Volume 1

A system of surgery / by Charles B. Ball [and others] ; edited by Frederick Treves.

Date:
1896-1898
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / by Charles B. Ball [and others] ; edited by Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    1113/1206 (page 1071)
    LOOSE BODIES IN JOINTS. 107] movement is again restored, and the functioia maj'^ be as perfect as before, until a similar attack, like the first in every way, comes on. AVhen a patient with such a history presents himself, one of two hypotheses at once suggests itself. Either the joint is the seat of a “ loose body,” or, as in the case of the knee, some part of the normal capsular appendages has become loose and has got nipped between the bones in their movement from flexion to extension. In the first case there is some mass within the articulation capable of moving about more or less freely between the bones, either attached by a pedicle or actually separated from all connection with surrounding structures, and capable of slipping to any part of the cavity. In the second instance, one or other of the semi-lunar cartilages is loosened at its capsular attachment, and moves in between the joint surfaces proper (Fig. 420). As a consequence of either of these two accidents a great strain is put upon the lateral ligaments as the limb is brought into the straight position, the long leverage of the bone with the foreign body as its fulcrum forcing the attachments of the ligaments apart. (See page 1015.) The diagaosis between these two conditions is sometimes a matter of considerable diflciculty. When the attack is due to a loose body of any size, however, the latter may often be felt by the patient or surgeon when the synovitis has subsided. In the knee it may be made out with the fingers, slipping about usually in one of the pouches above the patella, as a round or nodulated body, from the size of a pea to that of a filbert. It is usually very difficult to restrain, and while manipulated will often pass with a slip into some part of the joint in which it can no longer be felt by either the patient or surgeon. Flexion and extension will often again dislodge it and bring it within reach of the fingers, but not always; and it may be lost, so to speak, for days or weeks, only giving evidence of its presence at last by a fresh attack like the first. When a semi-lunar cartilage, on the other hand, becomes loosened from its capsular attachments, and moves in between the femur and tibia, although the symptoms are veiy much the same as in the other case, no projecting body can be felt at any time, but on the contraiy a depression may be discovered by careful comparison with the opposite side just above the articular border of the tibia. The patient’s sensations may also guide us in some cases. He may be conscious of something moving about in the joint, even before he is able to localise the loose body with his fingers, and when there is no pain to guide him. dies.—There are several varieties of loose bodies now recog- nised. They may consist either of hyaline cartilage, of fibro-cartilage, of bone, or of fibrinous material. The first two forms are derived from the synovial fringes of the joint, and are produced, as a rule, from remnants of embryonic tissue which have been left behind, as it were, in the development of the sac. Later, these remnants of embryonic tissue have grown with stored-up energy, and have formed more or less pendulous tags projecting into the joint. In this state