Annals of surgery . or later, however, theexternal swelling appears and, in most cases, advances to truefluctuation, and the tubercular abscess is present as a compli-cation. These abscesses may, and generally do, extend in everypossible direction ; upward in the multifidus spinae into the lum-bar region, downward along the psoas muscle or into the buttock,to the right or to the left, or directly inward to open into thebowel. The direction in which the pus travels may be:(i) Through the anterior ligament, keeping outside the pel-vic fascia, (a) following the course of the sacral nerves ami pyr
Annals of surgery . or later, however, theexternal swelling appears and, in most cases, advances to truefluctuation, and the tubercular abscess is present as a compli-cation. These abscesses may, and generally do, extend in everypossible direction ; upward in the multifidus spinae into the lum-bar region, downward along the psoas muscle or into the buttock,to the right or to the left, or directly inward to open into thebowel. The direction in which the pus travels may be:(i) Through the anterior ligament, keeping outside the pel-vic fascia, (a) following the course of the sacral nerves ami pyri-formis out through the great sacro-sciatic foramen, and formingan abscess under tin: gluteus maximus ; (/>) following the curve ofthe sacrum behind the rectum to point in the ischio-rectal tos>a,causing inflammation and adhesion of the rectum and ultimatelybursting into it; (c) coursing under the lumbo-sacral ligamentmuscle and thence into the thigh ; u/) or into theiliacus muscle and thence into the sroin,. Fig. j.—Abscess in Sacro-iliac Disease. SACRO-ILIAC DISEASE. 289 (2) Through the hack part of the joint into the multifidusspinas, creeping along it and pointing in the lumbar region, rdirectly over the joint itself. Muscular atrophy of the buttock and thigh muscles is uni-formly present Deep pressure over the articulation often causespain before much, if any, swelling is noticeable, and pressing togetheror pulling apart of the pelvic bones also usually produces pain appears to be due more to the motion imparted than tothe direct pressure exerted. At times there is a tilting of the bonesone upon the other, and the joint forms* a horizontal kyphosis or adeep depression. Spasmodic contraction of the psoas muscle is apretty constant and earl}- symptom ; resulting from this the thighbecomes somewhat flexed on the pelvis and rotated outward; hence,frequent confusion with hip disease. All of the motions at the hipmay appear to be restricted, but if the pelvis
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
