SYNCWAL FLUID ANALY’S ES USE? AS AN ADJUNCT TO DIAGNOSES OF CANENE JQ-ENT DES’EASES Husk: for Hm Degree of M. 5. MICHIGAN STATE UNIVERSITY Donald C. Sawyer 1962 W’Llsrz C TH Eszs LIBRARY Michigan State University _ ‘ h< c—pl,—o_’_- .4 qucwg‘a ‘A ,., ..‘ ABSTRACT SYNOVIAL FLUID ANALYSIS USED AS AN ADJUNCT TO DIAGNOSIS OF CANINE JOINT DISEASES by Donald Co Sawyer This project was undertaken to investigate the merits of synovial fluid examination as a diagnostic and prognostic aid in joint diseases of the canineo This study was restricted to those practical tests which could be performed by a veterinary practitioner, Synovial fluid analyses included the following: total leuko— cyte and erythrocyte cell counts, differential cell count, pH measurement, mucin clot, viscosity, and bacteriological tests. The results of this study were presented in tabular form. Using synovial fluid analysis, it is possible to determine the presence or absence of arthritiso It is also possible to differentiate arthritides of traumatic etiology from those of infectious etiologyo In some cases, a dif- ferentiation may be made between acute and chronic joint diseases° From the results of this study, it was concluded that synovial fluid analysis is a useful adjunct to the diagnosis of canine joint diseaseso Dedicated to Judy SYNOVIAL FLUID ANALYSIS USED AS AN ADJUNCT TO DIAGNOSIS OF CANINE JOINT DISEASES BY Donald C. Sawyer A THESIS Submitted to lienigan State University in partial fulfillment of the requirements for the degree of HASTER OF SCIENCE Department of Surgery and Medicine 1962 ACKNOWLEDGMENTS This study was made possible through the financial assistance of the Mark L. Morris Animal Foundation. Special thanks are accorded to them. The author is grateful to Dr. W. O. Brinker, Chair- man, Department of Surgery and Medicine, and Dr. G. H. Conner, Graduate Adviser, Department of Surgery and ledicine, for their advice and generous assistance in planning the course of study and guidance in conducting the project. The tech- nical advice by Dr. N. R. Cholvin in preparation of this manuscript is greatly appreciated. Sincere thanks are due to Dr. B. G. Schirmer for his cooperation in arranging work schedules in the clinic. I want to thank my colleagues for sharing portions of the clinic work load so that I might finish this project and for their cooperation in obtaining synovial fluid samples. The helpful technical assistance of Miss Susan Richards, lies Joyce Remsberg, and Dr. R. W. Van Pelt, Jr., is thankfully acknowledged. lany thanks to Mrs. Reba Murray and Mrs. Doris Doerema for their time spent typing portions of this manu- script. 11 INTRODUCTION. 0 TABLE OF REVIEW OF LITERATURE. MATERIALS AND METHODS O 0 0 RESULTS AND DISCUSSION. CONCLUSIONS . BIBLIOGRAPHY. O 0 O O O 0 0 0 CONTENTS iii Page 11 32 86 88 10. 11. LIST OF TABLES Synovial fluid examination form . . . . . . . . Preparation of the standard pH scale. . . . . . Identification key for the breeds of the dogs, articulations, synovial fluid nature, mucin clot and viscosity. . . . . . . . . . . . . . . Animal identification key for table 5 . . . . . Synovial fluid analyses from the following normal carpal, elbow, shoulder, hip, stifle and hook joints . . . . . . . . . . . . . . . . Statistical analysis of synovial fluid prOper- ties from normal carpal joints. . . . . . . . . Statistical analysis of synovial fluid proper- ties from normal elbow joints . . . . . . . . . Statistical analysis of synovial fluid prepar- ties from normal shoulder joints. . . . . . . . Statistical analysis of synovial fluid proper- ties from normal hip joints . . . . . . . . . . Statistical analysis of synovial fluid prOper- ties from normal stifle joints. . . . . .'. . . Statistical analysis of synovial fluid proper- ties from normal hock joints. . . . . . . . . . iv Page 12 14 37 39 41 47 4s 49 5O 51 52 12. Statistical analysis of synovial fluid proper- ties from normal carpal, elbow, shoulder, hip, stifle and hock joints. . . . . . . . . . . . . 13. Animal identification key for table 14. . . . . l4. Synovial fluid analyses from stifle joints with a ruptured anterior cruciate ligament less than 3 weeks duration. . . . . . . . . . . . . . . . 15. Statistical analysis of synovial fluid proper- ties from stifle joints with a ruptured anter- ior cruciate ligament less than 3 weeks dura-' tion. . . . . . . . . . . . . . . . . . . .'. . 16. Animal identification key for table 17. . . . . l7. Synovial fluid analyses from stifle joints with a ruptured anterior cruciate ligament more than 3 weeks duration. . . . . . . . . . . . . . . . 18. Statistical analysis of synovial fluid proper- ties from stifle joints with a ruptured anter-' ior cruciate ligament more than 3 weeks dura- tion. . . . . . . . . . . . . . . . . . . . . . 19. Animal identification key for table 20. . . . . 20. Synovial fluid analyses from hip joints with dysplasia . . . . . . . . . . . . . . . . . . . 21. Statistical analysis of synovial fluid proper- ties from hip joints with dysplasia . . . . . . 22. Animal identification key for table 23. . . . . 23. Synovial fluid analyses of possible septic arthritides from the carpal, shoulder, hip, stifle and hock joints. . . . . . . . . . . . . V 24. Statistical analysis of synovial fluid proper- ties of possible septic arthritides from carpal joints. . . . . . . . . . . . . . . . . . . . . 25. Statistical analysis of synovial fluid proper- ties Of a possible septic arthritis from the shoulder joint. . . . . . . . . . . . . . . . . 26. ”Statistical analysis of synovial fluid proper- ties of possible septic arthritides from hip joints. . . . . . . . . . . . . . . . . .'. . . 27. Statistical analysis of synovial fluid proper- ties of possible septic arthritides from stifle joints. . . . . . . . . . . . . . . . . . . . . 28. Statistical analysis of synovial fluid proper- ties of a possible septic arthritis from a hook joint . . . . . . . . . . . . . . . . . . . . . 29. Statistical analysis of synovial fluid proper- ties of possible septic arthritides from the carpal, shoulder, hip, stifle and hock joints . 30. Animal identification key for table 31. . . . . 31. Synovial fluid analyses of unclassified trau- matic arthritides of unknown etiology from the carpal, elbow, shoulder, stifle and hock joints 32. Statistical analysis of synovial fluid proper- ties of unclassified traumatic arthritides of unknown etiology from the carpal, elbow, shoulder, stifle and hock joints. . . . . . . . vi 33. 34. Animal identification key for table 34. Synovial fluid analyses of miscellaneous arthritides . . . . . . . . . . . . . . vii LIST OF FIGURES Page The four grades of mucin clot . . . . . . . . . 16 The procedure for arthrocentesis of the carpal joint (radio-carpal, intercarpal, and carpo- metacarpal joint capsules). . . . . . . . . . . 21 The procedure for arthrocentesis of the elbow joint (cubital joint capsule) . . . . . . . . . 23 The procedure for arthrocentesis of the should- er joint (scapulo-humeral joint capsule). . . . 25 The procedure for arthrocentesis of the hip joint (coxofemoral or coxal joint capsule). . . 27 The procedure for arthrocentesis of the stifle joint (femoro-patellar and femoro-tibial joint capsules) . . . . . . . . . . . . . . . . . . . 29 The procedure for arthrocentesis of the heck joint (tibia-tarsal, intertarsal, and tarso- metatarsal joint capsules). . . . . . . . . . . 31 Cell types observed in canine synovial fluid. . 