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The disease spreads throughout the capsule and synovial membrane, which becomes diffusely thickened and infiltrated with granulation tissue which eats into and replaces the articular cartilage.
This estimate, so far as the actual frequency of bone lesions is concerned, has been generally accepted, but recent observers, notably John Fraser, do not accept the presence of bone lesions as necessarily proving that the disease commenced in the bones; he maintains, and we think with good grounds, that in many cases the disease having commenced in the synovial membrane, slowly spreads to the bone by way of the blood vessels and lymphatics, and gives rise to lesions in the marrow.
The inflammation was but little influenced by this or any other treatment. The knee continued to slowly and surely enlarge. And this extended upward without first producing any great distention of the synovial sack under the patella. There seemed to be simply enlargement of all the tissues of the lower part of the thigh.
As the swelling of the joint is associated with wasting of the muscles, with stiffness, and with flexion, the condition closely resembles tuberculous disease of the synovial membrane. From errors in diagnosis such joints have been operated upon, with disastrous results due to hæmorrhage. The treatment of a recent hæmorrhage consists in securing absolute rest and applying elastic compression.
In the early stage the swelling is elastic, doughy, and non-sensitive, and corresponds to the superficial area of the synovial membrane involved, and there is comparatively little complaint on the part of the patient, because the articular surfaces and ligaments are still intact.
The young bone is replaced by granulation tissue, so that large clear areas are seen with the X-rays. The symptoms are referred to the joint, because it is there that the muscles are inserted and drag on the perichondrium when movement occurs; swelling is most marked in the vicinity of the joint, and it may be added to by effusion into the synovial cavity.
They are considered in greater detail in the chapter dealing with tumours of bone. Minute nodules of cartilage sometimes form in the synovial membrane of joints and lining of tendon sheaths and bursæ: they tend to become detached from the membrane and constitute loose bodies; they also undergo a variable amount of calcification and ossification, so as to be visible in skiagrams.
Multiple Chondromas and Osteomas of the Synovial Membrane. In this rare type of loose body, the surface of the synovial membrane is studded with small sessile or pedunculated tumours composed of pure hyaline cartilage, or of bone, or of transition stages between cartilage and bone.
They are not peculiar to joints, for they are met with in tendon sheaths and bursæ, and their origin from synovial membrane may be accepted as proved. They occur in tuberculosis, arthritis deformans, and in Charcot's disease, and their presence is almost invariably associated with an effusion of fluid into the joint.
Thus it is seen that because of its frequent communication with the other parts of this large synovial membrane, a wound which opens the external portion of the femerotibial capsule may be the cause of contamination and resultant infectious arthritis of the whole stifle joint.