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Updated: June 27, 2025
There are no bones resting on each other, no synovia; but where the scapula has its largest range of movement there is a remarkable amount of areolar tissue, which renders movement easy.
In the handling of open joint capsules where the perforation of the capsular ligament is small and discharge of synovia does not immediately follow, there is presented a problem which is difficult to decide upon and that is the manner in which such wounds are to be handled.
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.
A larger opening than is produced by means of an exploratory trochar may be made into a joint cavity, causing escape of synovia as it is secreted for days and even for weeks and no serious or permanent trouble is experienced in some cases.
In from one to two months wounds so treated, unless they are foot-wounds, will be ready to dress without being bandaged. It is ordinarily unnecessary to dress foot-wounds oftener than every second week after the discharge of synovia has ceased. When the wound has filled with granulation, a protective dressing is applied which is rendered water proof by the use of bandages covered with oil of tar.
The application of blistering agents is of no value in stimulating resorption of an excessive amount of synovia in chronic cases and the actual cautery when employed without perforation of the synovial structure, is of little benefit.
If there is evidence that the articulation contains infective material, it is washed out with copious quantities of peroxide of hydrogen usually as much as six or eight ounces. This is followed by injection of an ounce or two of tincture of iodin. Even though the joint appears to be clean some tincture of iodin is used, as it checks the secretion of synovia and is, in every way, beneficial.
The appearance of the wound varies in the different regions and the different tissues. If the tissues are badly torn or bruised, swelling and sloughing may occur. If the wound is transverse to the muscular fibres, it gaps more than when parallel to the muscle. Wounds involving tendons, bursae and closed articulations become swollen and discharge synovia.
Experience is necessary to judge as to this part of the work, but one may consider that a quantity between three and ten cubic centimeters of equal parts of tincture of iodin and alcohol constitutes the proper amount to employ. Where much synovia is contained within the sheath at the time of injection, there occurs great dilution of the agent injected and consequently less irritation results.
The articular aspect of the epiphysis is invested with a thick layer of hyaline cartilage, known as the articular cartilage, which would appear to be mainly nourished from the synovia. The external investment the periosteum is thick and vascular during the period of growth, but becomes thin and less vascular when the skeleton has attained maturity.
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