A treatise on orthopedic surgery . istance from the surface and are con-cealed by the muscles and other tissues. At the knee, on theother hand, the joint is superficial, and even slight effusionchanges, to a perceptible degree, its contour. If the disease isprogressive, sensitiveness to pressure, elevation of the local tem-perature, and infiltration or thickening of the tissues are usuallypresent. Even when the patients are seen comparatively early in thecourse of the disease the history of the affection almost alwaysindicates that it is chronic and progressive in character. Theimportance of e
A treatise on orthopedic surgery . istance from the surface and are con-cealed by the muscles and other tissues. At the knee, on theother hand, the joint is superficial, and even slight effusionchanges, to a perceptible degree, its contour. If the disease isprogressive, sensitiveness to pressure, elevation of the local tem-perature, and infiltration or thickening of the tissues are usuallypresent. Even when the patients are seen comparatively early in thecourse of the disease the history of the affection almost alwaysindicates that it is chronic and progressive in character. Theimportance of establishing this fact has been mentioned in theconsideration of hip disease, and it may be stated again that achronic painful disease of a single joint, accompanied by a ten-dency to deformity, is, in childhood, almost always tuberculousin character. The symptoms of tuberculous disease may be classified aslimpj, pain, local heat, sensitiveness and swelling, muscular spasmand limitation of m,otion, distortion and atrophy. Fig. Flexion deformity at the knee-joint, witti slight subluxation of the tibia. On physical examination one w^ll note the character of thelimp and the slight flexion of the limb that usually accompaniesit. The joint is, as a rule, somewhat enlarged, the normal de-pressions about the patella and the prominences of the componentbones being less accentuated than on the opposite side. There isusually slight local elevation of temperature and sensitiveness topressure, varying in degree with the character of the certain cases effusion is present, sufficient to be classed assynovitis, but in most instances the swelling is due, in great part, 422 OBTEOPEDIC SUBGEBT. to the thickening of the synovial membrane and capsule, whichgives the sensation of elastic resistance rather than of actualfluctuation. Limitation of Motion.—The most important diagnostic sign islimitation of the range of motion caused by muscular normal range is from complete
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