. Surgical differentials. pt under an anesthetic, to tellwhether such a stiffness is of the transitory or permanent , if transitory, when the element of pain, which symp-tom calls this muscular tone into action, is obliterated, the mus-cle relaxes, and the condition is seen to be spasmodic. Musclesin a state of chronic tonicity are apt to become permanentlyshortened. If no relaxation occurs a non-relaxing contractionis demonstrated. Myotomy or Muscle Section is indicated in non-relaxingcontractures. Familiar examples are, section of the sterno-mastoid for spastic torticollis, or
. Surgical differentials. pt under an anesthetic, to tellwhether such a stiffness is of the transitory or permanent , if transitory, when the element of pain, which symp-tom calls this muscular tone into action, is obliterated, the mus-cle relaxes, and the condition is seen to be spasmodic. Musclesin a state of chronic tonicity are apt to become permanentlyshortened. If no relaxation occurs a non-relaxing contractionis demonstrated. Myotomy or Muscle Section is indicated in non-relaxingcontractures. Familiar examples are, section of the sterno-mastoid for spastic torticollis, or of the flexors and adductorsin late stages of coxitis. Tenotomy usually takes the place ofmyotomy. The fasciae are very liable to degenerative changes. Aselsewhere in the body, so in the fasciae fibrous tissue tends onslight provocation to become very thickened, or sclerosed,1 asit is called. It will be remembered that this process has beendescribed in Chapter II, as dry productive inflammation. DUPUYTRENS CONTRACTURE. 49. Fig. 8 One of the most interesting, as well as most common, con-tractures of fasciae, is what is called Dupuytrens occurs in the palmar fascia. It has nothing to do with thetendons. It is a superficial lesion. It is infinitely more com-mon in men. It is characterized by a gradual closing of thefingers, which are held in a pathognomonic position as thoughby bands of steel. As it is often bi-lateral, a central cause hasbeen suggested for it. Probably chronic irritation favors thissclerosis, although it is by no means uncommon among menwho have done but little manual labor. The figure shows that the hand assumes, (no doubt for theconvenience of ones memory), the well known position ofPapal Blessing or Apostolic Benediction. Were it not for thisobliging resemblance, it would be very difficult to rememberthe fact that the lesion occurs almost entirely in the fascia lead-ing to the ring and little finger. Treatment. The open and the closed methods ar
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