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In more severe infections the exudate consists of pus mixed with fibrin, and, it may be, red blood corpuscles purulent or suppurative synovitis; the synovial membrane and the ligaments are softened, and the surface of the membrane presents granulations resembling those on an ulcer; foci of suppuration may develop in the peri-articular cellular tissue and result in abscesses.
A small puncture which introduces into the synovial cavity infectious material of active virulence will cause an arthritis that is more serious, much more painful and more difficult to handle than is occasioned by a wound of moderate size, that affords ready escape of synovia even through the virulence of the infection be the same.
One or two cases have been recorded in which a cartilaginous tumour growing from the synovial membrane has erupted through the joint capsule and infiltrated the adjoining muscles. Multiple cartilaginous tumours forming loose bodies are described on p. 544. Cysts of joints constitute an ill-defined group which includes ganglia formed in relation to the capsular ligament.
However, if synovial discharge persists too long because of tardy closure of an open joint, there is great danger of infection gaining entrance into the synovial cavity, or in some instances, desiccation of endothelial cells of the articulation occurs, in areas, and the reactionary inflammation eventually results in ankylosis.
They vary according to the kind and the amount of motion. The principal structures which unite in the formation of a joint are: bone, cartilage, synovial membrane, and ligaments. The joint-end of bones is coated with a thin layer of tough, elastic cartilage. This is also used at the edge of joint-cavities, forming a ring to deepen them.
The swellings may be due to an injury to the skin and the subcutaneous tissue, or more important structures may be involved, as the subcutaneous bursa, the tendon, or the synovial bursa or sack. Capped hock is caused by the animal kicking in the stall or in harness, shipping in freight cars and lack of bedding in the stall.
Could not the morbid material, which entered the circulation from the re-absorption of the deposit in the solidified lung, have been carried to the synovial membrane of the knee, and there found a lodgment, and set up the inflammation which resulted in the formation of so much pus? If not, Why not?
In acute arthritis, all the structures of the joint are involved; the articular cartilage is invaded by granulation tissue derived from the synovial membrane, and from the marrow of the subjacent bone; it presents a worm-eaten or ulcerated appearance, or it may undergo necrosis and separate, exposing the subjacent bone and leading to disintegration of the osseous trabeculæ caries.
Syphilitic osteo-arthritis results from a gumma in the periosteum or marrow of one of the adjacent bones. There is gradual enlargement of one of the bones, the patient complains of pains, which are worst at night. The disease may extend to the synovial membrane and be attended with effusion into the joint, or it may erupt on the periosteal surface and invade the skin, forming one or more sinuses.
The traditional view of König is that in the knee and most of the larger joints the disease arises in the bone and in the synovial membrane in about equal proportion, and that in the hip the number of cases beginning in the bones is about five times greater than that originating in the membrane.
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