

 the joint; these, but little altered from their 

 natural colour, are seldom in this articulation 

 found covered with vascular membranes, and 

 even when the surrounding struclures are mi- 

 nutely injected, the fluid cannot be made to 

 penetrate the synovial investment of the carti- 

 lages. 



Cartilage. When acute inflammation has 

 existed in the synovial membrane or bones of 

 the elbow-joint, the articular cartilages covering 

 ihese will very frequenlly be found to have 

 assumed, in patches, a dull yellow colour ; in 

 the latter discoloured points the cartilage is soft- 

 ened, and a blunt probe slighlly pressed will 

 sink into ils slructure, and its subjacent surface 

 will be found to be detached. A new vascular 

 membrane having been interposed between the 

 cartilage and the cancellous struciure of ihe 

 bone, ihis elevation and partial detachment of 

 ihe articular cartilages from the heads of ihe 

 bone, and inlerposition of a new organized mem- 

 brane, are probably ihe usual preludes lo ihose 

 olher changes we notice. Thus sometimes a 

 leaf or flap of the articular cartilage, adherent 

 only by an edge, hangs into the cavity of the 

 joint, and again fragments of this slruclure 

 complelely delached are found loose in ihe in- 

 terior of the articulalion. In ihese instances 

 there is reason to conjeclure lhal ihe diseased 

 action which detached the cartilage began on 

 Ihe surface of ihis slructure contiguous to the 

 bone. We have occasionally, however, evidence 

 of ulceralive absorption having commenced on 

 Ihe free surface of ihe cartilage. The peculiar 

 worm-eaten appearance which the surfaces of 

 cartilages next the cavity of the joint occa- 

 sionally present, and which, wherever it exists, 

 is considered by many pathologisls lo be the 

 resull of a process of ulceration which had be- 

 gun on the free surfaces of the articular carti- 

 lages, has been occasionally though rarely seen 

 in ihe elbow-joinl ; much more frequently in 

 examining elbow-joinls which have been ihe 

 seat of disease, ihe articular surfaces of ihe bones 

 have been found exlensively divesled of their 

 cartilages ; a few patches of them alone here 

 and there remain ; and these, iho agh apparently 

 thinner than natural, are of their ordinary tex- 

 ture, and are firmly adherent to bone. 



Such exlensive removal of cartilage, which 

 has exposed the cancel! i of the heads of the 

 bones, lias generally been the resull of some 