36 viii INTRODUCTION Synovial fluid analyses have been found to be use- ful in human medicine in the study of the arthritides. In surveying veterinary literature, reference to similar analyses, from the standpoint of clinical usage, is non-existent in canine medicine. This project was undertaken to investigate the merits of synovial fluid examination as a diagnostic and prognostic aid in joint diseases of the canine. This study was restricted to those practical tests which could be per- formed by a veterinary practitioner. It was necessary to establish normal values for the six most common clinically affected articulations. Synovial fluid samples were taken from diseased joints, analyzed, and then compared to the normal values. REVIEW OF THE LITERATURE Diarthrodial articulations are characterized by a joint cavity, a synovial membrane in the joint capsule and by their mobility.24 The articular or joint cavity is en- closed by the synovial membrane and the articular cartilages. Normally, it contains only sufficient synovial fluid to lubricate the joint. The joint capsules are membranous tubes or sleeves which enclose articular surfaces, epiphyses and in a few instances metaphases.l7 The capsule is divided into a fibrous layer (stratum fibrosum) and a synovial layer (stratum synoviale).l7’24 The mobility of the articulations are described by Sisson.24 The gross and histological char- acteristics of the coxofemoral and stifle joints in the canine were described by Adam.1 The synovial membrane lines the joint but does not cover the hyaline articular surfaces.17 The stratum syn- oviale is classified according to the character of the tis- sue beneath the lining cells into three types: fibrous, 1,15,22 adipose, and areolar. This highly vascular synovial tissue lining the inner surface of the articular capsule is not actually a membrane. It is a connective tissue with a modified inner aurrace.9vl7.22 The articular cartilage, usually hyaline in type,24 5,9,12 is avascular. Its nourishment is derived from synovial fluid except for a small supply from the subchondrium.12 Synovial fluid was so-named by Paracelsus because of its resemblance to egg white.23 Sisson stated that "the synovial membrane secretes a fluid, the synovia, which lub- ricates the joint."24 However, he questioned whether it is a true secretion or a transudate containing products of friction. Hopes and Bauer have definedsynovial fluid as a protein containing dialysate of blood plasma to which mucin, secreted by the synovial cell, is added as the plasma water diffusesthrough the synovial tissue spaces into the 22 Coggeshall stated large tissue space, the joint cavity. that the constituents and antibodies of synovial fluid are essentially the same as those in blood plasma, but that the protein content of synovia was higher because it con- tained mucin and the products of normal friction.12 Synovial mucin is the polysaccharide component of bovine synovial fluid.19 The hypothesis is advanced that this hyaluronic acid of the mesenchymal tissues is produced by mast cells in the bovine.3 Mucin is mainly responsible for the viscosity of synovial fluid. The viscosity of human synovial fluid is that of water following precipitation of 22 Gardner stated that there is mucin with acetic acid. little doubt that the synovial cells are responsible for the presence or mucin in synovial fluid.9 The mode of de- struction of mucin is unknown but it is more than likely that it occurs in the fluid or tissues.22 The functions of synovial fluid are many. The mucin content gives the fluid its lubricating properties. Frost indicated that there are two types of lubrication: boundary layer lubrication and hydrodynamic lubrication.7 He stated that in the normal human joints moving slowly and intermittently under load, boundary conditions exist. Crepitus may be noticed when a joint is manually moved with- out bearing weight. In joints moving rapidly, hydrodynamic conditions exist and wear is reduced to an insignificant level by a film of synovial fluid forced between the moving joint surfaces. In accordance with this theory, a wedge- shaped film of lubricant is formed and movement of the two bearing surfaces is in the direction of the narrow end of the wedge; the circulating fluid enters at the base and leaves at the narrow apex.9 It has been shown that a 50 micron film is effective in lubrication of the human knee.18 It also has been demonstrated that the coefficient of fric- tion in a dry joint is 14 times greater than that in'a joint kept lubricated by synovial fluid.12 In the stifle joint, the menisci automatically set themselves at the tilt which ensures the formation of the fluid wedge.9 Besides its lubricating preperties, the high base— binding property of mucin aids in the calcium equilibrium of the joint fluid. It is also important in the transfer and maintenance of the volume of plasma water in the joint.22 The plasma portion of synovial fluid serves as the 2 main source of nutrients to the articular cartilage. The metabolic rate of the hyaline cartilage is one-tenth that of connective tissue because there is a large amOunt of matrix.12 'hen the joint is in motion, the elastic action of the articular cartilage squeezes out and reabsorbs fluid, as a sponge.2 This is important in the nutrition of the cartilage as well as in the dissipation of the heat produced by normal friction.7 The pH of the stifle joint fluid of dogs has been determined under various physiological conditions and after intravenous injection of electrolytes.14 Parallel deter- minations of blood pH have also been carried out. The average pH of one control stifle was 7.30 taken during the resting state. The measurements were made with a needle in combination with a capillary glass electrode.' The removal of particulate matter and cellular de- bris from normal wear of the joint tissues is achieved pri- marily by the mononuclear phagocytes in the synovial 12’18’22’25 The cytology of synovial fluid in nor- fluid. mal joints of rabbits was reviewed by Key in 1928.15 'He stated that normal joint fluid contains living cells in numbers varying from 100 to 3OO/mm.3 He used supravital stains and classified the cells as follows: Cell Range ($) Average (fl lonocyte 42-84 58 Indeterminate macrophages 3-29 14 Primitive cells 0-10 1 Cell Range ($) Average (fl) Polymorphonuclear cells 0-12 _ 5 Synovial cells 0-7 3 These results were obtained from synovial fluid of 50 shoulder joints of the rabbit. According to Key, degener- ating cells and cartilage cells were practically never seen.15 Contrary to this, Iarren,.gt_§l. indicated that degenerating cells are frequently encountered in normal bovine synovial fluid.25 They are distinguished from normal living cells by their failure to react to vital dye, by their hyaline nuclei which are stained pale green, and by their shrunken or excessively vacuolated cytoplasm. Simultaneous studies of canine synovial fluid and blood indicated that the cytology of synovial fluid is not influenced by the blood cytology, i&2., the polymorphonuclear leukocytes of the blood in one animal averaged 66%, yet the synovial fluid contained none. The results of these cytological studies conducted on the stifle joints of 14 normal dogs are as follows:25 Nucleated cells --- 327 - l450/mm3 (average 963.8/mm3) Erythrocytes ------ O ' Phagocyticcells Polymorphonuclear leukocytes -------- O - 7% (average 1.7%) Honocyte ----------- 56 - 90% (average 68.5%) 20% (average 6.5%) 4% (average 3.4%) Clasmatocyte ------- 0 Unclassified cells - o Non-phagocytic cells Lymphocytes -------- 2 - 36% (average 15.7fi) Synovial cells ----- 1 - 9% (average 4.8%) A difference in the phagocytic cell content of the_ carpometacarpal and astragalotibial joint fluids has been reported.25 This difference represents the response neces- sary for the removal of friction debris as a result of the comparative differences of joint trauma. Bauer, gt_§l. indicated that nucleated cells found in synovial fluid in normal cattle are similar in number and types to those described previously in normal rabbits.18 Furthermore, he reported that 90-95% of all nucleated cells present are actively phagocytic. This implies that the function of these cells is the removal of tissue debris in the articulation. Studies of the cell content in cattle, sheep, and horses reveals that the content of nucleated cells varies considerably from joint to joint in the same animal, 3&5., in cattle from about 200/mm3 in the appendicular joints to aboutlZOO/mm3 in some of the axial joints.6 Davies found that of the cell types, monocytes form about 50% of the 6 The remainder total, accompanied by fewer clasmatocytes. were lymphocytes, polymorphonuclear leukocytes, synovial cells, and unclassified phagocytes. He showed a signifi- cant variation in the proportions of these different types from joint to joint and from species to species. .Key contended that red blood cells are normally found in joint fluid.ls However, Davies stated that red blood cells do not normally occur in synovial fluid, though small traumatic extravasations from the delicate capillaries 6 are frequent. Further, red blood corpuscles seem to be present in numbers directly proportional to the trauma to which the synovial membrane is subjected.18 Accurate differentiation of mononucleated cells can only be made from supravitally stained preparatiOns. It is not necessary to differentiate