. Manual of operative surgery. the head can be felt moving under the thumb. In luxations thehead is displaced posteriorly, upwards and outwards. So deep is it that it ismore readily recognized by the fingers which are posterior than by the thumbwhich is anterior; this is especially the case when the limb is markedly rotatedinwards. The range of motion of the luxated hip is increased in adductionwhile it is decreased in abduction. The lessened abduction is usually not somarked as in coxa vara (a lessening of the angle between the neck and shaft),although in some cases a condition of coxa vara m
. Manual of operative surgery. the head can be felt moving under the thumb. In luxations thehead is displaced posteriorly, upwards and outwards. So deep is it that it ismore readily recognized by the fingers which are posterior than by the thumbwhich is anterior; this is especially the case when the limb is markedly rotatedinwards. The range of motion of the luxated hip is increased in adductionwhile it is decreased in abduction. The lessened abduction is usually not somarked as in coxa vara (a lessening of the angle between the neck and shaft),although in some cases a condition of coxa vara may be present in which caseabduction would be markedly restricted. Adduction may be so much increasedas to allow the thigh of the affected side to be brought across the groin of theopposite one. The looseness of the joint may be demonstrated with the child lying on theback, having its limbs either extended or flexed. If the limb to be examined isextended, the surgeon grasps the two sides of the pelvis with his hands to fix Fig. 1259. On the suspected side the thumb is placed on the anterior superior spine whilethe index finger touches the top of the greater trochanter. An assistant nowgrasps the leg and alternately pulls it down and pushes it up. If the hip isluxated the greater trochanter will be felt sliding up and down. In examining the limb in a flexed position (Fig. 1259), a method valuable inchildren, the knee is grasped with one hand and the thigh flexed to a right thumb of the other hand is placed in front of the anterior spine and thefingers beneath the trochanter. On pushing and pulling the femur with onehand the greater trochanter is felt with the other to slide up and down on theside of the pelvis. Sometimes in examining these congenitally luxated hips inthis manner a distinct grating or cracking can be felt. While one is usually able to diagnose the condition by the physical exami-nation, it is nevertheless desirable whenever possible to have a skiag
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