. The diseases of infancy and childhood. ningand flattening of the whole gluteal region;the trochanter is unnaturally prominent; thegluteal fold is shortened, and often single in-stead of double. There is no characteristicposition of the limb in this stage. There isatrophy of the thigh and often of the calfIn Fig. U7 is shown the appearance of a typ-ical case in the full development of the firststage. In walking, the child favors the dis-eased side, throwing the weight as much aspossible upon the sound limb; but all thesesymptoms are of much less importance fordiagnosis than is an examination
. The diseases of infancy and childhood. ningand flattening of the whole gluteal region;the trochanter is unnaturally prominent; thegluteal fold is shortened, and often single in-stead of double. There is no characteristicposition of the limb in this stage. There isatrophy of the thigh and often of the calfIn Fig. U7 is shown the appearance of a typ-ical case in the full development of the firststage. In walking, the child favors the dis-eased side, throwing the weight as much aspossible upon the sound limb; but all thesesymptoms are of much less importance fordiagnosis than is an examination of the func-tions of the joint. For this purpose the child should be placed upon a table upon hisback, and the various movements of the hip—abduction, adduction,flexion, extension, and rotation—should be executed, first with the soundlimb and then with the suspected one, the two being carefully comparedat every point to determine the degree of motion allowed. It is notnecessary that force should be employed or pain inflicted. If the. Fig. 147.—Hip-Joint Disease,at the End of the FirstStage. Showing muscu-lar atrophy, prominenceof the trochanter, flatten-ing of the gluteal region,and a single gluteal fold. 914 DISEASES OF THE BONES AND JOINTS symptoms have existed for some weeks, there is generally a limitationof motion at the hip in all directions, but first usually in abduction,rotation, or extension. In more advanced cases, no motion whatevermay be permitted at the joint, the pelvis tilting with the slightestmovement of the femur. This fixation of the hip is due to tonic mus-cular spasm. Crowding the articular surfaces together, by pressureupon the heel or trochanter, produces pain, which is usually referredto the joint. This test should be carefully made, lest injury be should not be made under ether, since in this way seriousinjury may be done unconsciously. Second Stage.—This has been called the stage of arthritis. Itsexistence may be assumed
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