(Anatomical Museum, University of Edinburgh).]
In mild cases this condition of affairs may persist for months; in
severe cases destructive changes ensue with remarkable rapidity. The
joint becomes enormously swollen, loses its normal contour, and the ends
of the bones become irregularly deformed (Fig. 162). Sometimes, and
especially in the knee, the clinical features are those of an enormous
hydrops with fibrinous and other loose bodies and hypertrophied
fringes--and great oedema of the peri-articular tissues (Fig. 163). The
joint is wobbly or flail-like from stretching and destruction of the
controlling ligaments, and is devoid of sensation. In other cases,
wearing down and total disappearance of the ends of the bones is the
prominent feature, attended with flail-like movements and with coarse
grating. Dislocation is observed chiefly at the hip, and is rather a
gross displacement with unnatural mobility than a typical dislocation,
and it is usually possible to move the bones freely upon one another and
to reduce the displacement. A striking feature is the extensive
formation of new bone in the capsular ligament and surrounding muscles.
The enormous swelling and its rapid development may suggest the growth
of a malignant tumour. The most useful factor in diagnosis is the entire
absence of pain, of tenderness, and of common sensibility. The freedom
with which a tabetic patient will allow his disorganised joint to be
handled requires to be seen to be appreciated.
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