. Physical diagnosis . er motions of the hip—rotation, adduction, abduction, andflexion—are not impeded. General spasm of the hip muscles is tested with the patient on theback upon a table or bed (a child may be tested on its mothers lap)and the leg flexed to a right angle, both at the knee and at the hip. THE JOINTS 459 Using the sound leg as a standard of comparison, we may then drawthe knee away from the middle line (abduction), toward the past andmiddle line (adduction), and toward the patients chest (flexion).Rotation is tested by holding the knee still and moving the foot awayfrom the me
. Physical diagnosis . er motions of the hip—rotation, adduction, abduction, andflexion—are not impeded. General spasm of the hip muscles is tested with the patient on theback upon a table or bed (a child may be tested on its mothers lap)and the leg flexed to a right angle, both at the knee and at the hip. THE JOINTS 459 Using the sound leg as a standard of comparison, we may then drawthe knee away from the middle line (abduction), toward the past andmiddle line (adduction), and toward the patients chest (flexion).Rotation is tested by holding the knee still and moving the foot awayfrom the median line of the body or toward and across it. (2) Spinal column. Muscular spasm of the muscles guardingmotion in the vertebral joints can be tested by watching the bodyattitude (a stiff, military carriage in most cases), and by efforts tobend the spine forward, backward, and to the sides. In most cases We can make out limitation of these motions byasking the patient to stand with knees and hips stiff and then bend. Fig. 254.—Rigidity of Spine in Potts Disease. his trunk (of course, naked) as far as he can in each of the four direc-tions. If we are familiar with the average range of motility in eachdirection and at the different ages, this test is usually easy and bending is the least satisfactory, and in doubtful cases thepatient should be on his face, while the physician, standing above him,lifts the whole body by the feet (see Fig. 254). (3) In the joints of the shoulder, knee, elbow, wrist, ankle, toes,and fingers, there is usually no difficulty in testing for muscular spasm,and no special directions are needed. To distinguish muscular spasm from bony outgrowth as a cause oflimited joint motion, we should notice that bony outgrowths (, inthe hip) allow perfectly free motion up to a certain point; then motionis arrested suddenly, completely, and without great pain. Muscular 460 PHYSICAL DIAGNOSIS spasm, on the contrary, checks motion a little from th
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