Modern surgery, general and operative . and the psoas muscleand prevents pressure of its tendon upon the front of the joint. Outwardrotation relaxes the inner portion of theY-ligament and the posterior portionof the capsule. Pain exists, often sudden or starting, and is located in thejoint, on the front of the thigh, and to the inner side of the knee in thecourse of the obturator nerve; the pain is aggravated at night, and full exten-sion and complete abduction are not possible. The gluteal muscles waste,and the gluteal crease is on a lower level than is that of the sound side. Thegluteal crea
Modern surgery, general and operative . and the psoas muscleand prevents pressure of its tendon upon the front of the joint. Outwardrotation relaxes the inner portion of theY-ligament and the posterior portionof the capsule. Pain exists, often sudden or starting, and is located in thejoint, on the front of the thigh, and to the inner side of the knee in thecourse of the obturator nerve; the pain is aggravated at night, and full exten-sion and complete abduction are not possible. The gluteal muscles waste,and the gluteal crease is on a lower level than is that of the sound side. Thegluteal crease may be nearly or quite effaced because of hypertrophy of thesubcutaneous layer (Alexandroff), or from slight flexion of the leg (McClellan).As the disease progresses adductor spasm causes adduction, and the limb isflexed, adducted, and apparently shortened. This apparent shortening isaccomplished by a lateral curvature of the spine, which keeps the limb fromcrossing its fellow and being useless. It does so by raising the hip of the. Fig. 383.—Positions in hip-joint disease, a: e-f, lumbar spine; h-d, limb fixed in flexion and abduc-tion, useless for walking, b: e-f, lumbar spine. Patient corrects the condition in Figure a by curv-ing the lumbar spine forward and rotating the pelvis on its transverse axis, thus making the femurpoint downward. The lumbar spine is curved laterally, the pelvis ascending on the sound side anddescending on the affected side (apparent lengthening), c: h-d, hmb fixed in flexion and : e-f, curve of lumbar spine to correct condition in Figure C (apparent shortening). (After the plan ofHoward Marsh and Treves.) diseased side and drawing the femur outward (Fig. 2>^z)- This causes apparentshortening (Howard Marsh, in Trevess Manual of Surgery). The abovesymptoms arise chiefly from unconscious efforts to obtain ease, from joint-effusion, reflex irritation, and involuntary or spasmodic muscular is an appearance of lengthe
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
