. Roentgen interpretation; a manual for students and practitioners . entirely out of pro-portion to the injury and would not have occurred in a normaljoint. This condition is continually being encountered in industrialaccident work. Gout.—Gout is less common but, like the first type, occurs afterforty, more frequently in men than in women. In a typical case itpresents peri-articular swelling and very characteristic punched-outareas in the bones at the margins of the articular surfaces. Theseholes are sharply cut and vary from one to several millimeters indiameter, in severe cases causing compl
. Roentgen interpretation; a manual for students and practitioners . entirely out of pro-portion to the injury and would not have occurred in a normaljoint. This condition is continually being encountered in industrialaccident work. Gout.—Gout is less common but, like the first type, occurs afterforty, more frequently in men than in women. In a typical case itpresents peri-articular swelling and very characteristic punched-outareas in the bones at the margins of the articular surfaces. Theseholes are sharply cut and vary from one to several millimeters indiameter, in severe cases causing complete destruction of an articular7 98 JOINTS, TENDONS AND BURSM end of the bone. There is httle effusion in the joint, erosion of thecartilages occurs only in the late severe cases and there is no decal-cification. Usually some slight hypertrophic spurs are present. Itordinarily occurs in the phalangeal joints of the hands and feet,but may affect the carpus or tarsus and in rare cases a large joint,such as the knee, simulating here an early Charcot joint from the. Fig. 71.—Gout. amount of destruction and new bone formation which takes the early stages before the punched-out areas become evidentit may be mistaken for a hypertrophic arthritis. It is, of course,accompanied by other clinical evidence of the disease. Charcot Joints.—A striking picture which occurs in patients withtabes or syringomyelia is seen usually in middle age. There is tre-mendous swelling of the soft parts, destruction of articular surfaces. ATROPHIC ARTHRITIS 99 amounting to complete disorganization, and large irregular massesof calcified material scattered throughout the joint. There is nodecalcification of bone. Its commonest sites are the knee, hip,ankle and spine. Conditions which may be confused with it are(1) gout, which is rare in large joints and always involves the smallerones in addition; (2) loose bodies in joints, in which case the cal-cified masses are small, dense and few in number
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