United States or North Korea ? Vote for the TOP Country of the Week !
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.
The deposit of urates in the synovial membrane is attended with effusion into the joint and the formation of adhesions, while in the ligaments and peri-articular structures it leads to the formation of scar tissue. The metatarso-phalangeal joint of the great toe, on one or on both sides, is that most frequently affected.
Ledderhose and others regard ganglia as entirely new formations in the peri-articular tissues, resulting from colloid degeneration of the fibrous tissue of the capsular ligament, occurring at first in numerous small areas which later coalesce. Ganglia are probably, therefore, of the nature of degeneration cysts arising in the capsule of joints, in tendons, and in their sheaths. Treatment.
A peri-articular abscess may spread in several directions, sometimes invading tendon sheaths or bursæ, and finally reaching the skin surface by tortuous sinuses. Reactive changes in the vicinity of tuberculous joints are of common occurrence, and play a considerable part in the production of what is clinically known as white swelling.
In the milder forms recovery is the rule, with more or less complete restoration of function. In more severe forms the joint may be permanently damaged as a result of fibrous or bony ankylosis, or from displacement or dislocation. From changes in the peri-articular structures there may be contracture in an undesirable position, and in young subjects the growth of the limb may be interfered with.
The joint is held rigid in the flexed position, and the least attempt at movement causes severe pain; the slightest jar even the shaking of the bed may cause agony. The joint is hot, tensely distended, and there may be œdema of the peri-articular tissues or of the limb as a whole. If the pus perforates the joint capsule, there are signs of abscess or of diffuse suppuration in the cellular tissue.
Recovery is apt to be attended with impairment of movement due to adhesions, ankylosis, or contracture of the peri-articular structures. Caseous foci in the interior of the bones may become encapsulated, and a cure be thus effected, or they may be the cause of a relapse of the disease at a later date.
The occurrence of dislocation is also favoured by destructive changes in the bones. Peri-articular tubercle and abscess may result from the spread of disease from the bone or joint into the surrounding tissues, either directly or by way of the lymphatics.
It usually subsides in two or three weeks under rest, but tends to relapse. An acute synovitis with peri-articular phlegmon is most often met with in the elbow, but it occurs also in the knee and ankle. There is a sudden onset of severe pain and swelling in and around the joint, with considerable fever and disturbance of health.
New connective tissue forms in the peri-articular fat and between muscles and tendons. It may be tough and fibrous, or soft, vascular, and œdematous, and the peri-articular fat becomes swollen and gelatinous, constituting a layer of considerable thickness. The fat disappears and is replaced by a mucoid effusion between the fibrous bundles of connective tissue.
Word Of The Day