. Physical diagnosis . legs andhead, though most of the otherbones are also affected. In the legthe most characteristic lesions areforward bowing of the femur andtibia with outward rotation of thewhole limb (see Fig. 233). The#-ray shows marked thickening of some areas, with thinning of „ _, _. fr. L ... ^ 0 tiG. 233.—Paget s Disease (Osteitis De- Otners. formans). Note the outward and forward (4) Intermittent Claudication and bowing of legs and arms. (Robin.)Cramps.—Insufficient circula-tion through the arteries of the legs may give rise to sudden givingway of one or both during running or wa
. Physical diagnosis . legs andhead, though most of the otherbones are also affected. In the legthe most characteristic lesions areforward bowing of the femur andtibia with outward rotation of thewhole limb (see Fig. 233). The#-ray shows marked thickening of some areas, with thinning of „ _, _. fr. L ... ^ 0 tiG. 233.—Paget s Disease (Osteitis De- Otners. formans). Note the outward and forward (4) Intermittent Claudication and bowing of legs and arms. (Robin.)Cramps.—Insufficient circula-tion through the arteries of the legs may give rise to sudden givingway of one or both during running or walking, the power returningafter a short rest. In patients at rest the frequent recurrence ofpainful cramps in the muscles may be the only manifestation of thedisease. In other cases there are various forms of paresthesia suchas numbness, prickling, and hot feet at night. Obliteration of the dorsalis pedis (or larger arteries) by arterio-sclerosis is often found, but there is reason to believe that local anaemia,. 428 PHYSICAL DIAGNOSIS due to vasomotor disturbances or other causes, may produce similarcramps (, those seen in football players during a hard run and inpregnant women). Paralyses. (i) Paralysis of one leg, occurring in children, is usually due toanterior poliomyelitis; in adults it usually forms part of a hemiplegia oris of hysterical origin. Neuritis, due to alcohol, lead, arsenic, ordiphtheria, may affect one leg predominantly, but both are usuallyinvolved. Cerebral monoplegias, due to cortical lesions of the leg area,are rare. Chorea may be associated with a limp, half-paralyzed condi-tion in one leg, usually with some involvement of the arm on the sameside, and the characteristic motions (see above, page 47) make thediagnosis clear. The differential diagnosis of the other varieties of monoplegia isusually easily made with the aid of a careful history and a thoroughexamination of the other parts of the body. (2) Complete paralysis of both legs (paraplegi
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