American practice of surgery : a complete system of the science and art of surgery . The experiment is notas conclusive, however, as might appear at first sight, because a very consider-able degree of pressure is necessary within the capsule in order to produce theattitude in question in the cadaver. In the presence of effusion into the joint TUBERCULOUS DISEASE OF BONES AND JOINTS. 637 one would expect this attitude in order to accommodate the joint cavity to theeffused material, and this is undoubtedly the case in acute synovitis. In hip-joint disease, while there is seldom, if ever, much ef
American practice of surgery : a complete system of the science and art of surgery . The experiment is notas conclusive, however, as might appear at first sight, because a very consider-able degree of pressure is necessary within the capsule in order to produce theattitude in question in the cadaver. In the presence of effusion into the joint TUBERCULOUS DISEASE OF BONES AND JOINTS. 637 one would expect this attitude in order to accommodate the joint cavity to theeffused material, and this is undoubtedly the case in acute synovitis. In hip-joint disease, while there is seldom, if ever, much effusion, nevertheless the thick-ening of the synovial membrane, where that exists, or the sensitiveness of thejoint structures, may have the same effect. Flexion, rotation outward, andabduction relax the strong ilio-femoral ligament, and this is probably thetrue explanation of the assumption of the attitude in question; the sensitivestructures are protected from pressure, and, while a considerable degree ofmovement may be carried out painlessly, nevertheless any attempt to produce. Fig. 262.—Tuberculous Disease of the Hip in a Child Six Years of Age. The amount of flexionis calculated by means of the goniometer. The limb is elevated until the spine lies flat upon thetable, when the angle of flexion is estimated. (Original.) full extension or complete adduction is resisted and produces much pain. Itis obvious, also, that with the thigh flexed there is less jar produced in the sen-sitive joint when the patient moves about. In some instances, even in the early stages of the disease, the thigh is flexed,rotated outward, and adducted instead of abducted; this may occur when theprocess is very acute, and we may imagine that in such cases early extensivedestruction has been done to the joint tissues, resulting in softening of the liga-ments and thus permitting the joint to assume this attitude through muscularspasm without inducing the tension within the joint which demands abduc-tio
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