the various types of mononuclear cells as the most important diagnostic criterion is the percentage of polymorphonuclear cells. For this reason, the fixed smear method (Wright's stain) is prac- tical for the usual clinical examination. Coggeshall stated that the polymorphonuclear cells should not exceed 25% of the synovial fluid leukocytes in normal human joint fluid.12 Kling has commented on staining methods of synovial fluid.16 The drawbacks of supravital staining are that it requires special technical training, prolonged observation by the technician, immediate examination of the fluid, and poor visibility of nuclei. Also, the use of specific gran- ulations is doubtful as a reliable criterion for identifi- cation of the cells. The advantages of routine blood stains (Wright's stain) are many. It is a technique with which 'every technician is familiar. It can be carried out at any time. It is observed and easily read. It gives a dis- tinct picture of the nucleus with its chromatin and centro— SOMB o Ropes and Bauer have classified pathological fluids in the human into the following groups:22 Group I. Inflammatory reaction of traumatic origin A. Traumatic arthritis 1. Injury to semilunar cartilage 2. Hemorrhagic effusions B. Osteochondritis dissecans C. Degenerative joint disease D. Heuroarthopathy E. Osteochondromatosis Group II. Infectious arthritis of known origin, Reither's syndrome, and Rheumatoid arth- ritis. The above authors explain that the cytology of the synovial fluid is related to the type, severity, and duration of pathology. It is possible to differentiate groups I and II by a total leukocyte count and an absolute polymorpho- nuclear cell count in almost all cases. Normal synovial fluid is sterile. Therefore, positive synovial fluid cul- tures are essential in order to prove a diagnosis of infec- tious arthritis. A positive culture is expected in fluid containing more than 30,000 synovial fluid leukocytes/mm.3 Ropes, gt_gl. have indicated that there is no definite cor- relation between the size of the effusion and the etiology, severity, or duration of the joint disease.22 They found that as the inflammation in the joint subsided, the amount of fluid that could be aspirated decreased. They reiterated 10 that the relative proportion of polymorphonuclear and mono- nuclear cells gives the best indication of the degree and type of inflammation present. It is also important to de- termine the total number of phagocytes to ascertain the degree of tissue irritation and injury to the articulation. The following results were collected on normal human synovial fluid from the stifle joints using supravital stain- ing techniques for cellular classificationzzz Analyses ’ ‘ Range ' Average Amount (cc) 0.13 - 3.5 ' .1.10 pH =‘ 7.29 - 7.45‘ 7.39 Leukocytes/mm3 l3 - 180 ' 63 Differential counts in f Polymorphonuclear . ‘leukocytes 0 - 25 6.5 Lymphocytes 0 - 78 24.6 lonocytes ‘0 - 71 I 47.9 Clasmatocytes 0 - 26 10.1 Unclassified cells 0 - 21 4.9 Synovial cells 0 - 12 4.3 MATERIALS AND METHODS Canine synovial fluid in most articulations is normally present in very small quantity. In order to min- imize loss of fluid in the barrel of the syringe,'a’two cubic centimeter syringe was used for collection of fluid for analysis. Initially, the use of a one cubic centimeter syringe was attempted. However, the construction of this syringe does not allow sufficient negative pressure to as- pirate fluid. Eighteen, 20, and 22 gauge hypodermic needles are preferred, with a range in length from 1 inch to 2.5 inches. A regular point needle was used. The gauge and length of the needle used were governed by the size of the articula- tion, the thickness of the surrounding tissues, and the accessibility of the capsule. For routine use, a 1 inch, 20 gauge, disposable needle was satisfactory. The needles and syringes were autoclaved at 250 F for 15 minutes.21 The assorted needles were sterilized in reusable nylon Needletainers.’ The syringes were ster- ilized in packets** for easy handling. A form (table 1) was used to record the informa- tion obtained from the fluid analysis. *Sterilon Corporation, 500 Northland Ave., Buffalo, New York.7 fl0K Sterilization Bags. Propper Manufacturing 00., Inc., Long Island City, N.Y. 11 ( 12 Table l. Synovial Fluid Examination Form Case No.* Date ‘ Clinic No. Breed Sex Age Restraint Previous Examination: Yes____No____Date_____Case Nb.;____ Articulation: Fluid collected by: Remarks: ' Amount: ml. Nature Hucin clot: Normal Fair Poor Very Poor ' pH Viscosity: Normal Reduced Greatly Reduced Leukocytes /cu. mm. (cells / ‘ squares O dilution) Erythrocytes /cu. mm. (cells / squares o ’4 dilution) Polymorphonuclear leukocytes fl ' / cu. mm. Nonocytes f 9/ cu. mm. Clasmatocytes i ;L/ cu. mm. Lymphocytes gfi ,/ cu. mm. Bacteriological exam: *Each synovial sample was given a case number. copy of this report was filed with the animal's medical record, by clinic number. A 13 The term, nature, as used on the record form, re- fers to some of the gross physical characteristics. 'Such descriptive terms as follow might appear: clear, slightly cloudy, cloudy, flocculent, and purulent. Terms used to describe color were: light yellow, yellow, sanguineous, and sanguineous due to technique. I A. Properties of joint fluid examined in a routine analysis. 1. Incin The quality of the mucin was measured by its degree cf precipitation when mixed with acetic acid.§ One to two drops of a non-oxalated sample of syn- ovial fluid were added to an acetic acid sclution prepared as follows: a. One tenth of a milliliter of 7 N glacial acetic acid was added to 4 ml. of distilled water in a 10 ml. vial. For convenience, these vials can be frozen for storage and thawed before use. b. The synovial fluid is added slowly to_the acid, taking care that the sample does not contact the glass as it is added. c. Allow to stand for 15 to 30 minutes. d. Gently shake the solution. e. Four grades of mucin clot are observed: (see figure 1) (l) NORNAL--tight, ropy clump in a clear solution (2) PAIR-~soft mass in a slightly cloudy solution (3) PO0R--small, friable masses in a cloudy so- r lution ‘ 14 (4) VERY PO0R--few flecks in a cloudy solution 2. pH The pH of the synovial fluid was measured using phenol red as an indicator. One drop of the syn- ovial fluid was added to 1 ml. of phenol red indi- cator. The preparation of the indicator was as follows: 28.2 ml. of 0.01 N NaOH was added to 0.1 gram of phenol red. This was brought to a pH of 7 by diluting it with distilled water. The follow- ing table illustrates the procedure used to prepare the standard pH scale. Table 2. Preparation of the Standard pH Scale 'Velume of xszro4" pH of ‘l' Volume of NaZHPO solution in ml. 4 solution in ml. mixture 10.00 0.00 8.3 9.75 0.25 8.0 9.50 0.50 7.8 9.00 1.00 7.6 8.00 2.00 7.4 7.00 3.00 7.2 6.00 4.00 7.0 5.00 5.00 6.8 3.00 7.00 6.4 *ll.so7 grams of sazsro4.2sos were ldded to one liter of distilled water.10 fl9.078 grams of KR'ZPO4 were added to one liter of distilled water.10 15 Figure 1. The four grades of mucin clot. A. Upper left...Norma1 B. Upper right...Fair C. Lower left...Poor D. Lower right...Very poor l6 17 One drop of each solution was then added to‘l ml. of thephenol red indicator to establish the stand- ard pH color scale. The phenol red indicator with the synovial fluid added was then compared to the standard scale for pH measurement. 3. Viscosity The viscosity of synovial fluid was measured by subjectively estimating it to be either normal, reduced, or greatly reduced. The limited volume of fluid which normally can be aspirated from canine articulations does not allow a practical method of viscosity measurement. 4. Cytology All cellular studies were done using a Dialux or Labolux IIIa microscope.” The differential cell count was best done under the oil immersion objec- tive. The total leukocyte and erythrocyte count was made using a standard hemacytometer.