. Medical and surgical therapy. onthe external popliteal, ankylosisof the knee or ankle is hardlyever seen. It is only the phalangealjoints of the toes which maybe affected by a certain degreeof stiffness. But very marked joint affections are caused by incompletelesions of the trunk of thesciatic, especially those whichinvolve and irritate the fibresof the internal popliteal. Ankylosis of the knee is veryfrequent, and is occasionallyvery marked, but what is seen still more frequentlyis ankylosis in extension of the tibio-tarsal and meta-tarso-phalangeal joints, those of the big toe being themo
. Medical and surgical therapy. onthe external popliteal, ankylosisof the knee or ankle is hardlyever seen. It is only the phalangealjoints of the toes which maybe affected by a certain degreeof stiffness. But very marked joint affections are caused by incompletelesions of the trunk of thesciatic, especially those whichinvolve and irritate the fibresof the internal popliteal. Ankylosis of the knee is veryfrequent, and is occasionallyvery marked, but what is seen still more frequentlyis ankylosis in extension of the tibio-tarsal and meta-tarso-phalangeal joints, those of the big toe being themost affected. The articulations of the tarsal bones with each otherand with the metatarsals may also become involved,which explains the rolling up of the foot towards itsinternal border, and the rotation which the front ofthe foot seems to undergo on the back of the foot(fig. 56). From this brief summary it appears that incompletelesions of the median and sciatic nerves, the verylesions which give rise to the causalgic Fio. 56.—Claw-toe defor-mity following a lesion ofthe trunk of great sciatic.(Painful form.) JOINT AFFECTIONS 395 have the most pernicious effect on the joints, andespecially on those of the extremities. Besides which, in fairly numerous cases, the jointsof the fingers become thickened, and their swellingcontrasts with the thinning of the inter-articular digitalsegments. Sometimes radiography shows not onlydecalcification of the bones of the hand or foot, butin addition a very slight increase in size of the bonyextremities of the phalanges, and especially of theheads of the metacarpal bones. It is therefore obvious that the nature of the nervouslesion constitutes a highly important factor. In many cases of this kind it is the only cause, andneither a fracture of the limb nor a prolonged sup-puration can be incriminated. Muscular contracture,ischsemic retraction, and vascular lesions may also bediagnosed. Ankyloses of the elbow^re chiefly met with in l
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