A system of surgery . e instancesthe effused fluid is absorbed, and the joint returns to its natural condition; but inothers—which are, unfortunately, the more common—the effusion isbut the commencement of a series of changes, which rapidly termi-nate in the destruction of the articulation. Within a few weeks ormonths of the first attack the patient notices that the joint getsweaker, and gives way under him; and very rapidly the articulationbecomes so loose and freely movable that in many cases dislocationensues (Figs. 194, 195). Morbid changes.—An examination of such a joint showschanges very
A system of surgery . e instancesthe effused fluid is absorbed, and the joint returns to its natural condition; but inothers—which are, unfortunately, the more common—the effusion isbut the commencement of a series of changes, which rapidly termi-nate in the destruction of the articulation. Within a few weeks ormonths of the first attack the patient notices that the joint getsweaker, and gives way under him; and very rapidly the articulationbecomes so loose and freely movable that in many cases dislocationensues (Figs. 194, 195). Morbid changes.—An examination of such a joint showschanges very similar to those of osteo-arthritis, but, especially in thecase of the bones, the lesions are much more extensive. The thick-ening of the synovial membrane and the formation of fringes onit, the fibrillation and wearing away of cartilage, the growth ofecchonclroses, and the wearing away and destruction of ligaments,are so similar to the lesions of osteo-arthritis that they need nospecial description (Fig. 194).. 195.—Another View of the Femur and Tib:Fig. 194. 02 DISEASES OF NERVES. The changes in the bones are of more importance, and are alsomore characteristic. In typical cases they are worn down to anextent never seen in osteo-arthritis, and are, moreover, often simplyworn down without any new bone being produced, as is common inthe latter disease. In typical cases, the whole head of the femuror humerus, the condyles of the femur, or the head of the tibia areground down and destroyed, as if they hadbeen rubbed away by a grindstone or a file(Fig. 195). It is this extensive destructionof bone even more than the wearing away, ofthe ligaments which must be held accountablefor the dislocations and undue mobility abovementioned. But whilst the above changesmay rightly be considered as typical of cer-tain cases of tabetic arthropathy, it must beallowed that in some examples of this affec-tion the destruction of bone is not so rapidor so complete as here described; and whil
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