A system of surgery . in a more unyieldingpart would not be possible. The symptoms of acute synovitis of the wrist, however produced,are similar to those observed in other joints. At first there is stiff-ness, then pain of a dull aching character follows, and before longswelling most marked on the dorsal aspect. If the affection be veryacute, and especially if septic, there will be oedema of the subcutan-eous tissue. Fluctuation of fluid in the joint can rarely be felt,the capsule being comparatively small and covered on both aspectsby tendons. In uncomplicated cases the latter move freely and
A system of surgery . in a more unyieldingpart would not be possible. The symptoms of acute synovitis of the wrist, however produced,are similar to those observed in other joints. At first there is stiff-ness, then pain of a dull aching character follows, and before longswelling most marked on the dorsal aspect. If the affection be veryacute, and especially if septic, there will be oedema of the subcutan-eous tissue. Fluctuation of fluid in the joint can rarely be felt,the capsule being comparatively small and covered on both aspectsby tendons. In uncomplicated cases the latter move freely andwithout pain in their sheaths, and the fingers can be flexed andextended without difficulty. But in many cases the inflammatoryirritation has extended from the joint to the tendon sheaths, andall movements of the tendons within the latter are painful, as is alsopressure over the joint. The treatment of simple traumatic cases is easily carried out. Itconsists in absolute rest on a splint, such as that depicted in Fig. 463.—Leather Splint for the Wrist. 463 and in the elevated position. General rest in bed will also bedesirable at first, to quiet the circulation, and saline aperients willalso help in relieving vascular tension. Locally, ice or evaporating lotions may be applied at the outset,and, later, hot fomentations with belladonna. If seen very earlyleeches ought to be applied in cases where there is much these remedies, simple acute synovitis, as a rule, subsidesrapidly in robust individuals, and nothing but stiffness and someswelling is left behind. These effects will often give muchtrouble, owing to the painful neuralgic conditions left, as theconsequence of the bygone inflammation and the consequent dis-inclination of the patient to use the part. They are best met byrubefacients and massage, followed by regular passive it will be necessary to break down adhesions under ananaesthetic, but this must be resorted to with much caution. W
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