A treatise on orthopedic surgery . ic and confined to a single joint it is, in childhoodat least, almost always tuberculous in character. At first therestriction of motion is caused almost entirely by reflex muscular 314 ORTHOPEDIC SUBGEBY. spasm, as is shown by the fact that when the patient is anaes-thetized the range of motion becomes practically free. As thedestructive process progresses motion is still further restrainedby adhesions and contractions within and without the joint. Distortion of the Limb.—-Persistent reflex muscular spasm isalways accompanied by a certain change in the attit
A treatise on orthopedic surgery . ic and confined to a single joint it is, in childhoodat least, almost always tuberculous in character. At first therestriction of motion is caused almost entirely by reflex muscular 314 ORTHOPEDIC SUBGEBY. spasm, as is shown by the fact that when the patient is anaes-thetized the range of motion becomes practically free. As thedestructive process progresses motion is still further restrainedby adhesions and contractions within and without the joint. Distortion of the Limb.—-Persistent reflex muscular spasm isalways accompanied by a certain change in the attitude of thelimb, slight flexion being the earliest indication of distortionhere as at every other joint. With flexion ther^ is ^usually ab-duction with slight outward rotation of thelimb. Flexion^ Abduction, and Outward Rotation. ApparentLengthening.—This is the passive attitude or the attitude ofrest and in disease it shows the instinctive adaptation of thelimb to a sensitive joint which is still capable of a certain Fig. The degree of fixed flexion is shown when the lumbar spine is held in contactwith the table by flexing the other thigh. amount of work. Flexion lessens the direct jar and abductionplaces the limb aside, as it were, making it a prop and adjunctof its fellow instead of an active aid in the propulsion of thebody. This attitude is not voluntarily assumed by the patient;it is involuntary and persistent. The limb is apparentlylengthened, because it is held away from the axis of the body,and in order to bring it into the middle line and parallel to itsfellow the pelvis must be tilted downward on the diseased sideand upward on the other. The sound limb is drawn upwardand the affected limb is lowered according to the degree of ab-duction for which compensation is made (Fig. 213). If theanterior superior spines of the pelvis are placed upon the sameplane, the distortion becomes evident (Fig. 212). Thus the TUBERCULOUS DISEASE OF THE EIP-JOINT. 315 deformity of
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Keywords: ., bookauthorwhitmanr, bookcentury1900, bookdecade1910, bookyear1910
