. Diseases of bones and joints . l interference,and not to muscular spasm. Grating and crackingmay be perceived on palpation or on auscultation. Herberdens Nodes manifest themselves as smallhard nodules on the sides of the terminal phalanges,not painful, as a rule, except during the process offormation. They are accompanied by lateral dis-tortions and slight flexions of the end phalanges. DIAGNOSIS. v In the early stages of the disease, especially of the deeper joints, a positive diagnosis may be impos-sible ; hence the advisability of conservatism. Manyof these joints have been resected as tu
. Diseases of bones and joints . l interference,and not to muscular spasm. Grating and crackingmay be perceived on palpation or on auscultation. Herberdens Nodes manifest themselves as smallhard nodules on the sides of the terminal phalanges,not painful, as a rule, except during the process offormation. They are accompanied by lateral dis-tortions and slight flexions of the end phalanges. DIAGNOSIS. v In the early stages of the disease, especially of the deeper joints, a positive diagnosis may be impos-sible ; hence the advisability of conservatism. Manyof these joints have been resected as the later stages the bony and cartilaginous out-growths, the lipping of the joint circumference, 140 DISEASES OF BONES AND JOINTS the bony thickening, with the wearing away of thecartilage in places, should clinch the diagnosis. The cases accompanied by the formation ofHeberdens nodes should occasion no difficulty. Tuberculosis is uniarticular and begins insidiouslyalso, but is more painful as a rule, is accompanied. Fig. 57. Photomicrograph of the same case as the preceding. This pic-ture shows well the degenerating cartilage—its fibrillation. Notethe cartilage tatters. Zeiss objective aa, no ocular. by muscular spasm, and shows in a skiagram anearly rarefaction of the bone. The limitation ofmotion in tuberculosis is caused by muscular spasmas well as by the products of inflammation in thejoint, while in this type of arthritis the obstructionis almost exclusively mechanical. Bony and car- DISEASES OF BONES AND JOINTS 141 tilaginous outgrowths do not occur in tuberculosis,though the bone tissues may be increased in densityin the later stages. Other cases- in Type I, as we have seen, are char-acterized by bony atrophy, thickening of the syno-via, and atrophy and erosion of the articular carti-
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