. Diseases of bones and joints . Fig. 25. Tuberculosis of an adults wrist. Note the swelling. This pic-ture would do equally well to illustrate any joint disease in Type is nothing characteristic about it. No one could possiblymake a diagnosis from its inspection. long time, communicating with the joint and withthe surface by tracts called sinuses, whose walls, as The Sinuswell as the tissues of the joints to which they run,are lined with tubercles, and discharge large quan-tities of foul pus. 58 DISEASES OF BONES AND JOINTS SYNOVAL DISEASE. When the disease starts in the synovia the o
. Diseases of bones and joints . Fig. 25. Tuberculosis of an adults wrist. Note the swelling. This pic-ture would do equally well to illustrate any joint disease in Type is nothing characteristic about it. No one could possiblymake a diagnosis from its inspection. long time, communicating with the joint and withthe surface by tracts called sinuses, whose walls, as The Sinuswell as the tissues of the joints to which they run,are lined with tubercles, and discharge large quan-tities of foul pus. 58 DISEASES OF BONES AND JOINTS SYNOVAL DISEASE. When the disease starts in the synovia the orig-inal tubercle is deposited in its lymphoid tissue, andthe disease extends down to the fibrous capsule andover part of the membrane, or throughout it all,. Fig. joint tuberculosis in the adult, of about ten years duration—the slow chronic form. Note the disappearance of the joint car-tilage, the worm-eaten appearance of the bone, and the areas ofbone condensation. An arthroplasty operation was done on this joint,but of course the wound broke down, suppuration ensued, and asubsequent resection was necessary. possibly involving the bone by extension into itssubstance at the margin of the cartilage, where thesynovia is attached. From this point there is noessential difference in the behavior of the twoforms, bony and synovial. DISEASES OF BONES AND JOINTS 59 On the other hand the disease may remain foryears confined to the synovia and may never ex-tend to the bone, unless this extension be broughtabout by unwise operative measures. The surface of the synovia may be covered by Necrosis innecrotic tissue in places, and necrosis may also be the Synoviadetected in its substance. Layers of fibrin havebeen described by many writers as o
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