. Physical diagnosis . Fig. 223.—a, Charcots Joint with Loose Bodies ; b, Pulmonary Osteo-arthropathy. tion. All may be complicated by endocarditis, but in those of un-known origin (rheumatic) this complication is especially com-mon. There is no bony hypertrophy, bone destruction,1 sinusformation, or marked irregularities of contour. A general enlarge-ment (more or less spindle shaped, owing to periarticular thick-ening and muscular atrophy) is the rule. The joint motions are 1 See note on page 493. 496 PHYSICAL DIAGNOSIS. limited chiefly by pain and effusion; muscular spasm is not prom-inent.
. Physical diagnosis . Fig. 223.—a, Charcots Joint with Loose Bodies ; b, Pulmonary Osteo-arthropathy. tion. All may be complicated by endocarditis, but in those of un-known origin (rheumatic) this complication is especially com-mon. There is no bony hypertrophy, bone destruction,1 sinusformation, or marked irregularities of contour. A general enlarge-ment (more or less spindle shaped, owing to periarticular thick-ening and muscular atrophy) is the rule. The joint motions are 1 See note on page 493. 496 PHYSICAL DIAGNOSIS. limited chiefly by pain and effusion; muscular spasm is not prom-inent. One or many large or small joints may be affected in any of thevarieties of infectious arthritis, though the gonorrhceal virus is apt. Fig. 224.—Atrophic Arthritis. Early stage. to lodge in few joints (oftenest the knee or ankle) and the rheu-matic virus in many joints, while the typhoid poison has a predi-lection for the spine. III. Atrophic Arthritis.—Two types must be recognized: (a) Amonarticular form, secondary usually to tabes or syringomyelia(■Charcots joint, neuropathic joint), and other diseases of thespinal cord, (b) A polyarticular primary form ( rheumatoid ar-thritis). In both, the distinguishing characteristic is atrophy and destruc-tion of cartilage, bone, and joint membranes—a process which inthe early stages can be identified only by the cc-ray (see Fig. 222). THE JOINTS. 497
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