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Effusion of

joint, joints, inflammations, swellings, patient, affected and treatment

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EFFUSION OF FLUID.—.\n accumulation of fluid may take place in a joint in consequence of inflammation (see the paragraphs following).

Inflammation.—This is usually a very serious affection, the more serious the larger the joint involved. The seriousness is due to the fact that the function of the affected joint may become impaired, and that even stiffness, with its attendant disability, is liable to set in. In some cases the affected joint, instead of becoming stiff, becomes too movable (shaky), so that it is necessary to apply supporting apparatus in order to render the joint fit for some use. Some diseases of the joints cause severe destructions, so that it eventually becomes necessary to remove the affected bones of the joint. The severest cases may even necessitate amputation in order to preserve the life of the patient. It is obvious, therefore, that in cases of inflammations of joints, it is of the utmost importance to call a physician as early as possible. Nor should the patient lose courage and hope even if recovery or improve ment be long delayed. Inflammations of joints are protracted affections which often require months, or even years, to be cured.

Not all cases are uniformly severe. In the first place, the nature of the effusion which accumulates in the affected joint must be considered. If the effusion be a watery one, the affection, as a rule, is not very serious. The joint becomes swollen, but not red and hot. The disease is more dangerous, however, if a purulent effusion develops. The patient is then usually feverish, and can move the joint only with great pain. It is swollen, and the skin covering it is red and hot ; frequently the swelling has a doughy consistency on pressure.

The cause of the inflammation is of the utmost importance. Certain diseases, especially tuberculosis, syphilis, acute rheumatism, and gonorrhoea, give rise to very severe inflammations. Many inflammations which run a slow course are due to tuberculosis which originates either in the bone or in the membrane of the joint, and which may cause extensive destructions in the joint. Inflammations of the hip-joints and knee-joints in children are

often tuberculous in nature, and are distinguished by a particularly pro tracted course. Naturally, the treatment of the various forms of inflamma tion of joints is quite varied. Massage and medico-mechanical treatment are indicated in some instances ; whereas absolute rest of the joint in an appropriate bandage may be in order in other cases. In many cases, especially in the purulent ones, immediate operation is necessary in order to drain the pus. Others may require surgical interference only in the course of time ; and this is especially the case in tuberculous inflammations. It follows, therefore, that only a physician or a surgeon who is familiar with the different forms of the disease, and with their proper treatment, is able to take the steps necessary to benefit the patient.

Swelling.—In the preceding paragraphs it has been emphasised that inflammation of a joint is a frequent cause of swelling. Other common causes are injuries, such as blows, contusions, or sprains. Articular rheuma tism (acute as \veil as chronic) may likewise give rise to swellings of the joints. When the swelling is the result of an injury, it is caused by an extravasation of blood, which is located either in the soft parts covering the joint or in the joint-cavity. If located in the joint-cavity, the extravasation may be removed by massage, or, if this proves ineffectual, by a slight operation consisting in introducing a hollow needle into the joint, thus draining the blood. After the operation it is necessary to cover the joint \vith a bandage, and to keep it at rest. Many swellings located at a joint do not involve the joint itself, hut are swellings of the mucous pouches (bursa mucosa) which arc situated over the joints. Such swellings of the bursa occur at the joints of the shoulders, knees, and wrists. In simple swellings due to injury, such as spraining the ankle, etc., hot-water applica tions afford much relief. They may be applied by means ofhot cloths or by the use of hot-water bottles.

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