DISEASES OF THE ARTICULATIONS. 

 INFLAMMATION OF THE JOINTS. 



General Pathological Anatomy of Inflammation of the Joints. — A 



common aft'cction of the joints is synovitis. In a simple case of in- 

 flammation of the joints, we see an increase of blood vessels, an in- 

 filtration of the small cells, and even disintegration of the endothelial 

 cartilage; the tissue under it becoming granular. We find cjuite freciuently 

 an accumulation of fibrinous or " croupal-like " membranes, followed by 

 a cicatrization of the synovial membrane. In all acute forms of synovitis 

 we see hemorrhages in the form of small, tick-like bodies. In inflamma- 

 tion of the joints, when it takes a chronic form, the synovial membrane 

 becomes thickened, is tougher, with marked indentations on the membrane 

 which are tree-like in form. The synovia appears in large quantities, 

 is yellowish, clear, or slightly turbid, and dulled l^y cells or fibrinous 

 flakes. If the synovia is gathered in a large quantity, we find a dis- 

 tention of the capsule, producing a hernia-like protrusion of those parts 

 of the joint, where there is the least resistance. Occasionally we find 

 the synovial membrane covered with thick clotted masses. These oc- 

 cur from the excessive secretion of synovia in the joints. Sometimes 

 small bodies appear in the joints due to some parts of the hard cartilage 

 becoming detached and in rare instances by a breaking off of small 

 pieces of bone, and, finally, we may see the development of a cicatricial 

 contraction of the synovial membrane; which is due to an acute or 

 chronic inflammation of the joints, or when for any cause (for instance, 

 dressing of fractures) a healthy joint is rendered immovable for some 

 time. This condition may produce a temporary stiffening of the joint, 

 but this, as a rule, is overcome in a short time. 



The fibrous capsule of the joint is occasionall}^ inflamed, but, as a 

 rule, in acute and chronic inflammation of the joint it remains unaffected. 

 "Where there is suppuration present the capsule may become detached 

 from the periosteum with the bone, and also may be perforated by the 

 pus. The ligaments also become impregnated with the pus from a 

 purulent inflammation, but, they are rarely destroyed. Occasionally, 

 however, we may see chronic inflammation of the joints in which there 

 is a cicatricial contraction, where the joints become firm and united, 

 and their mobility is lost. Sometimes from traumatisms we find only the 

 soft parts which surround the joint, such as the external ligaments or 

 the neighboring tendons, become involved in the inflammatory process, 

 while the inner joint seems to be very little affected. 

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