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The fringes of synovial membrane may also undergo a remarkable development, like that observed in arthritis deformans, and described as arborescent lipoma. Both these types are almost exclusively met with in the knee. The Contents of Tuberculous Joints. In a large proportion of cases of synovial tuberculosis the joint is entirely filled up by the diffuse thickening of the synovial membrane.
The slightest movement causes pain, and the part is sensitive to touch. The skin is hot and tense, and in the case of the elbow may be red and fiery as in erysipelas. The deposit of fibrin on the synovial membrane and on the articular surfaces may lead to the formation of adhesions, sometimes in the form of isolated bands, sometimes in the form of a close fibrous union between the bones.
Some of these consist simply of bands, connecting the joint on its different sides, while others form continuous sheaths around the joint. Tendons. 2. Ligaments. 3. Cartilage. 4. Space containing synovial fluid. This space is lined, except upon the articular surfaces, by the synovial membrane. This secretes a thick, viscid liquid, the synovial fluid, which prevents friction.
If daily injections are necessary, dilution of the tincture of iodin with an equal amount of alcohol is advisable in order to avoid doing irreparable damage to the articular cartilages and synovial membranes. An antiseptic powder composed of equal parts of boric acid and exsiccated alum is employed to protect the wound surfaces and the margins, and the parts are then bandaged.
The object sought by the introduction of iodin is not only for a local effect upon the synovial membranes in checking secretions, but the production of an active inflammation and great swelling, which will remain from four weeks to three months subsequent to the injection.
The disease may commence in the synovial membrane or in the marrow of one of the adjacent bones, and the relative frequency of these two seats of infection has been the subject of considerable difference of opinion.
#Pneumococcal affections of joints#, the result of infection with the pneumococcus of Fraenkel, are being met with in increasing numbers. The local lesion varies from a synovitis with infiltration of the synovial membrane and effusion of serum or pus, to an acute arthritis with erosion of cartilage, caries of the articular surfaces, and disorganisation of the joint.
Little closed sacs, called synovial sacs or bursæ, similarly lined and containing fluid, are also found in special places between two surfaces where much motion is required. Without these, the constant motion of the knee-pan and its tendons in walking would produce undue friction and heat and consequent inflammation.
#Bacterial Diseases.# In most bacterial diseases the organisms are carried to the joint in the blood-stream, and they lodge either in the synovial membrane or in one of the bones, whence the disease subsequently spreads to the other structures of the joint. Organisms may also be introduced through accidental wounds.
Ulceration and Necrosis of Cartilage. The synovial tissue covering the cartilage causes pitting and perforation of the cartilage and makes its way through it, and often spreads widely between it and the subjacent bone; the cartilage may be detached in portions of considerable size. It may be similarly ulcerated or detached as a result of disease in the bone. Caries of Articular Surfaces.
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