** A standard NBC pipette was used for diluting the synovial fluid. Ihen possible, a 1:10 dilution was made. However, a limited volume of the sample may neces- sitate a higher dilution. Cells in all 9 large squares were counted because of the small number *Ernest Leitz, Inc., New York, N.Y. HSharp Line Hemacytometer. Improved Neubauer Rul- ing, Chicago Apparatus Co., Chicago, Ill. 18 normally present. Since synovial fluid will clot when mixed with acetic acid, 0.85% NaCl solution (normal saline) was used as the diluting fluid in- stead of the customary white blood cell diluting fluid (2* acetic acid). Crystal violet was added to the saline solution to make a final concentra- tion of 1% and then filtered. The crystal violet was added to stain the leukocytes, thus making them easier to count. A synovial fluid smear was prepared by placing one to two drops of synovia between two 75 X 75 milli- meter microscOpe slides. The slides were pressed together by circular sliding movements until the fluid was distributed evenly, and then separated by sliding one off of the other with a quick, snappy motion. The smears were air dried and stained with Iright's stain for a differential cell count. The stain was added to the slide and allowed to remain for ninety seconds. The buffer was then added and mixed with the stain by gently blowing on the slide. This staining procedure helps prevent over-staining to the cells. The stain should be filtered daily to minimize stain debris. Bacteriology A Bacteriological examination was made on the synovial samples if there was sufficient volume to perform 19 all of the other tests. Following the initial tests, a sterile swab was used to absorb the remaining fluid in the barrel of the syringe. The swab was then plunged into 5 ml. of semi-solid brain-heart infusion agar and incubated for 10 to 14 days at 37 C. If there was no growth, the culture was dis- carded. If growth was noticed, further attempts for isolation of the organism were made. Bacter- iology is not an essential part of the analysis in routine practice. Procedures for arthrocentesis To prepare the site for arthrocentesis, the follow- ing method was used. First, the hair on the skin was clipped at the site of the needle puncture. Second, this area was scrubbed 5 times with Liquid Germicidal Detergent.* The procedures for arthrocentesis of the six most common clinically affected joints in the canine have been adapted from the work of Hennau and Lassoie,11 and from a booklet on injection techniques.13 *Parke, Davis and Company, Detroit, Michigan. 20 Figure 2. The procedure for arthrocentesis of the carpal joint (radio-carpal, intercarpal, and carpo- metacarpal joint capsules) The animal is positioned in lateral recumbency. The carpus is flexed to open the joint spaces. It is en- tered from the anterior surface. The tendons of the extensor muscles of the carpus pass over the anterior surface and must be penetrated before reaching one of the three joint capsules. The radio-carpal capsule surrounds the distal end of the radius and ulna and the proximal articular sur- faces of the radial, ulnar, and accessory carpal bones. It is non-communicating and may be reached by directing the needle into the joint space between the radius and the radial carpal bone (A). The intercarpal capsule surrounds the distal articular surfaces of the radial and ulnar carpal bones and the proximal articular surfaces of carpal bones I, II, III, and IV.20 The carpo-metacarpal joint capsule surrounds the distal articular surfaces of the metacarpal bones. The latter two capsules communicate with one another and may best be reached by entering the joint space between the radial carpal bone and carpal bones II and III (B). The proximal collateral radial artery, accessory cephalic vein, and superficial radial nerve must be avoided as they pass over the anterior surface of the carpus. The vein is easily identified in most cases. 21 22 Figure 3. The procedure for arthrocentesis of the elbow joint (cubital joint capsule) The animal is positioned in lateral recumbency. With the elbow joint in a slightly flexed position, the lateral condyle of the humerus (A) is palpated at its ar- ticulation with the semilunar notch of the ulna. The joint is approached from the postero-lateral surface of the fore- limb. The needle is placed posterior and medial to the. lateral condyle and slightly dorsal to the olecranon pro- cess (B). The anconeus muscle and the tendon of insertion of the triceps muscle group are penetrated before reaching the joint capsule. If the needle hits the bone it is par- tially retracted and redirected into the joint space. 24 Figure 4. The procedure for arthrocentesis of the shoulder joint (scapulo-humeral joint capsule) The animal is positioned in lateral recumbency. Arthrocentesis is best accomplished with the joint in a flexed position. Using the acromion process as a guide, the needle is placed ventral to it and directed Obliquely downward and posteriorly through the biceps brachii and deltoideus muscles to the joint space. 25 .,.,_ fl... ., . .T." /_44 .., 3.... .1. .4. _ A. d . L.. at: 26 Figure 5. The procedure for arthrocentesis of the hip joint (coxofemoral or coxal joint capsule) The animal is positioned in lateral recumbency. The hind limb is allowed to rest in the normal standing position. Pulling the leg slightly upward and rotating the femoral head anteriorly facilitates arthrocentesis. The hip joint is covered on its dorsal surface by the large glutial muscles. The greater trochanter is palpated. The needle penetrates the skin at a point anterior to the greater trochanter and is directed postero-ventrally toward the joint space. If it contacts the femoralneck, head, or acetabular rim, re- direct the needle until it penetrates the joint capsule and enters the joint space. The sciatic nerve must be avoided as it passes posterior to this articulation. One may oc- casionally lacerate the circumflex femoral artery which overlays the joint capsule and thus aspirate gross amounts of blood. 28 Figure 6. The procedure for arthrocentesis of the stifle joint (femoro-patellar and femoro-tibial joint capsules) The animal is positioned in lateral recumbency. The stifle is flexed to tense the joint capsule. The leg is abducted to a vertical position. Arthrocentesis is ac- complished from either side of the straight patellar liga- ment. By pressing downward on the tense capsule on the opposite side of the ligament, a bulge is produced; The skin is penetrated at this point and the needle is directed obliquely downward under the ligament into the synovial cavity. The two joint capsules communicate. 29 30 Figure 7. The procedure for arthrocentesis of the heck I joint (tibia-tarsal, intertarsal, and tarso- metatarsal joint capsules) The animal is positioned in lateral recumbency. Arthrocentesis is best attained from the anterolateral or anteromedial aspect of the heck joint. By alternately flex— ing and extending the jbint, the interspace between the tibia and tibial tarsal bone is palpated. The needle is inserted alongside of the flexor tendons of the heck and directed into the joint space. ..r/V.1./.1.J./$c ”h!“ 31a C. Environmental conditions for experimental dogs. There were 105 animals used in this study. Forty- six of these were used to establish the normal values. These animals underwent physical examinations and were de- termined to be normal. The normal dogs were randomly se- lected from dogs purchased by the university to be used for other experimental purposes. In a few instances, fluid samples were taken from normal dogs prior to euthanasia requested by the owners. Pathological synovial fluid samples were taken from arthritic dogs following their admittance to the veterinary clinic. In most cases, a general anesthetic was necessary for sampling procedures. In a few instances, tranquilize- tion with a local anesthetic was adequate for restraint. RESULTS AND DISCUSSION The results of this study are presented in tabular form. In order to minimize repetitive information in each table, a key which presents basic information about each animal has been used. This key is table 3. The following example will help explain the record- ing procedure. In table 4, a mongrel (N), female (F), 5 years old, is designated animal number 18. In table 5, the number 18 appears at the top of the table. Reading across the page, it is noted that on 6-19-61, 0.10 cc of synovial fluid was aspirated from the left carpus (A). Initially the fluid obtained from the joint was clear (c) but toward the end of the sampling procedure, blood was introduced into the sample (t). The mucin clot was normal (N) and the viscosity was normal (I). The pH was 7.4. The leukocyte count was 1.00/mm3 and the erythrocyte count was 66,400/mm3. The differential cell count was presented as both per cent and absolute numbers for each cell type. This recording procedure is followed for each sample. General