am showing Multiple partially
ossified Cartilaginous Loose Bodies in Shoulder-joint. The lowest one
is in the synovial prolongation along the tendon of the biceps.]

#Tuberculous disease# is the most common and important affection (Fig.
106). It usually occurs in patients under twenty, but may be met with
at any age; in children the age-incidence is earlier than in the other
large joints, a considerable proportion being met with in the first
two years of life (Stiles). When the disease is confined to the
synovial membrane, its onset is insidious, there is little or no pain,
and no interference with any movement except complete extension. The
chief evidence of disease is a white swelling on either side of and
above the olecranon, obscuring the bony landmarks. The further
progress is attended with wasting of the triceps, symptoms of
involvement of the articular surfaces, and with abscess formation.

[Illustration: FIG. 106.--Diffuse Tuberculous Thickening of Synovial
Membrane of Elbow (white swelling) in a boy aet. 12.]

The occurrence of articular caries without swelling of the synovial
membrane is exceptional, and is associated with a good deal of pain
and considerable restriction of movement. Rigidity from muscular
contraction occurs late, and is rarely complete. Tuberculous foci in
the bones are met with chiefly in the lower end of the diaphysis of
the humerus; in children, the epiphyses are so small that the
ossifying junction is intra-articular. Foci are also met with in the
upper end of the ulna. The grosser osseous lesions cause enlargement
of the bone, and are readily demonstrated by skiagraphy. Abscess
formation most commonly occurs beneath the triceps, and the abscess
points at one or other edge of that muscle. A subcutaneous abscess
may form over the upper end of the ulna or over the radio-humeral
joint. Tuberculous hydrops with melon-seed bodies is rare.

[Illustration: FIG. 107.--Contracture of Elbow and Wrist following a
burn in childhood. Treated by resection of both joints, and the
insertion, on the palmar aspect of each, of a flap from the abdominal
wall.]

_Treatment._--Conservative measures are persevered with so long as
there is a prospect of securing a movable joint. The limb is placed in
a light form of splint reaching from the axilla to the wrist, flexed
to rather less than a right angle and with the hand semi-pronated and
dorsiflexed. To inject iodoform or other anti-tuberculous agent, the
n