WRIST-JOINT (ABNORMAL ANATOMY). 



1526 



Arthritis, or White Swelling, of the Wrist. 

 When we remove the integuments from the 

 wrist, in one of those advanced cases of 

 chronic strumous disease of the radio-carpal 

 and inter-carpal articulations, we encoun- 

 ter the usual appearance of a gelatiniform 

 effusion, of a yellowish-green colour ; we 

 observe the tendons and nerves somewhat 

 swelled, as if infiltrated; the ligaments all 

 softened ; purulent matter occupying the in- 

 terstices of the articular surfaces ; the bones 

 easily yielding to pressure, hollow and carious 

 in the centre of their cancillated tissue ; and 

 leading from these carious bones, are seen 

 fistulous canals opening extensively by nu- 

 merous orifices on the cutaneous surface of 

 the wrist. 



In the Museum of the College of Surgeons 

 of Dublin we find a preparation, which is 

 truly designated as an instructive one, show- 

 ing the effects of scrofulous disease on the 

 bones and other structures of the wrist. To 

 save the patient's life, it became necessary to 

 perform an amputation of the forearm. The 

 hand has been preserved in spirits, and the 

 back of the carpus has been laid open to 

 view. The wrist is semi-flexed ; the palm and 

 fingers are swollen, and the front of the joint 

 is studded with fistulous orifices. One soli- 

 tary fistulous orifice appears in the centre of 

 the palm. The bones of the carpus, deprived 

 of their synovial membranes and ligaments, 

 are loose and disjointed ; and to use the words 

 of the donor, the late Professor Todd, "they 

 felt during life like a bag of marbles." 



There is also another preparation, styled 

 " scrofulous disease of the carpus, meta-car- 

 pus, and extremity of the radius," presented 

 by Professor Porter. The bones are re- 

 remarkably soft, light, and porous. The na- 

 tural shape of each is considerably altered, 

 by loss of substance in some parts, and de- 

 posits of new osseous matter in others : the 

 latter, wherever it exists, has a peculiar spi- 

 culated appearance; some of the bones are 

 increased in size, others diminished ; the car- 

 tilages have, for the most part, disappeared ; 

 the synovial membrane of the smaller joints 

 had been completely destroyed ; that of the 

 radio-carpal articulation was hypertrophied, 

 soft, and pulpy. The ligaments were not 

 recognizable, and the bones lay almost loose 

 in a quantity of purulent matter, with which 

 a fistulous orifice, in the front of the joint, 

 communicated. The skin, the cellular tissue, 

 and the sheaths of the tendons were infil- 

 trated with a thin gelatinous fluid ; the median 

 and ulnar nerves were remarkably enlarged. 



The scrofulous disease, commencing in the 

 centre of the cancellous structure of the 

 bones of the carpus and carpal extremity of 

 the radius, does not always proceed thus un- 

 favourably. Anchylosis, with partial displace- 

 ment of the forearm at the wrist-joint, may, 

 as already stated, be established, as the result 

 of the morbid action we are here treating of. 



In the Museum of Anatomy in Leyden 

 there is a preparation of the bones of the 

 wrist, in which the carpal extremity of the 



radius and ulna are much enlarged and remark- 

 ably scabrous on their surface ; the radius 

 and ulna are anchylosed firmly with each 

 other near to the carpus ; the os lunare was 

 united to both radius and ulna; the os sca- 

 phoides, cuneiform and magnum, had totally 

 disappeared ; the trapezium was also firmly 

 united to the meta-carpal bone of the thumb 

 and with that of the index finger. 



In the above-mentioned Museum at Ley- 

 den there is also another preparation, ex- 

 hibiting anchylosis of the bones of the forearm, 

 and of the carpus, at the wrist-joint, after the 

 disease, which had arisen, we are told, from a 

 scrofulous cause, had happily been cured. 



In concluding, then, the account of the 

 anatomical characters of the scrofulous caries 

 of the bones which compose the region of the 

 wrist, we may observe, that, as a result of this 

 disease, some of the carpal bones are di- 

 minished in size in many cases, while in others 

 they are enlarged. We have noticed some 

 specimens in which two or three of the carpal 

 bones have disappeared altogether, while 

 others have had additional bony growths 

 attached to them. The lower extremities of 

 the bones of the forearm, in almost all the 

 cases, were found rough and scabrous, and 

 increased in bulk, particularly close to the 

 wrist-joint. We, also, after our own examina- 

 tion of the bones of the region of the wrist, 

 have to make the same observation that 

 Sandiford has made relative to the specimens 

 he has preserved in the Anatomical Museum 

 of Leyden, of which he says, " Omnia hoec 

 ossa levissima sunt."* 



Chronic Rheumatic Arthritis of the Wrist. 

 The wrist-joints, together with the joints of 

 the carpus, are very frequently affected with 

 the disease we have elsewhere, in this work, 

 called " Chronic Rheumatic Arthritis," or 

 rheumatic gout. 



When the joints which enter into the region 

 of the wrist are engaged, the fingers are all 

 more or less distorted, and their joints en- 

 larged, as already described. (See HAND.) 



Females are more liable to have their wrist- 

 joints affected with chronic rheumatic arth- 

 ritis than males, and elderly persons more 

 commonly than those who are young; but 

 this disease is to be seen, occasionally, in 

 young persons of both sexes. The disease, 

 when it appears in the wrist-joint, will, in 

 general, be found to affect, symmetrically, the 

 right and left wrist of the patient. The cause 

 of the disease is generally referred to rheu- 

 matic fever, and the other articulations of the 

 patient are usually more or less implicated. 

 The patient complains of pain in the joints, 

 particularly at night, of stiffness and rigidity, 

 and of a crackling sensation in them when 

 they are moved. When we come to examine 

 the wrist, it is remarked to present a preter- 

 natural convexit}' on its dorsal aspect, arising 

 from an inordinate quantity of fluid poured 

 out into the synovial sac of the joint. The 



vol. iii. 



Museum Anatomicum, Sandiford, p. 244. 



