.,CLOSED ACUTE SYNOVITIS. __- 327. 
“days: Sometimes the suppuration is slow to stop, and recovery demands | 
six weeks or two months to take place. Too often adhesions have taken 
‘Place; the tendons do not move any longer in their. sheath ; there re- 
‘mains a marked stiffness, so much more that the suppuration has lasted , 
longer... Massage, warm water, moderate exercise, form the base of the 
“treatment during convalescence. When an important tendinous synovial 
(carpal, tarsal, great sesamoid) has been the seat of suppurative inflam-~ 
“mation,.it is -rare if the region recovers the entire freedom of its motion. 
In.guch, cases, be overcome the remaining induration, cauterization must | 
~be resorted. to. 7 
spnliee rigde se > UL 
BF « 
ae CLOSED ACUTE SYNOVITIS. 
Dee to various causes (overwork, contusions, luxations, sprains, juxta- 
-epiphysar fractures, perisynovial abscesses), simple acute synovitis offers, 
in its mode of development, various characters which have justified the . 
-division into a dry form (crepitant or plastic synovitis) and another with 
-effusion (serous or purulent synovitis). On account of its ‘superficial 
“Situation and the important part it plays during locomotion, the great ses- 
-amoid synovial is the most frequently affected. 
In crepitant synovitis, there is no marked exudation ; the congested 
-serous, partly deprived of its endothelium, remains dry and the friction of 
its wall gives rise to a sort of crepitation. This variety, which sometimes 
‘js: but the initial condition of the serous Om has not been well 
-studied in our animals. j 
Plastic synovitis begins also dry; the synovial becomes covered by a 
‘layer first embryonic, then fibrous, which creates tendinous adhesions. It 
-occurs specially after sprains, luxations or traumatic synovitis. The ten-' 
-don, more or less ankylosed in its sheath, retracts; and functional impo- 
‘tence or deformity of the joint are the results. When they exist in the. 
‘tendons of the flexors of the phalanges, these “ vagino-tendinous sym-, 
-physis » promote the production of knuckling. 
« Serous synovitis is characterized by the exudation, on the surface of the 
‘synovial, of a reddish liquid, doce in the cavity and. distending its 
-cul'de sac. 
The clinical characters of acute synovitis sane anatomical data. permit: 
can dasy diagnosis. The region is painful, tumefied, and little by little the 
‘serous is distended, pushed out by the fluid- accumulated in it. 
* At the beginning, the inflammatory phenomena-are treated by rest and 
-coritinued irrigation or by cold compresses and repeated astringent lotions. 
"To control the intra and perisynovial exudation, itis advantageous, to apply. 
-on the compresses a band:of flannel or of linen ; rubber bands can also-be: 
