CONTUSED KNEE, BUMPED OR CAPPED KNEE 93 



The effused material may be clear and serous, or blood-tinged. In the 

 latter case some of the small blood-vessels are ruptured, particularly the 

 terminal branches of the interosseous artery of the forearm, which it will 

 be remembered ramify superficially over the anterior aspect of this joint. 

 At times the fluid contains flocculi of fibrinous material. 



At first the swelling is soft and fluctuates, and spreads out over the 

 anterior aspect of the joint. Later it becomes harder, and its walls become 

 very much thickened. The presence of the swelling markedly interferes 

 with the action of the joint. 



Treatment depends upon the age of the affection. In cases seen im- 

 mediately, hot fomentations and massage from above downwards may 

 frequently be resorted to with considerable advantage. 



Where the swelling is soft and fluctuating, the best method of treat- 

 ment is to puncture and allow the fluid to escape. The method of 

 operation is as follows : The fluid should first be displaced in the downward 

 direction as much as possible by applying friction with the hand from 

 above downwards. This is in order that the punctured wound may be 

 removed as far as possible from the joint. The part should then be 

 shaved, cleansed, and thoroughly disinfected, and a twitch and blinds 

 having been put on the animal, the knee is semi-flexed, and a small 

 puncture made in the most dependent part of the swelling with a Symes 

 knife. The liquid contents are now pressed out through the opening 

 made, by running the palm of the hand downwards over the front of the 

 knee. Should there be no signs of purulent material in the discharged 

 liquid, a pad of cotton wool or tow, upon which has been sprinkled some 

 dry dressing, is placed over the wound and carefully moulded to the front 

 of the knee. At the back of the joint two rolls of similar soft material 

 are placed vertically one on either side the elevation caused by the edge of 

 the pisiform bone. A very long and narrow bandage is now taken, with 

 which the joint is covered by adopting the figure-8 method. The 

 bandage should be very tightly applied — the rolls of soft material will 

 take the pressure off the edge of the pisiform bone. A long narrow 



