Lectures on orthopedic surgery . ndleg. The distant or referredpain, characteristic of tuber-culous arthritis elsewhere,is usually present here, butmay be absent. It is morefrequently found in this af-fection than in disease ofthe hip or spine; if present,it is usually felt in the lowerabdomen, but may be com-plained of anywhere alongthe front of the thigh andalso along the area of distri-bution of the sciatic nerves. At first the swelling ofthe joint-structures is moreeasily made out by palpa-tion through the rectum,probably owing to the an-terior sacro-iliac ligamentoffering much less resist
Lectures on orthopedic surgery . ndleg. The distant or referredpain, characteristic of tuber-culous arthritis elsewhere,is usually present here, butmay be absent. It is morefrequently found in this af-fection than in disease ofthe hip or spine; if present,it is usually felt in the lowerabdomen, but may be com-plained of anywhere alongthe front of the thigh andalso along the area of distri-bution of the sciatic nerves. At first the swelling ofthe joint-structures is moreeasily made out by palpa-tion through the rectum,probably owing to the an-terior sacro-iliac ligamentoffering much less resist-ance than the powerful and - . , . ,. , , Fig. 74.—Right sacro-iliac disease,thick posterior ligament, and Leg abducted and gluteo-femoral - -,. ^, „ . crease lowered and nearly effaced. the swelling, thereiore, is directed toward the interior of the pelvis. Sooner orlater the external swelling appears and in most casesadvances to true fluctuation, and the tuberculous ab-scess is present as a complication. Such an abscess. 114 may extend in any direction; upward in the multifidusspin^e, into the lumbar region, downward along the psoas muscle, or into thebuttock, to the right orto the left, or directlyinward, to open intothe bowel. The direction inwhich the pus travelsmay be: (1) Throughthe anterior ligament,keeping outside thepelvic fascia; (a) fol-lowing the course ofthe sacral nerves andpyriformis out throughthe great sacro-sciaticforamen and formingan abscess under thegluteus maximus; (b)following the curve ofthe sacrum behind therectum to point in theischio-rectal fossa, caus-ing inflammation andadhesion of the rectumand ultimately burstinginto it; (c) coursingunder the lumbo-sacralligament into the psoasmuscle and thence tothe thigh ; (d) or into the iliacus muscle and thence intothe groin. (2) Through the back part of the joint intothe multifidus spinse, creeping along this and pointingin the lumbar region or directly over the joint atrophy of the mus
Size: 926px × 2698px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