Observations Four nucleated cell types are seen in the canine joints (figure 8): polymorphonuclear leukocyte, monocyte, lymphocyte, and clasmatocyte. The eosinophil was not ob- served in joint fluid during this study. The synovial cell 32 33 was seldom seen and was not included in the differential cell count. Erythrocytes (figure 8) may or may not be found in normal joint fluid. Blood may be introduced into the joint fluid during the sampling procedure. Contamination of the sample with trace amounts of extraneous blood does not appear to interfere with the analysis of joint fluid. Experience has indicated that gross amounts of bloOd will interfere with joint fluid analysis. The appearance and staining characteristics of the nucleated cells from normal joint fluid differ slightly from those seen in fluids obtained from pathological joints. The cytoplasm and the nucleus of cells from normal joint fluid do not appear as distinct as those from abnormal fluid. Some cells which have been smeared on a slide stain much darker than do others. Degenerating nucleated cells were seen in fluids obtained from normal joints and pathological articulations. These cells could not be classified as a definite cell type. They were more commonly seen in normal joint fluid. The amount of synovial fluid obtained from the nor- mal articulations averaged 0.24 cc (table 12). Inch less than this may be aspirated from either normal or patholog- ical articulations. When a limited volume, i;2., 0.05 cc, does not allow for all of the laboratory tests, the differ- ential cell count should be done first. With any remaining fluid, the total cell counts should be attempted and then the mucin clot test. 34 The characteristics or normal canine stifle joint fluid differ from those of normal human knee joint fluid which were stated previously. The leukocyte count of the canine samples ranged from 200 to 1180/mm3 compared with a range of 13 to 180/mm3 in the human. The pH of canine joint fluid averaged 7.58.1 .08 compared with 7.39 in the human. In general, the differential cell count of canine stifle joint fluid is similar to that found in human knee joint fluid. 35 Figure 8. Cell types observed in canine synovial fluid A. Upper left...A monocyte (Wright's stain, x 3750) B. Upper right...Two clasmatocytes (Wright's stain, X 3750) C. Lower left...Two lymphocytes (Wright's stain, x 3750) D. Lower right...Two polymorphonuclear leukocytes and an)erythrocyte (arrow) (Wright's stain, X 3750 36 stle 3. 37 identification key for the breeds of the dogs, articulations, synovial fluid nature, mucin clot, and viscosity. Breeds of-dggs B Be Be Bm Bt C Cs D De Eb EP Es Gd "9 ‘Ne Boxer Basset hound Beagle Ball Mastiff Boston Terrier Collie Cooker Spaniel Doberman Plnscher Dachshund English Bulldog English Panter English Setter -Great Dane Gordon Setter German Short-heir Pointer German Shepherd Dog lrlsh Setter Keeshond Laborsdor Retriever Mongrel Miniature Poodle Norwegian Elkhound Articulations: left LISTS Csrpus A A' Elbow B B' Shoulder C C' Hip D D' Stlfle E E' Hock F F' Lamas 29.2252 c - clear slightly cloudy U! I c' - cloudy f - flocculent purulent '0 I color I - light yellow y - yellow 5 - sanguineous t - sanguineous due to technique 38 Table 3. (Continued) Breeds of dog; (continued) Mucin clot S - Shetland Sheepdog N - Normal Sp - Standard Poodle = F - Fair 55 - Springer Spaniel P - Poor Stb - St. Bernard V - Very poor V - Vizsla w --Weimaraner Viscosity N - Normal R - Reduced G - Greatly reduced 40 Table 4. (Continued) Breed Sex Age, Animal Number M -- -- 2“ M F 7 yr. 2 Ba M l3 wk 26 Ba M lggwk 27 Sp F 3 yr. 28 M F 7 yr. g_gg_ M F 6 yr. 30 M -- -- 3| M -- -- L M -- -- _31 Gs M liyr. 34 GS F ii wk 35 Stb M #2 mo. #36 65 M 5%yr. 38 Es M 1 1r. 2 M247 F 1 mo. #0 Mp ’ F 45%mo. hi Bt F 10 yr 52: K F hiyr. 41 Sp F 1 yr. M M F # yr. #5 M M hgyr. 46 Table h. Animal identification key for Table 5 Breed Sex Age Animal Number Gs F 4 mo. 1 Gs F 4 mo. gf Gs F h mo. #1 M F 5 fl. if M F 4_yr. 5 B M l yr. 6 M F 2 yr. 7 M -- -- 8 M -- -- .2, M -- -- IO M -- -- ll M -- -- I; M -- -- I3 M -- -- lh M -- -- 15 M -- -- l6 __§s F 3 yr. 1] M F yr. 18 M F 7 yr. [37 Gs F yr. 20 M F 4 yr. 4;;L M -- -- 3; MA -- -- 33 :. : mm mN mm~ me o o o:.o mm.o m.~ z > u om.o .< ~o-__-: 0 0 on we :_ NM 0 0 m_.0 :0.0 :.n z z u N_.0 .< Nmu__u: t5 0N __ N_ m 00— mm NN m 0 :~.0 in z z o mN.0 .< _wu_u_ 0 0 0 0 0 0 0 0 0 0 N.m in in o 0_.0 .< _0n-iN_ 0 0 :0 Nu mN mm 0 0 m_._ m0.0 _.N z in u mN.0 < Non:~i_ Jam 0 0 :0. Nu .n ma 0 0 no.0 0~.0 0.x 2 z o m.0 < «mum—um 0 0 0mm. on wo~ :N 0 0 No.0 mm.0 _.N z > u m.0 < Nmim_n: 41 0 0 mmw ow no 0N 0 0 m_.0 mm.0 :.m z u u mN.0 < NoumNuJ 0 0 0 0 0 0 0 0 w_.N m0.0 m.n z z u ~_.0 < N0u__u# 0. w :0. mm ow 0: 0 0 _0.0 0N.0 N.n z z o ~_.0 < _oiwim in ii in in 0m.- 0 0.x 2 in no _.0 < _oi0Nio m. a 0m: 00 Nm 0 Nm 0 0:.00 03.0 ¢.N‘ z 2 no _.0 < .0um_u0 Synovial fluid analyses from the following normal carpal, elbow, shoulder, hip, stifle and hock Table 5. no no . . . . 0 0 Buns N 33¢ N 3on N Bonn w... a 0 0 m m t 5' t 0' v.n e n v. o n t x 0' “0' t m 0' ‘ F m m m S e t U .n o n r n c n u .u. u a .u. u .... a do; £955 6:0: are“. r c e m H i u a m r a cell .LII D. ”V M” M" An nu Number Animal 42 (Continued) Table 5. m: m om: mm .3 m o o o Afloflfl§ z u 2.0 ”fl 493$ 4 o o Baa .m. wma‘ mm o a. -.o mm«o N z >, To m~-o .ul Ne-mNu¢ .N1 s .N .m om .m m o. o lo 84. E z 2 Id mule a 3.43. 5 mm A mm 0 mm: Am 0 o o mic -- z z u mm.o u _o-_-_ NH) o o mmN NM :mm mm o o o mm.o _. z > u om.o Tu. No-m~-: N o o we om mm o: o o :o.o Ms.o N z a u m~.o u Ne-.eu¢ .N o o NAN mm mm N. o. o m:.m Hm.o .N z z u m~.o (a Nouaa-: _ o o mm «A N. mu .TO 0 e~.o .ao.o .m. z 2 Bo N o .m Ne-m~-: N o o o o o o 1o o 9.0 8.0 :N z n_ u omio . No-32“ N o o mmN mm m. m o o no.0 om.o .N z .z u M.o .< Ne-m- an! o o we oo_ o o o o mo.o ow.o .N z .z o m~.o _< No-mumi an! N : eN o... m. on o o 8.0 .3103 2 z u $6 .< $-fi-fi NW 0 0 40QO xx. ._0mnm ox. 40QO x 40QO N. 5% m c n u e]. .I c O b t s t .l m Vin en VI 0 n t U C.l t.l t .I- .l a N mm Wm .M. C e t M .l .35 .1953 6:0: Tron. m m m m w .m w n .m e m 3.. m; H n m. a m n a .m E/ L/_ D. V M N A A D A 43 (Continued) Table 5. KN . m o -- -- u ~..o .m-m-m .m 0 0 mm 00 RN :N 0 0 0 __.0 u mN.0 .mu:~u0_ m: 0. #0 0 0 ii in o m0.0 .mnmuN_ _: 0 0 0 0 in in o .0. .0nmnN_ 0: RN 0 0- we ow :m 0 0 0 mm.0 o 0m.0 .mumnm_ mN o o 0 0 N_m 0m _N : mm.~ mm.0 “0 mN.0 .0n~:__ RN 0 0 N. # mu~ 0m 0 0 0_.m Nu.0 uo m~.0 .0u~n__ mm o.. o. 0mm om 0.. o. o o ~.: o... u .o.o .o-m.-m : -- -- -- -- m.mm ou.o .0 ~..o ..o-o~-m on 0. 0. m w Nm N0 0 0 0 0_.0 o mN.0 _0u_n_ n. 0 0 0 0 0 0 0 0 0 0 o 0_.0 .muownw mN 0 0 add mm mm. 0N 0N : _N.M 00.0 o 0m.0 ~0n__u: _ 0 0 r . Oman o\ .3on .\ 43% o\ .33» .\ 5% m c n e — o o o o m .I S I. t C .nlv .m mum .mum WM mm .m mm Um .m m m m m n m Mm w .U .mm_u .;QE>4 .Oco: m>_0m r. .k c .I u u .I .m m E / L / D. V M N A D A 44 (Continued) Table 5. .m-wuN. o o oN. we NM NM 0 o o m..o N.M z -- u N..o .n a: o 0 MM mm M .. o o o No.0 o.M z -- u MN.o .o .m-:N-o. M: NM M leN .N me :M o o o.m. M... -- x e .0 m.o .o .m-MN-m N: . M om N -- -- N.M z -- .0 Mo.o .a .m-M-N. .: o o o o -- -- o.M z -- u .o.o .o .m-M-N. o: we. we NM NM o o o o M..o :N.o M.M z -- u MN.o .a No-.-M MM -- -- -- -- ONM MN.o e.M z --- ..u ..o .a .o-0N-o MN o o GMJN am am: e. o o ON.MN om.N m.M -- -- u ..o .o .o-m.-o : NM e MM :. 0.: MN .. N :o.o MM.o :.M 2 m u MN.o .o .o-N-.. MN M: e ..M o. Mam am o o MM.o .M.o :.M 2 z u o.. .o .o-N-.. 0N N m. :M o -- -- -- -- -- u MN.o .o .o-m-m NM N NN oM . -- -- -- -- -- u N..o .o .o-m-m MM .33.. .\. .2...m x .333 e. .33... x m m r s o 0 C n e e .I .I C O b t S t .l m Y.m mm w. .m .m u m m v. .u n» e .L .m I. h m m m 0 n r n C a .33 .5953 .95: mice n. u k u u .m w m H. m .m .2 .wk up .v. m .N. A M m M ) “Zed o a . a. L (Con Table 5. -- -- -- -- ::.M 0:.a -- -- -- u mo.o .M om-M-.. N. M 0 MM M -- -- -- -- -- o MN.o .M 0M-MN-N. M. M. M OM o. MM. NM o o o ON.o -- z z u MN.o m 0M-N-.. M NM N_ OMM cm :3. «N :N a o:.. oM.o M.N z z u MN.o M .M-ON-M M o o NM: NM MN :. .N : NN.MM MM.o :.N z a .u MN.o M NM-M.-: M o 0 com. MM NaM Ms M . Mo.M MN.o M.N z m u MN.o M NM-MN-: N o o 0N: :m cm M. o o oN.o oM.o M.N z z 0. .N..o M .M-M.-M : . MM .M N. -- -- -- -- -- u mo.o m om-:N-o. M a .. MN 0. -- -- -- -- -- u mo.o M oe-:N-o. o. . .M NM . -- -- -- -- -- u MN.o M om-:N-o. .. -- -- -- -- o:.M o:.o -- -- -- u mo.o M oo-N-.. M. N c. on N -- -- -- -- -- o mo.o M oo-¢N-o. M 0 0 0 0 r .3430 .33»... {Eng .32.»