. Physical diagnosis . -ease (see Fig. 204). The lesions in the other parts of the body make the diagnosis clear. Local lesions of the bones of theforearm are chiefly tuberculosis andsyphilis, both of which have- been suf-ficiently described in the last the wrist bones we find: 1. Rachitic enlargement of the epi-physes. In rickets the terminal epi-physes at the wrists take part in thegeneral epiphyseal enlargement so com-mon in the disease. The diagnosis iseasy, for there is no other disease ofinfancy producing general enlargementof the epiphyses (see Fig. 23). 2. Hypertrophic pulmo
. Physical diagnosis . -ease (see Fig. 204). The lesions in the other parts of the body make the diagnosis clear. Local lesions of the bones of theforearm are chiefly tuberculosis andsyphilis, both of which have- been suf-ficiently described in the last the wrist bones we find: 1. Rachitic enlargement of the epi-physes. In rickets the terminal epi-physes at the wrists take part in thegeneral epiphyseal enlargement so com-mon in the disease. The diagnosis iseasy, for there is no other disease ofinfancy producing general enlargementof the epiphyses (see Fig. 23). 2. Hypertrophic pulmonary osteo-arthropathy (Figs. 24, 25, and 26). Anenlargement of the lower ends of theradius and ulna, with clubbing of thefingers (see below, page 47), is recog-nized by its association with pulmonary or pleural diseases of many years duration (chronic bronchitis, em-pyema). 3. Acromegalia (see page 9) affects chiefly the bones and softtissues of the hand. 4. Hypertrophic, atrophic, or tuberculous disease of the wrist-. FiG. 23.—Rachitic Epiphysitis. THE HANDS. 41 joint will be described below (see Examination of the joints,page 486). 5. Weephvg sinew or ganglion (tenosynovitis) forms a fluc-tuating, spindle-shaped swelling along one of the tendons of the
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