. Physical diagnosis . amiliar. (d) Bony outgrowths may be obvious (as in Heberdens nodes), butif within the joint they may be recognized only by the sudden arrest of 458 PHYSICAL DIAGNOSIS an otherwise free joint motion at a certain point. In many cases radio-scopy is necessary. (e) Gouty tophi are identified positively by transferring a minutepiece to a glass slide, teasing it in a drop of water, covering with a coverglass, and examining with a high-power dry lens and a partly closeddiaphragm. The sodium biurate crystals are characteristic. Fluid or semi-fluid exudates in joints may fill up
. Physical diagnosis . amiliar. (d) Bony outgrowths may be obvious (as in Heberdens nodes), butif within the joint they may be recognized only by the sudden arrest of 458 PHYSICAL DIAGNOSIS an otherwise free joint motion at a certain point. In many cases radio-scopy is necessary. (e) Gouty tophi are identified positively by transferring a minutepiece to a glass slide, teasing it in a drop of water, covering with a coverglass, and examining with a high-power dry lens and a partly closeddiaphragm. The sodium biurate crystals are characteristic. Fluid or semi-fluid exudates in joints may fill up and smooth outthe natural depressions around the joint, or, if the exudate is large,may bulge the joint pockets; in the knee-joint four eminences maytake the place of the natural depressions, two above and two belowthe patella. (/) Limitations of motion due to muscular spasm are seen withespecial frequency in tuberculous joint disease, but may occur inalmost any form of joint trouble, particularly in the larger Fig. 253.—Testing for Psoas Spasm. (Bradford and Lovett.) (1) Hip-joint, two forms of spasm are important: (1) That whichis due to irritation of the psoas alone (psoas spasm); (2) that in whichall the muscles moving the joint are more or less contracted. In pure psoas spasm the thigh is usually somewhat flexed on thetrunk, though this may be concealed by forward bending of the slight degrees of psoas spasm may be appreciable only when,with the patient lying on his face, we attempt hyperextension (seeFig- 253). The other motions of the hip—rotation, adduction, abduction, andflexion—are not impeded. General spasm of the hip muscles is tested with the patient on theback upon a table or bed (a child may be tested on its mothers lap)and the leg flexed to a right angle, both at the knee and at the hip. THE JOINTS 459 Using the sound leg as a standard of comparison, we may then drawthe knee away from the middle line (abduction), toward the past andmid
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