File:Lectures on orthopedic surgery (1899) (14590111539).jpg

Identifier: lecturesonortho00ridl (find matches)
Title: Lectures on orthopedic surgery
Year: 1899 (1890s)
Authors: Ridlon, John, 1852-1936 Thomas, Hugh Owen, 1834-1891 Jones, Robert, joint author
Subjects: Orthopedics
Publisher: Philadelphia, E. Stern & Co., Inc.
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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such untreatedthan to commence forcible bendings before a completesubsidence of the inflammatory process. Tuberculosismay here, as elsewhere, commence as a primary ora secondary focus in the bone or in the synovial mem-brane; and as a synovitis it commences here next infrequency to the same condition at the knee. Chronicdisease, the result of inherited syphilis, is not infre-quently met with at this joint. Disease following a neglected slight traumatism hasits symptoms grafted on to those of the original injury.When first seen there is some obliteration of the nor-mal bony outlines ; thickening and some tenderness can 239 be made out between the olecranon and the condyles oneither side, and there is some restriction to full flexionand extension, but no true involuntary muscular spasm.As the case progresses the swelling increases, thethickening becomes more pulpy and ultimately fluctu-ates, and sooner or later the bone is invaded, and thentrue muscular spasm restricts the joint motion.
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Fig. 195.—The halter applied in elbow-joint disease. A tuberculous synovitis presents no symptoms exceptswelling and a slight elastic restriction to full flexionand extension, until the bone is invaded or an abscessforms. Those cases which follow severe injuries and resultfrom the efforts of the surgeon in the direction of pas- 240 sive motion follow much the same course. The thick-ening, the tenderness, and the restricted motion are stillpresent when the passive motion is commenced, andthey go on increasing until all the structures are in-volved and muscular spasm absolutely locks the joint. The symptoms of tuberculous osteitis are restrictionto normal motion, a sense of w^eakness often accom-panied by an aching pain, and shrinking of the musclesboth above and below the joint. When the tubercularfocus has made its way out of the bone, whether intothe joint or external to it, swelling appears, at firstpulpy to the touch, and afterwards breaking down intoa tubercular abscess, which p

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