... am m m m m wm mm w m .m .m m m y ._... m t I .n m m m o. n n n w .m .35 £93.. .020: 9:0... Wu .uuku v. .m m u H. m i um um w w m m m m M M '46 (Continued) Table 5. .PH L .o o om. MM .M .N , N ., Mo.M :N.o -- z c .u. oN.o .. NM-MN-M M: o o am on M. M. M : MM.N mo.o -- z . m u Mo.o .. NM-MN-M e: N. m M.. MN mm. M. o o M:.M e..o -- z . .u ON.o . NM-MN-M o: .11 N . MN MN o -- -- -- z n. 3 ON... . 8-3M M.. -- -- -- -- MM.o oM.o -- -- z u. N..o .M om.N-N. MM e. m m., o. MM. N» o o o oN.o -- -- -- u MN.o .M . om-N-.. N o o mmM OM mmM om, o o Mm.o m... M.. 2 > u oM.o .N NM-MN-: N o o o:M NM o.N MN .o o oM.o MM.o M.M z z u N.o .m .M-M.-M : M N .am M -- -- -- -- -- u MN.c .m QM-NN-N. :. e O Na M -- -- -- -- -- u MN.o .M om-mN-N. M. , .32.. N .8... N. .8... M. A .32.. N, m m. r . so 0 C n e mi sl t c .m. .m Y n e n Y O . n f. U , «.1 ”M.. n. MM A z. .u “u m m N m M n m m w m .33 £95.. 6:0: 9:0... .v...u w u u d w W H. m i f. C C C II U C r C n _ i E/ L/ V H N A D A 47 Table 6. Statistical analysis of synovial fluid prOperties from normal carpal joints Analyses Amount (cc) pH Leukocytes/mm3 in 1000 Erythrocytes/mm3 in l000 Pmn.* % Pmn. abs.** Monocytes % Monocytes abs. Lymphocytes % Lymphocytes abs. Clasmatocytes % Clasmatocytes abs. Mucin clot Viscosity Number of cases l6 IS l6 16 15 15 15 15 IS IS 15 15 l3 15 Range .l0 - 0.50 .00 - 7.60 - 0.87 - 66.h0 - 238 - 100 - 658 Mean : 0.26 1 .Oh 7.21+ 1 0.05 0.28 i 0.0l3 5.80 i h.27 1.13 1 0.77 3.60 1_2.SI 2h.27‘1,6.15 65.h0 :_22.73 52.53 i 9.36 “+8.20 2: 1.9.00 2.07 i 0.90 4.93 :_2.20 * Polymorphonuclear leukocytes _ **Absolute numbers 48 Table 7. Statistical analysis of synovial fluid properties from normal elbow jOints Analyses Number of cases Amount (cc) 2 pH 2 Leukocytes/mm3 in 1000 2 Erythrocytes/mm3 in 1000 2 Pmn.* % 2 Pmn. abs.** 2 Monocytes % 2 Monocytes abs. 2 Lymphocytes % 2 Lymphocytes abs. 2 Clasmatocytes % 2 Clasmatocytes abs. 2 Mucinfclot 2 Viscosity 2 Range 0.25 7.A0 0.0h 6.26 12 - 72 - 32 - - 7.50 - 0.3l - 6.h6 28 27 88 272 Meanl: 0.25 7.1-5 :0 0.17 10.12 6.36 i.°-'° 0 0 20 + 8 2h.5 3; 12.50 80 1 7.115 152 1120 0 0 *Rolymorphonuclear leukocytes **Absolute numbers 49 Table 8. Statistical analysis of synovial fluid pr0perties from normal shoulder joints Analyses Number Range of cases Amount (cc) 8 0.10 - 0.50 pH 7 7.10 - 7.80 Leukocytes/mm3 in 1000 8 o - 0,95 Erythrocytes/mm3 in 1000 8 0 - 3.71 Pmn.* % 8 0 - h Pmn. abs.** 3 0 - 26 Monocytes % 8 0 - 87 Monocytes abs. 8 0 - 653 Lymphocytes % 8 0 - 90 Lymphocytes abs. 8 0 - A90 Clasmatocytes % 3 0 - 7 Clasmatocytes abs. 3 0 - 33 Mucin clot 7 N - V Viscosity 8 N Mean‘i 0.28 ¢_0.0005 7.h0 :_0.10 0.h8 i.°-'3 0.50 :_0.45 0.50 :_0.50 3.25 1.3.20 38.50 1 11.65 257.12 1 101.20 h7.00 :_12.38 212.00 1. 69.30 1.50 :_0.88 6.87 1 11.86 *P01ymorphonuclear leukocytes **Absolute numbers Table 9. 50 Statistical analysis of synovial fluid prOperties from normal hip joints Analyses Amount (cc) pH Leukocytes/mm3 in 1000 Number of cases 22 17 15 Erythrocytes/mm3 in 1000 15 Pmn.* % Pmn. abs. ** Monocytes % Monocytes abs. Lymphocytes % Lymphocytes abs . Clasmatocytes % Clasmatocytes abs. Mucin . ox " 9. 0 1x 00 1\ N —, E .o 3? ” as \0 <3 -— cu 39 c: —- 4: cm cu rx . M 1:— \O N 0‘ . o o M N m \D o O 01 C .D o a z: 32 c> «a <3 ox :1 cu xo <3 -= s g. 3 c> c: c: c: c: \o J —- .n ‘2 o as as c: c: c: c> c> o1 C> c1 —- '<3 Erythrocytes as N 1x as <3 /cu m in MOD 3: m m <3 0 \0 cu <3 cv- en 61 co ~o c1 ox Leukocytes o 3 _ N _ M /cu mm In l000 o o o o _r N cu c: as ~o ' :3 PH N N N N I N ' . Viscosity 0‘ ‘9 z 0‘ ' 0‘ Mucin Clot > > > “- a 0- Nature “ m m m .5 m .' In In Amount 1n cc “1 o, U) N, ”2 0, Art1culat1on u, m u, L a, [u c: I— — 0— \o — ‘9 “1’ 3 ‘9 Jx ‘1’ Date m m 1 4r — m N .— m .— I N I I I I -- I ox «a co xo —- ax o N — M Ammo] Number 8 o g o 0 <3 57 ~Table l5. Statistical analysis of synovial fluid properties from stifle joints with a ruptured anterior cruciate ligament less than 3 weeks duration Analyses Number Range of cases Amount (cc) 6 0.25 - 2.00 pH 5 7.00 - 7.60 Leukocytes/mm3 in 1000 6 .02 - 2.39 Erythrocytes/mm3 in 1000 6 0 - 44.30 Pmn.* % 6 0 - 28 Pmn. abs.** 6 0 - 669 Monocytes % 6 0 - 63 Monocytes abs. 6 o - 693 Lymphocytes % 6 o - 72 Lymphocytes abs. 6 o - 1719 Clasmatocytes % 6 o - 72 Clasmatocytes abs. 6 o - 288 Mucin clot 6 F - V Viscosity 5 N - G Meani1 1.25 1 .37 7.20 1 .11 .73 1.36 29.67 1 8.95 h.67 1_h.7 111.50 1_112 16.00 1 9.89 131.33 1 113 31.33 1 10.20 364.17 1 272 31.00 1 12.h0 113.17 1,h5 *Polymorphonuclear leukocytes **Absolute numbers 58 Table 16. Animal identification key for Table I7 Breed Sex Age Animal Number Duration* Be F 21 yr. 110 3_mos, Bm M 2 yr. 110 6 mos, B F 9 yr. 112 h mos. M F 3 yr. 113 13 mOS. Mp1, M hi yr. 11h 2 mos. _L M hi yr. 115 6 mos, M F 10 er 116 6 wks. SS F 10 1:. ll] 31mOS. Cs F k yr. 118 2 mos. Bm F l%_yr. 113_, 10 mos B F 8 yr. 120 10 mo. Eb F 16 mo. 121 2 mos. B F 3 yr. 122 3 mos. Cs F 5 yr. 123, 2 mos. M F 6 yr. 12h 6 wks. Stb F 31 yr. 125 3 mos. Gs F 101yr. 126 lgyr. MD F 5 yr. 127 2 mos. *Duration time established from onset of lame— ness to clinical examination. 59 ° ts with a JO|n Synovial fluid analyses from stifle Table 17. ruptured anterior cruciate ligament more than 3 weeks duration - - - 11 o oo.o - - a m m.o u No1:.-: :N. mew m Nam. mm mum m. mm. o o:.:m uK.~. -1 11 a 1.1 m~.~ No-N-N :N. 83 fl 3.. m. m; m S . 8.. 9.13 ... z ..1 m... m. Gil-m 2. com oN owo. Na cm a on N om.o m.. 3.“ a a ..m o.. u .o-s~1m .N. o o ooN ow mN o. mN o. o.om m~.o 6.5 2 2 .U m~.o m .o-m-m cm. as mm m: an .. m m N .o.o ...o ..k m z u m~.o m .o1m-o. N_. as m Mme .m oo 5 1mw m. o om.o ..u a 12 as m~.. m .e-mN-m 6.. em on m.. .o a. m o o o om..o ~.~ -11 a 1 o.~ m .e-N1o. m.. mm m cum as m.. mu 6 o mm.m m:.o o.~ z a .6 m~.o w «m-m1m a.. e. m. mm am . . o o o ...o..aw. a > s o.. m ~61.- ~.. MNNN N. mom km 6N . . o o :~.o om.~ o.~ ,z a .u. om.o u ~61m1. ... a 6 ma. .m .m N 01- 3...: 3...: z - 1.. a... m. 3.2.: .... . o O .6313 .321. ..omnax .63.;. 5% m c n .... . .... .... 1 c .... 1.. Y" en V1 O n f. U “I ”1| o”. .m .I h N Mmmm .W m m .m m .mm w 1 e .W .11.... .12.: .22. 1:2. 3 «w a n m m m .m .... .m E/ L/ D. V M .N A D A 60 (Continued) Table 17. m: 6 mm: mm NNN on o 6N.o om.o Nm-N.-: NN. m: o. m_N ow .. a o NN.o “N.o Naum.um- .NN. co. m. mmm on an m .o No.o o.N 1m6-WMN. NW1- :m o. a. : mNN .m N. .am.o mN.o oe-mN-.. 6N. am a. mm: .m mN : m . om.o m.o .e-aN-m NN. Nm. mm o o m a . o oN.o mN.o .m-m-m 0N. oo. o. own an com 1 on osN :N oo.. m.N .m-N1o m.. one. am o o ON. o. o oN.. N.o .61N.-o 3.. o o .m. NN mNo .lmN o Nm.o o.N .m-oN-.. M.. mom N: o o .no.. am am m..N o.N oo-mN-.. 6N. m.m .a MNM a: Na o. m wk.o. o.N .o-mN-m mN. 11 - - 1- o N.o No-mN-m :N. , MW mw r 402.0% ..Omnofl Jaw-30$ Jagufiv ”mu- ..01 m m a w- N1 1 N 1. .... m .... n1 u .... .- .. 1 rm 1mm 5 . O f. U .I h o n pl n c m .mou .9; .0: «>0 Wu uu m .m m u ...-.1. 1»... .1 . .. s s. .. an an 11 w m .1. m ... m M 61 Table 18. Statistical analysis of synovial fluid properties from stifle joints with a ruptured anterior cruciate ligament more than 3 weeks duration Analyses Number Range Mean 1 of cases Amount (cc) 2# 0.20 - 2.25 0.97 1 0.17 pH 19 7.0 - 8.0 7.90 1 0.067 Leukocytes/m3 in 1000 211 0 - 6.25 1.31 1 0.3l-1 Erythrocytes/m3 in 1000 24 o - 70.00 15.06 1 £1.30 Pmn.* °/, 22 0 - 211 2.68 11.15 Pmn. abs.“ 22 0 [2110 30.111 1 13.00 *Monocytes % 22 1 - 81 18.60 1 5.09 Monocytes abs. 22 1 - 1161 189.68 1 61.00 Lymphocytes % 22 0 - 91 51.68 1 7.20 Lymphocytes abs. 22 0 - 1897 h51.82 1 109.00 Clasmatocytes % 22 0 - 96 26.23 1 6.00 Clasmatocytes abs. 22 0 - #687 486.6h 1 230 Mucin clot 22. N - V Viscosity 18 N - G *Polymorphonuclear leukocytes 7'1“}: Absolute numbers 62 The diagnosis of a ruptured anterior cruciate lig- ament was made using the criteria of sudden lameness and anterior drawer movement. If surgery was performed, the ligament was examined grossly. In all surgical cases, the ligament was found to be ruptured. For the animals examined at this clinic, an inter- val of approximately three weeks between onset of lameness and treatment appeared to be a critical period. When the interval was less than three weeks, surgical treatment gen— erally produced satisfactory functional results. However, when the interval exceeded approximately three weeks, the results from surgical treatment were not as satisfactory. This interval varied slightly, depending upon the degree of activity of the dogo For the purpose of this discussion, this time interval has been used as a criterion for classify- ing Joint disease (those cases more or less than 3 weeks' duration) (tables 14-18). It is interesting to compare the absolute polymor- phonuclear leukocyte count in tables 15 and 18 and the nor- mal absolute count in table 10. The count is higher in the more acute cases (those cases less than 3 weeks' duration). The per cent and absolute clasmatocyte counts are higher than normal for both divisions. Further, the absolute clas— matocyte count is higher in the more chronic cases (those cases more than 3 weeks' duration). 