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Inflammation of Joints

joint, fluid, membrane, severe, swollen and swelling

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The most delicate part of a joint is the syn ovial membrane, which pours out the synovia or fluid lubricating the joint (p. 64). It is liable to inflammatory changes, in which the amount of blood flowing through the vessels of the membrane will be increased, the membrane will be swollen to some extent, and the amount of fluid it pours into the joint will consequently be augmented. This constitutes the commonest form of joint inflammation.

Inflammation of the Synovial Mem brane (Synovitis, Dropsy of Joints).--The in flammation may rapidly subside, and the excess of fluid be absorbed. On the other hand, it may proceed to a more severe form, when the mem brane becomes very full of blood, and greatly swollen, the edges being fringed with pulpy deposits formed by the material poured out by the blood-vessels. Suppuration may occur, and the fluid of the joint become mixed with matter, or a regular abscess may exist in the joint, while the ligaments become thick and swollen. The disease may extend to the cartilages, produc ing dulness and cloudiness of their substance. In chronic cases the cartilages are wore seriously concerned, the continuance of the inflammation causing them to become softened or ulcerated, or parts of them may die so that they may be peeled off in large or small pieces, the bone they cover being also affected. The condition in which the synovial membrane has passed into pulpy degeneration is called white-swelling.

Symptoms.—Corresponding with this differ ence in the severity and acuteness of the attack is the nature of the symptoms. In the simple acute case you may have an otherwise healthy man complain of a stillness of his joint—gener ally the knee-joint. The joint is seen to be swollen, and if one hand rest on one side of the joint and the other side be tapped by a finger of the other band a feeling of a wave passing through the joint will be experienced. This is called fluctuation, and signifies the presence of fluid in the joint. This accumulation of

fluid invariably alters the shape of the joint-- an alteration which may easily be observed by comparing the affected joint with the sound one of the opposite side. The swelling is most prominent at the least-covered portions of the joint: in time knees it is seen at each side of the patella, which is projected forwards: at the elbow-joint it is above the olecranon process, and between it and the projection on each side of the arm-bone: in the case of the ankle the fulness is at each side of the joint. There is some pain, but little fever or serious general disturbance. In time severe cases of the acute form, however, the pain in the joint is very great, and aggravated by the least motion. The swelling is great, the skin over the joint being red and tender ; and the fever is often very high and severe. The patient lies in bed with the leg bent and turned outwards, and all the muscles are on guard, as it were, to pre vent any change in that position. The swelling and puffiness extend to the leg. In the chronic forms, where the cartilages are ulcerated or partly dead, besides a (lull, aching pain, worse at night, and swelling, &c., there will be sudden startings of the limb, which may occur while the patient is asleep and awake him. This is always a symptom characteristic of degenera tive changes occurring in the joint. The occur rence of shiverings, m high range of tempera ture, and severe sweating indicates the forma tion of an abscess in the joint. In abscess as well as in ulceration the matter may burst through the joint, work its way among the soft parts to the surface, through which it breaks, and an opening or openings are left from which the matter escapes.

The causes- of the disease are exposure to cold, blows, strains, wounds, or mechanical in juries. Besides these purely local causes, there are others which are constitutional, such as rheumatism, gout, venereal disease, and blood poisoning (pyamruia).

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