On ankylosis, or stiff-joint : a practical treatise on the contractions and deformities resulting from diseases of joints / by W.J. Little.

Date:
1843
Catalogue details

Licence: Public Domain Mark

Credit: On ankylosis, or stiff-joint : a practical treatise on the contractions and deformities resulting from diseases of joints / by W.J. Little. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    21/184 (page 5)
    circumstance also exists, which tends to explain the greater ease experienced in the semi-flexed position of the knee diuing inflammation, — I allude to the greater amplitude during flexion than extension of the synovial sac, and the diminished pressure of its fluid contents on the inflamed tissues. The severity of suffering in inflammation of an articulation is acknovs^ledged to arise from the inextensi- hility of the fibrous structures composing it: they cannot so readily swell as the more elastic cutaneous and cellular tissues of the frame; the turgid capillaries compress the accompanying nervous fibrils, the sensibiHty of which may, moreover, be augmented by the inflammatory process ; every part of an articulation rapidly and acutely inflamed is exposed to pressm-e from the increase of the secretions into the syn- ovial sac; and hence the suflferer promptly avails himself of the smallest relief obtainable from suitable position. The examination of the course of the simplest case of inflammation of the knee, which tends to ankylosis, will render more clear the manner in wliich immobiHty and con- traction take place. I will suppose a slight inflammation of the knee from mechanical injury: the characteristic heat, pain, and tumefaction, if not the redness, successively present themselves; these are combated by antiphlogistic measures, the knee assuming and retaining the bent position. At the expiration of days, weeks, or even mont]is, according to the healthiness of the constitution, and propriety of the treat- ment to which the practitioner may have resorted, the inflammatory symptoms subside without suppuration or dis- organisation ; but the previous constitutional distm-bance, the debihty necessarily succeeding to the use of antiphlogistic treatment, and the experience the patient acquired during the inflammation of the exquisite pain and tenderness in the articulation, leave a moral as well as physical morbid sensi- bility in the patient which strongly oppose any attempt to straighten the limb. The inflammation may have subsided without producing disorganisation, but the interstitial infil-