63 Table 19. Animal identification key for Table 20 Breed Sex Age Animal Number B M 6 yr. 80 L F 3%Yr. 81 Mp M 8 mo. 82 Gs M l3mo. 83 V F 3 Yr. 84 Gs M 7 mo. 85 005 F 8 mo. 86 p joints with dysplasia a .0 1— 'l V I1 64 .. Til- d analyses from o 11 I Synovial flu Table 20. Nmm m: NoN MN .oN mN m: oo.o. om.o 1. om.o .m-mN-m am MMN om OON m: mm N o o:.N 66:.o u mN.o .o-N1o. .m a on so - 11 u N..o .m-m.1m .m NN. a: mm. mm m . o m...o me.o u N..o .o-N1o. om cos. om N.. : wwN. a: o mo.o om.N u mN.o oo1.1N. mm ohm. um NNN m mo.. Nm :0. oo.m N:.m bu m.o om-m1N. mm moN mm .6. MN :m. NN m.. mm:.N ou.o mu 0.. oo-m-.. mm 1- -1 1- 1- -1 om.N mo.o u mN.o ow-.-N. mm mm o. am. .N moo mm o om.N NNm.o u mN.o oo-m.-.. mm mm mN : 1- - . mN.o .o-m.-N mm mam mm mm. 6N mo. m. o Mm o om.o u N..o .uumwm. Nm -1 11 1- - 11 u N..o .o-m.1 .m .3on w“. .330 N ..oflo x. Jeans x ”W W a m ..m t s t .1 mum mm m. m .m m. m . . . Wm mm m .m m m m. 1 m 65 (Continued) Table 20. . mNN on can m. :Nm 6. New on o.m NNo.N 1- 1- -1 bu m.o .o oo-m-.. om oNN m: oN. oN o.N mm o Nm.o om.o - a a o m.N _a oo-m-.. mm - 1- -1 -1 oowN mow 1- a u mN.o _a oo-.-N. mm o o o o o o o o o:.m o. - - 2 mo mN.. _a oo-m.1.. mm . . . . .u “w .931 N .8... N .8... N .8... N s m o c n N . m.1 s.1 t c .m .m mm mm w .m .m u w v. .1 .0 1- m m m m m .m m m m 1 m .mo—u £9.31. .95: m>—On_ u . u u s c t W t t .1 mm an ...1 w m .1. ... m m 66 Table 21. Statistical analysis of synovial fluid prOperties from hip joints with dySplasia Analyses Number Range Mean 1 of cases . Amount (cc) 16 0.12 - 1.75 0.55 1 0.16 PH 5 7.0 - 7.6 7.30 1_0.10 Leukocytes/m3 in 1000 13 o - 3.117 0.99 1 0.30 Erythrocytes/m3 in 1000 13 0.05 - 10.60 2.89 10.78 Pmn.* % 13 o - 30 11.39 1 2.5" Pmn. abs.*"" 13 0 - 667 71.92 1 51.00 Monocytes % l3 0 - 69 26.39 1 6.2 Monocytes abs. 13 0 - 1288 315.00 1 119 Lymphocytes % l3 0 «.55 23.00 1.h.12 Lymphocytes abs. 13 0 - 36h 1h9.15 1.27 Clasmatocytes % l3 0 - 68' 38.5h 1_5.8 Clasmatocytes abs. 13 0 - 1976 hh7.92 1_27 Mucin clot 8 N - P Viscosity 10 N - R *Polymorphonuclear leukocytes **Absolute numbers 67 The diagnosis of hip dysplasia was made from radio- graphs. The Joint fluids from these cases had an average total leukocyte count slightly above normal (tables 9 and 21). The per cent and absolute polymorphonuclear cell counts were also above normal. It is interesting to note that the clasmatocyte counts were elevated. 68 Table 22. Animal identification key for Table 23 Breed Sex Age Animal Number 0 F figiyr. 60 __!_ F 19 mo. 61 V F 15mo _6;_ M27 M g1yr. 63 B M _9_yr 66* _QP M 3 yr. 67 C F N yr. 68 Gr F 11 yr. LO M M 2 r. .21 - Gs M h yr. 1h2 . M F 6 yr. 7;1_ * Staphylococcus aureus isolated from culture. 69 Joints Synovial fluid analyses of possible septic arthri ides from the carpal, shoulder, hip, stifle and hock Table 23. ommm #N o o ON_m wN ONmM_ QN. m mN,o.N x m _.m _.o w _w1J1: mm mm m: N m. 11 11 11 11 11 mo —.o m _01JN1M mm mm N o_N_ mm Nmm m #:NN _m mo.o #.J. 11 11 2 «0 om.o m Nm1mN1m we 0mm NN ~9m m. o, 0 mix. mm mw.m mm1N —.N 11 11. 11 mN1o u N©1m1N mm o. N NN .os 11, 11 11 11 11 u mN.o a _m1_N1m _N_ ow . o 6 ON 11 11 :.N 11 11 m —.o a _wLNI: om NmNN mN .ww_m QJ _Nm m _wJN MN NwN N.o_ 11 2.. z m. m.o a _w1OM1m ow om_m NN .om#_ 0_ 0mm: om o_mm mm w1m m.#_ o.m..¢ m u-U O.- .u _01_MI# _o 11 11 11 11 0mm m._F,m.o a > m.m mN.o .< .m1m_1_ on - 11. 1- 1- mm.o m.m. 6.N_ z, > ..U N < .61N-N No a? N 4? N 8w .N 40mm. Nm 91.3 n._~ mN z a ..0 am; < Sum-w 3 —w m 1Nmm mN mm m o_w ow N.w_. mm._ 11. z- 2 no ON.o < —wIw—1# No n. n. ..3... N ..8... N ..8... N .31.... N am m c n N t 1 $1 . . t c .101 .m yum _m.m .w. o n .t “m m _ y N. .11. .- u .n m «Hm. o n m M" w .m t . k C .I U . .I e .33 £93.. .95: mica N1 w w w H .m. m u m n ..u .m :51] net! D. ”V. M” “N Am nu .A '70 (Continued) Table 23. omN J 0:5m om m:h N_ om_ :N 0.0. N.@ N.N z > mu mN.o m Nm1m1: NJ. -- -- -- -- o.» mm.N -- -- a m.u ma.o .u _m-:_-: NN o o mmm m NNN meo_ mm 0:.0 o_.—— o.h 11 m —.u m.N .u —w1mN1m NR 0 o co; N OONm +~ 092: Nm om om_ OK 1 a mu o._ .m _w1m—1m mm o o oww— 0_ ohm N :3mm- mm m.mm w.m_ o.n z u mu om.o .m _w1¢1# mm .1 N mam mm i N R _ 9.: E -- a, .m 8 85 L :33 8 o o 09 #N O o mON mug mN.o NN.o 11 11 2 no om.o .u _o1mN1o om oom— J ooo¢ 0— Cam N coomm :w o o: m.w x > _.u o.— m —o1m_1m mm m m r ..omfiN ..oEoN ..ouaoN ..omaoN «m m a m m. mm mm m. m .m w m Mm «M N n .... m w m .mfl . fir=> . > “U 1W C “ om w U .....1. MW .l. s _. s 22 I: an ”Z w w m m m m m m 71 Table 2h. Statistical analysis of synovial fluid prOperties of possible septic arthritides from carpal joints Analyses Number Range Mean i of cases Amount (cc) 4 0.20 - 1.50 0.99 i 0.45 pH 3 6.50 - 7.50 7.20 i 0.35 Leukocytes/mm3 in 1000 ’4 1.35 - 21.70 13.56 _+_ 11.66 Erythrocytes/mm3 in 1000 L1 0.115 - 630 162 i 156 Pmn.* °/o 2 6o - 92 76 i 16 Pmn. abs."'"""‘ 2 810 - 19,96t1 10,387 2“. 9,577 Monocytes % 2 h - S 4.50 :_0.50 Monocytes abs. 2 68 - 868 #68 i 400 Lymphocytes % 2 2 - 29 l5.50 i l3.40 Lymphocytes abs. 2 392 - 43h hi3 :_2l Clasmatocytes % 2 2 - 6 4.00 :_2.00 Clasmatocytes abs. 2 8i - h3h 257.50 :_l76 Mucin clot h N - V Viscosity h N - R ~kPolymorphonuclear leukocytes "”Absolute numbers 72 Table 25. Statistical analysis of synovial fluid properties of a possible septic arthritis from the shoulder joint Analyses . Number Range Hban :_ of cases Amount (cc) l l.00 pH l 7.00 Leukocytes/m3 in 1000 1 “1.50 Erythrocytes/m3 in 1000 1 6.60 Pmn.* 11. 1 38 Pmn. abs.** 1 5510 Monocytes % l 30 Monocytes abs. l #350 Lymphocytes % l 10 Lymphocytes abs. l thO Clasmatocytes % l 22 Clasmatocytes abs. l 3l90 Mucin clot l P Viscosity l R *Polymorphonuclear leukocytes **Absolute numbers 73 Table 26. Statistical analysis of synovial fluid prOperties of possible septic arthritides from hip joints Analyses Number Range Mean 1 of cases Amount (cc) 3 0.l0 - 0.50 0.28 :_O.l# PH 1 ~--- ---- Leukocytes/mm3 in l000 1 ---- ---- Erythrocytes/m3 in 1000 1 ---- ---- pmn.* 11. 3 20 - 70 37.67 1 l6.l-19 Pmn. abs.** l ---- ---- Monocytes % 3 O - 22 3.33 1 6.89 Monocytes abs. l ---- ---- Lymphocytes % 3 0 - 48 l6.67 : 15.67 Lymphocytes abs. l ---- ---- Clasmatocytes % 3 6 - 80 37.33 Clasmatocytes abs. 1 ---- ---- Mucin clot l ---- N Viscosity l ---- N *Polymorphonuclear leukocytes 7'mAbsolute numbers 74 Table 27. Statistical analysis of synovial fluid pr0perties of possible septic arthritides from stifle joints Analyses Number Range Mean 1 of cases Amount (cc) ll 0.l0 - 2.50 0.67 :_0.20 pH 6 6.80 - 7.10 6.98 i 0.011 Leukocytes/m3 in 1000 10 0.27 - 130 211.30 1 12.70 Erythrocytes/m3 in 1000 10 0 - 53.60 11.80 1 5.58 Pmn.* % 10 1 - 95 57.30 1 10.70 Pmn. abs.“ 9 37 - 106,600 206011.67 : 11,305 Monocytes % l0 0 - 28 5.50 1.2.63 Monocytes abs. 9 0 - 8l20 l,682.67 1 975 Lymphocytes % '0 0 ' 95 25.20 1,9.07 Lymphocytes abs. 9 0 - 9100 2,352.33 1,973 Clasmatocytes % lO 0 - 39 9.30 :_h.39 Clasmatocytes abs. 9 0 - 6960 i,0hl.33 1 760 Mucin clot 9 N - V Viscosity 6 N - R *Polymorphonuclear leukocytes **Absoiute numbers Table 28. a possible septic arthritis from a hock joint Statistical analysis of synovial fluid properties of Analyses Amount (cc) pH Number of cases Leukocytes/m3 in 1000 1 Erythrocytes/mm3 in 1000 l Pmn.* ‘1, Pmn. abs.** Monocytes % Monocytes abs. l Lymphocytes % ' Lymphocytes abs. ' Clasmatocytes % I Clasmatocytes abs. ' Mucin clot Viscosity Mean‘t 0.25 7.20 6.20 l0.00 2h ISO 12 749 3746 250 *Polymorphonuclear leukocytes 4A. "“Absolute numbers 76 Table 29. Statistical analysis of synovial fluid prOperties of possible septic arthritides from the carpal, shoulder, hip, stifle and hock joints Analyses Amount (cc) pH Leukocytes/1111113 in 1000 Erythrocytes/mm3 in 1000 Pmn.* % Pmn. abs.