. Diseases of bones and joints . Fig. 23. Low power photo-micrograph of a case of knee joint tuberculosisin a child about ten years old. The focus was located on the shaftside of the epiphyseal line. The tuberculous granulations madetheir way to the periosteum, and burrowed along under this, andthen under the articular cartilage. A—articular cartilage, B—epiphy-sis, C—epiphyseal cartilage, D—-periosteum, E—-tuberculous granu-lations. break through at some one spot, or they may spread Damage to the out and break into the joint at the margin of the Cartilage cartilage. Sometimes they spread out
. Diseases of bones and joints . Fig. 23. Low power photo-micrograph of a case of knee joint tuberculosisin a child about ten years old. The focus was located on the shaftside of the epiphyseal line. The tuberculous granulations madetheir way to the periosteum, and burrowed along under this, andthen under the articular cartilage. A—articular cartilage, B—epiphy-sis, C—epiphyseal cartilage, D—-periosteum, E—-tuberculous granu-lations. break through at some one spot, or they may spread Damage to the out and break into the joint at the margin of the Cartilage cartilage. Sometimes they spread out under the entire cartilage and lift it off. When they gain the DISEASES OF BONES AND JOINTS 55 joint, they infect the synovia on its surface, or, ifthe disease has reached the margin of the cartilagewithout breaking into the joint, then the synoviais probably involved by direct extension. The dis-ease then attacks the other bone or bones of the. Fig. 24. Low power photo-micrograph of a portion of a collection of ricebodies in their capsule, from a tuberculous knee joint in an adult. articulation, entering them at or near the peripheryof the joint cartilage. Before the tuberculous granulations reach thejoint a serious effusion is often formed in its cavity. Reaction of The synovia shows the typical tubercles when it the syn°viahas been involved, on its surface or in its substanceor both. It is thickened, succulent, and usually 56 DISEASES OF BONES AND JOINTS presents greatly enlarged villi: again, it may betough and fibrous. It may be involved throughoutits extent or only in certain areas. It sometimeshypertrophies, and extends outward over the jointsurfaces, hiding them more or less completely—sy-novial pannus. This pannus may be attached tothe degenerated cartilages or it may not be. It doesnot eat its way into the cartilages, as some writersSynovial have affirmed, but the disease spreads from thePannus synovia under the
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