Lectures on orthopedic surgery . e for true tuberculous disease to bepresent in an hysteric patient as well as in simulation of tuberculous osteitis is even patient walks with a limp, complains of pain, theleg is somewhat flexed, the joint-motions are restricted,there is tenderness to pressure and increased heatabout the joint, and the circumference of thigh and 195 calf may be less than those of the other side. Practi-cally, all the symptoms except the tuberculous abscessmay be present, and only the trained eye of the neu-rologist, accustomed to recognize hysteric manif
Lectures on orthopedic surgery . e for true tuberculous disease to bepresent in an hysteric patient as well as in simulation of tuberculous osteitis is even patient walks with a limp, complains of pain, theleg is somewhat flexed, the joint-motions are restricted,there is tenderness to pressure and increased heatabout the joint, and the circumference of thigh and 195 calf may be less than those of the other side. Practi-cally, all the symptoms except the tuberculous abscessmay be present, and only the trained eye of the neu-rologist, accustomed to recognize hysteric manifesta-tions, or the hand of the surgeon, practised to appre-ciate the resistance of the involuntary spasm of truebone-disease, may be able to make the diagnosis. Oncertainly one occasion a knee-joint has been laid openfor excision and found perfectly healthy by a surgeonwho disregarded the diagnosis of a neurologist and anorthopedist. As a rule, the hysteric joint is not accom-panied by muscular atrophy of the thigh and calf, and. Fig. 157.—Showing the direction of supports and pressure pads the absence of this symptom should always be regardedas a significant fact. Muscular atrophy, however, doesarise from disuse, and when present must not be takenas positively conclusive evidence in favor of a tubercu-lous inflammation of the bone ends. Acute traumatic synovitis should be readily excludedon account of the history, the heat and pain, and thefluidity of the contents of the greatly distended joint-capsule. The difierentiation from rheumatic inflammationshould be readily made. The suddenness of the onset 196 U cE^^^ai Fig. 158.—The caliper , the ring around theui^per part of the thigh ;A, pad for backwardpressure; B, bandage ;C, bandage; F, leathersling for support at theback of the limb; D, astrip of bandage fasten-ing together the pressure-pads to prevent slippingand consequent loss ofpressure. and the acuteness of the symp-toms are out of all proportion tothat which
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