** Monocytes % Monocytes abs. Lymphocytes % Lymphocytes abs. Clasmatocytes % Clasmatocytes abs. Mucin clot Viscosity Number of cases 20 12 i7 17 17 1h i7 1h 17 1h 17 16 12 0.10 - 1.50 6.5 - 7.6 0027 ' '30 0 37 - 106,600 0 0 0 0 Range - 282 - 95 - 3o - 8120 - 95 - 9100 - 80 9100 0.67 1 0.15 7.09 -_1_ .09 19.311 1 7.110 62.62 1 39 5h.l2 ¢_7.h0 15,309.79 :_7h98 7.71 i 2.110 1,535.71 :_668 23.71 1_6.h0 2,3l2.79 :_689 111.117 1 5.00 1,800.6h 1_760 J. ”Polymorphonuclear leukocytes ¢4 “‘Absolute numbers 77 The septic arthritis cases were diagnosed only upon the bases of total leukocyte and polymorphonuclear cell counts. A positive diagnosis of septic joint disease can only be made following isolation of a bacterial organism. It has been reported22 that bacterial isolates from fluid obtained from infected human articulations are difficult to obtain. The results of this study confirm this finding. This difficulty may be either due to the very active phago— cytosie by mononuclear phagocytes or to inadequate culturing techniques. A tabulation of the laboratory analyses of the samples obtained from the carpus, shoulder, hip, stifle, and hook appear in tables 24-28, respectively. For the purpose of comparison, in the tabulation of the characteristics of all septic arthritis cases, all the samples are considered as a group (table 29). The total leukocyte count is con- siderably higher than in normal fluids. The erythrocyte count is also elevated. The differential and absolute poly- morphonuclear leukocyte counts are substantially above nor- mal. The absolute clasmatocyte count is above normal in all cases. 78 Table 30. Animal identification key for Table 31 Breed Sex ' Age_ An ima_1:Number Bm F 9 yr. 130 Es M 3 yr. 131 EP M‘ 3 yr. 132 S M 8 mo. 133 Gs “ M 6 mo. 13h Ne M 3 Yr. '35 Ba M 3 y r. 136 Da ‘F h yr. 137 Gs M h yr. 138 Ba 'F 1 yr. 139 is F 8 mo. lhO Cs F 5 yr. lhl Gs M h yr. 142 atic d analyses of unclassified traum O lf‘iul' 0 7‘10V as Table 31. arthri ides of unknown etiology from the carpal, elbow, shoulder, stifle and hock joints NM. o: e a 11 11 :.N z 11 u MN.o m .o1NN1.. .e. sNN. mm ONN MM NM. 6 NN . N.N N.N M.N z z .6 0M.o _u .s1o.1M NM. oN o. oN o 11 11 11 11 11 u o..o .u .61MN1m NM. om oM .N N mm. Ms 0 o o oM.o 11 1m 11 u om.o u os1N1.. 0M. :. :. oN N 11 11 11 11 11 o o..o u .m1N1N MM. mo. m so» No Na. m. mm m m.m N.. ..N z a mu MN.o .m Nm1oM1M :M. mN :: mN o is 11 11 11 z 11 u o.qo m No1o.1M MM. M.m mm MN: oM mm. N. o o N:.N 6.. :.N .z 11 N6 MN.o M No-6.1N MM. Mm. M.‘ M.N. .m MN M M. . o.M M.. M.N z a .6 MN.o .< .s1M.1M NM. NM 6. Mm :N mm. mm a. s m.M. MM.o 11 x z s0 MN.o < .s1m1m NM. wN. m. Nam MN .N M o o N.N MN.o ..N x 2 “Nu o.N < No1sN1. .M. N: .N mm. mN o o o o M..o oN.o o.N z 11 No MN.o < No1MN1. oM. Iowan N. .32.. N ..oBa N ..om a N m w c n A u o o a “mm mm 1. c .m .m .wn mm w o ...... .... m ...- y .- m 1 .1 1 .mm «m N n .... n w .. .33 .5931. .95... v.39. w. u .w u v. .u _ m u ..1. m .m an an M. w m m m ... .... M 80 '3 r _1 ‘1ort1nued' ‘- \V Table 31. o 0 mm. mm s N o 0 ..MN M.. M.N z a .6 MN.o . No1m1M Ne. o N msN om mm m. o o o .M.o N.N. N a No oo.N . No1NN1N Na. NM m 6mm .M 6 . o o N.M. ss.o—..N z . .6 MN.o .m N61N1M .s. 11 1- -1 -- o. N271 z 1- t ..o ... .61NN1: .... ooN o: M.. MN QM. 6N M . o om.o_s.N z z u N.o .m .m1m1M 0:. cm. a: m.. MN m.. mN o o o N:.o 11 z a .6 m.o .m .m1sN1: as. Ms N mom m. :NMN om o o M.. N.M 11 z m 6 M.o _m os1.N1.. MM. 1idsN MM, +86 1M: 0:6 0: 11mm. .N 1M. 0.. 11 .z. a u ..o m 1wo1m1M .s. ..omsoN ..omsaN ..omfiN ..63oN m m r . SO 0 C n e _m.1 s.1 1. c .m .m n f. U mum .m.m my .m .1 a “u mm Mm ..N. .M. .... m m .. nu Nu .... .... w u w..N .... .m ...: es: .2... ...... ....n .2 w w m .1. m ... m m 81 Table 32. Statistical analysis of synovial fluid properties of unclassified traumatic arthritides of unknown etiology from the carpal, elbow, shoulder, stifle and hock joints Analyses Number Range Mean 1 of cases Amount (cc) 20 0.10 - 2.00 .h3 :_.h9 PH 12 7.0 - 717 713“ 1,.063 Leukocytes/111113 in 1000 16 .19 - 2.20 .96 1 .68 Erythrocytes/m3 in 1000 16 0 - 28.10 0.95 1 1.90 Pmn.* % l9 0 - 8 1.21 1 J17 Pmn. abs.“ 15 0 - 96 12.27 1 6.50 Monocytes % 19 0 - 80 27.79 1 6.20 Monocytes abs. 15 0 - 252“ 285.73 :_165 Lymhocytes % l9 7 - 98 116.90 1 6.80 Lymphocytes abs. 15 21 - 1215 #38.h0 1.86 Clasmatocytes % l9 0 - 58 23.58 1 11.20 Clasmatocytes abs. 15 0 - 1296 231.20 1.9h Mucin clot 12 N - P Viscosity 18 N - R *Polymorphonuclear leukocytes **Absolute numbers 82 Those cases diagnosed as unclassified traumatic arthritis could not be classified as to etiology, but in- stead were grouped using clasmatocyte counts and clinical symptom of lameness (with an unknown etiology) as criteria. For the purpose of comparison, in the tabulation of the characteristics of these cases, all samples are considered as a group (tables 31 and 32). 83 Table 33. Animal identification key for Table 3h Breed Sex Age Animal Number Diagnosis Gunshot wound invol- L M 6 yr. 90 ving1ioint ggpsule Osteogenic sarcoma Gd F 6 yr. 91 of radius (distal) Lateral luxation Stb M _1 mo. 92 of patella Osteochondritis Gd M 7 mo. 93 dissecgns Ununited anconeal Gs M 4 yr. 95 process 84. Synovial fluid analyses of miscellaneous arthri ides Table 3h. NMN. MN MM N .oM MN o o MM.. MN.. 11 -1 z .0 M.. .M .M1M.-. NM 11 11 11 11 Ms... oM.o 11 M a m M.. M MM1N1N. NM 1N.. M MMM. Na MMM :N MoN. .M MM.NN oM.M M.N M > .M M.o M .M-:N1N MM ::M M: NMM. Ms NM a NM : MN.MM oM.o 11 M a M MN.. .8 .M1M1: MM MNi. MM .M MM M N o o N.o M..o 11 z z u M.. _M .M1MN1. MM N : MM o: MM NM N a oo.M ...M 11 z z n0 MN.o .M 0M1..1.. MM 0 MM 0 a 11 11 11 11 11 u ..o M .M1M1s MM .oMN MN MMN o. MMN M M.. .. oo.¢M MM.N 11 M u no M.. M .M1M.1N MM M: M: NN .N .M .M o o M..o o..o 11 z z u M.. M .M1MN1., MM . N MN MM NM MM M : MN.o No.0 11 z 2 M M.q M oM1NN1.. MM .NM NM MMN NM M.N :. o o .... MM.. M.N M -> no M.. .M NM1M.1M MM 11 11 11 11 o MM.o :.N z. a N M.. < .M1MN1M. .M .336 N .321 N .3... N ..88 N 5m m c n r w ...... ..1 1 . .... m yum .m.m w. o .m t u m y .M m u N .m m .m m o n m _m m. .m .ma_u .cae>4 .0coz m>_oa w.u u u u .m m m H“ _m .1 an an w w m m A m m m 85 Diseased joints of known etiology, but where case numbers were no more than 1, were grouped in the category of miscellaneous arthritides. A gunshot wound case (animal number 90) was placed in this classification for two reasons. The injury had occurred 10 days prior to the examination. It was not known whether the elevated polymorphonuclear cell counts resulted from an infection following the gunshot or from trauma to the joint capsule produced by the shot. This can be either a traumatic arthritis, a septic arthritis, or both. With reference to the osteochondritis dissecans case (animal number 93), it is interesting to note the variations in the clasmatocyte counts (table 34) as com- pared to normal counts (table 8). In those fluid samples where the clasmatocyte count is within the normal range, one may suspect that a loose joint body (an articular carti- lage fragment) had caused either locking of the articula— tion or restriction of movement. Where this occurs an arth- ritis may not deve10p. In those samples where the count was abnormal, one may suspect that abnormal friction pro- duced by a loose joint body, in a joint where movement has not been restricted, may produce cellular changes. In this situation, an arthritis, with subsequent lameness, would be present. The ununited anconeal process (in animal number 95) produced a traumatic arthritis and elevated clasmatocyte counts. CONCLUSIONS Normal joint fluid values established by this study have been found to vary from one articulation to another. Therefore, each joint was considered to be a separate en- tity. If polymorphonuclear leukocytes are present in num- bers exceeding approximately lSO/mm3 or the differential cell count exceeds 20%, a diagnosis of a possible septic arthritis should be considered. A cellular count of this nature would justify an attempt to culture the synovial fluid. If the clasmatocyte count exceeds approximately lSO/mmB, or the differential cell count exceeds 30%, one should consider a diagnosis of traumatic arthritis. In cases where both the clasmatocyte and polymor- phonuclear cell counts are above normal, a tentative diag- nosis of septic arthritis should be made. In all cases, subsequent synovial fluid samples should be taken for analysis to evaluate the response of the diseased joint to treatment. Using synovial fluid analysis, it is possible to determine the presence or absence of arthritis. It is also possible to differentiate arthritides of traumatic etiology from those of infectious etiology. 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