SYNOVITIS.
Simple acute ioflaimodlion of the synovial membrane due to sprain or other form of trauma should be met by absolute rest of the affected joint. This may he carried out in various ways, as by the use of splints, sand bags, etc., and the joint should be fixed in the most useful position should ankvlosis unfortunately follow—e.g., the elbow should be placed beyond a right angle, with the hand well supinated, the knee fully extended. Such appliances, however, are not to interfere with the application of the remedies about to be mentioned.
Cold, either in the form of e\ aporating lotions, or, what is much better, ce applied freely round the joint, or Leiter's tubes is the most successful of all treatments. Leeching may he resorted to when the pain and high tension do not rapidly yield to ice-bags applied round the joint. Upon an inflamed knee-joint a dozen, or more leeches may be placed, and bleeding from the bites may be encouraged by the application of warm poultices or fomentations. When the pain does not yield to cold applica tions, warmth should be tried and hot Boric compresses covered in by oiled silk are the best means of carrying out this form of treatment.
Green Extract of Belladonna rubbed up with twice its weight of glycerin is a favourite local application for the relief of pain; the stronger B.P. belladonna preparations should not be employed owing to the risk of absorption. The method of producing venous congestion is sometimes followed by excellent results.
Opium for the relief of pain may be necessary, 15 grs. I over's Powder with 2 grs. An timonial powder every 8 hours may he given.
Purgation by Sulphate of Magnesia,followed by a diaphoretic containing small doses gr.) of Tartar Emetic, at short intervals, is the best constitu tional treatment in sthenic and traumatic cases occurring in the robust.
The following nix litre he administered: .1/agnexii SoIphdli.N Tarlardil gr. j.
l'inelniCe Syrupi nra nth 5j.
,Igurp oullia? Piperild. ad 5xvj.
Fiat misliira. capiar coehlearia duo magna sccundis Aspiration should be resorted to when the joint is distended with fluid, strict antiseptic precautions being followed. If the fluid is found to be purulent, the best plan is free incision and drainage, the drainage extending down to, but not into, the synovial cavity; the joint should be thoroughly flushed with an antiseptic solution, and in apparently hopeless cases the method of continuous irrigation with warm Saline or Boric solution, and the occasional injection of Hydrogen Peroxide may restore the integrity of the articulation. A vaccine prepared from the pus should be employed to hasten resolution, and when septic inflam mation extends to the osseous tissue excision or resection will be neces sary, and in some cases an amputation may be the only means of saving life.
In rheumatic cases large doses of Salicylate of Soda should be given, and where gout figures in the causation Colchicum may be safely pre scribed, with a padding of absorbent wool round the joint, which should then be enveloped in oiled silk. I n synovitis in syphilitic patients treatment
should be inaugurated by two or three full doses of Salvarsan or its substitutes, and when the immediate effects of these have passed off a course of mercury or, better still, mercury and iodide should be prescribed.
The acute symptoms having subsided in an ordinary simple synovitis, the question of commencing passive movements arises. The mistake is likely to be made of prolonging the rest treatment unduly. Massage, friction and douches with radiant heat baths should be cautiously com menced and persisted in till the function of the articulation has been restored.
In chronic synovitis the treatment is to be carried out on similar lines, and if fluid remain in the joint after the subsidence of pain and local heat, elastic pressure, by layers of cotton-wool, beneath a calico bandage firmly applied or by a perforated rubber bandage, will be found very effeotive, and in addition counter-irritants are to be employed. Small blisters may he applied in 3 or 4 places over a large joint like the kn ee„ or the actual cautery may be lightly pressed against the skin in a few places. Counter irritation by means of strong Iodine preparations is a valuable routine, and massage, douches and passive movements may be carried out whilst the iodine is being daily applied.
Hydrops articuli,which fails to yield to pressure and the above measures, should he aspirated and the elastic bandage reapplied. In other cases strapping by adhesive plaster spread upon some strong fabric serves the same purpose, provided the plaster be removed and reapplied at short intervals as the swelling diminishes. Scott's dressing or a mild Mercurial preparation spread upon lint may be applied to the joint under the strapping. By these means much fluid and even thickening of the synovial membrane may be got rid of, by the assistance of passive motion and gentle exercise of the joint and the internal administration of Iodide of Potassium in full doses.
Hydrops articuli is frequently of tuberculous origin. It must then be treated as tubercle elsewhere by rest, pressure, tuberculin, and on general hygienic principles. In the case of the knee it will often he advisable to apply a Thomas's splint and accept at once the disability of a stiff joint.
In neglected cases or when the rest cure has been througli undue caution kept tip too long. ankvlosis results; should an attempt under general anesthesia fail to break down adhesions, operative procedures may be necessary to restore the mobilit\ of the articulation. When the svnovitis is clue to presence of a loose cartilage in the joint, it should be removed ; when due to imperfect repair of ligaments after a sprain, a thickened sole or steel may be used to prevent further stretching of the injured ligament; failing this, it must he removed by opening the articulation.