A treatise on orthopedic surgery . e floor, when the body, instead of bending over thesupporting hands, retains almost its original contour (Fig. 18). As has been stated, even in early cases one may detect oftena slight fulness about the spinous processes or a slight irregu-larity in their line, about which the muscular spasm is mostmarked; this indicates the exact seat of the disease. Deeppressure on the spinous processes may cause discomfort, andsometimes greater elasticity at this point may be in the hands of an expert, it is, however, a test of com- TUBEBCULOUS DISEASE
A treatise on orthopedic surgery . e floor, when the body, instead of bending over thesupporting hands, retains almost its original contour (Fig. 18). As has been stated, even in early cases one may detect oftena slight fulness about the spinous processes or a slight irregu-larity in their line, about which the muscular spasm is mostmarked; this indicates the exact seat of the disease. Deeppressure on the spinous processes may cause discomfort, andsometimes greater elasticity at this point may be in the hands of an expert, it is, however, a test of com- TUBEBCULOUS DISEASE OF THE SPINE. 45 parativelj little value; and again it may be mentioned thatlocal pain and local sensitiveness to j)ressure on the spinousprocesses are not characteristic signs of Potts disease. Finally, one should examine for pelvic abscess. This maybe suspected when unilateral psoas contraction is present inmarked degree, although psoas contraction may be presentwithout abscess, and abscess may be unaccompanied by psoas Fig. Disease of the lumbal- region before the stage of deformity. A test for rigidity. contraction when the substance of the muscle is not typical psoas abscess, as pictured and described, is afluctuating tumor that suddenly appears on the inner side ofthe thigh, although it may have been many months in descend-ing to this position from its original site. Demonstrable abscessis present at some time in at least 50 per cent, of the cases oflumbar disease, and its detection is a matter of importance,since its subsequent behavior will often materially influencethe treatment. The child is placed on the side, the thigh isflexed, and the hand is pressed gently down into the loin and 46 OETHOPEDIC SUEGEBY. iliac fossa. Sometimes the examination will be made easier bjextending the limb and thus bending the spine forward towardthe hand. Often in this manner one can make out a peculiarsausage-like thickening on one or the other side of the spine, ora la
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