Surgical diagnosis / Daniel N. Eisendrath.

  • Eisendrath, Daniel N. (Daniel Nathan), 1867-
Date:
[1907], ©1907
Catalogue details

Licence: In copyright

Credit: Surgical diagnosis / Daniel N. Eisendrath. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    (c) Exploratory juincture. This is a very valuable aid in ascer- taining the character of the fluid, and must be performed with every possible regard for asepsis (see Fig. 412). (d) X-ray. This gives much information in regard to the con- dition of the articular ends of the bones entering into the joint forma- tion. In acute cases it is of httle value; in chronic cases the changes are often slight or appear very late, especially in tuberculosis. (e) Mensuration. The measurement of a joint and the com- parison of the result obtained with that of the corresponding joints of the opposite Hmb is of great value in confirming other data. The chief diagnostic features of the principal joint affections are as follows: Acute Traumatic Arthritis. This may follow (a) a blow over a joint or a fall upon a joint; (b) a distortion or twisting; (c) it may accompany a dislocation and, finally, (d) it occurs as the result of a fracture into the joint or in close prox- imity to it. The history is usually quite clear. The injury is followed by severe pain over the joint and by loss of function. Within a few hours there is noticeable swelling of the joint. It loses its normal con- tour, all of the depressions over it being effaced by the rapidly increas- ing swelhng. Exploratory puncture is rarely necessary for diagnostic purposes. If performed, however, the exudate will be found to be a clear, straw- colored fluid containing much albumin, more or less fibrin, and a few leukocytes. As a rule, fever is not a diagnostic sign in an acute traumatic ar- thritis. There is, however, a rare possibihty of a pyogenic infec- tion of hematogenous origin, which will change the chnical picture. Under these latter circumstances the pain and swelhng will be exces- sive. The presence of such increased local signs, accompanied by constantly increasing leukocytosis and fever, will speak for a joint infection. Another fact is also of value from a diagnostic point of view. A joint trauma may be followed by an acute gonorrheal arthritis in a patient suffering from a subacute gonorrheal urethritis. Such a case is not readily recognized unless it be borne in mind that infection of a traumatic arthritis is very rare. If fever and other signs occur in such a joint, a search should be made for primary foci of pus infec- tion, such as the urethra, etc. Acute traumatic arthritis is also of interest on account of its sequelae.