Lectures on orthopedic surgery . 114 may extend in any direction; upward in the multifidusspin^e, into the lumbar region, downward along the psoas muscle, or into thebuttock, to the right orto the left, or directlyinward, to open intothe bowel. The direction inwhich the pus travelsmay be: (1) Throughthe anterior ligament,keeping outside thepelvic fascia; (a) fol-lowing the course ofthe sacral nerves andpyriformis out throughthe great sacro-sciaticforamen and formingan abscess under thegluteus maximus; (b)following the curve ofthe sacrum behind therectum to point in theischio-rectal fossa, caus
Lectures on orthopedic surgery . 114 may extend in any direction; upward in the multifidusspin^e, into the lumbar region, downward along the psoas muscle, or into thebuttock, to the right orto the left, or directlyinward, to open intothe bowel. The direction inwhich the pus travelsmay be: (1) Throughthe anterior ligament,keeping outside thepelvic fascia; (a) fol-lowing the course ofthe sacral nerves andpyriformis out throughthe great sacro-sciaticforamen and formingan abscess under thegluteus maximus; (b)following the curve ofthe sacrum behind therectum to point in theischio-rectal fossa, caus-ing inflammation andadhesion of the rectumand ultimately burstinginto it; (c) coursingunder the lumbo-sacralligament into the psoasmuscle and thence tothe thigh ; (d) or into the iliacus muscle and thence intothe groin. (2) Through the back part of the joint intothe multifidus spinse, creeping along this and pointingin the lumbar region or directly over the joint atrophy of the muscles of the buttock and. Fig. 75.—Right sacro-iliac disease. Leg adducted and gluteo-femoral crease raised. 115 thigh is uniformly present. Deep pressure over thearticulation often causes pain before much, if any, swell-ing is noticeable, and pressing together or pulling apartthe pelvic bones also induces pain. This pain appearsto be due more to the motion imparted than to the
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
