Palpation and manipulation over the =intestines= are practiced a great
deal by the osteopath in various intestinal diseases. By his educated
sense of touch he is usually able to locate at once any =impactions= of
=fecal matter=. Such impactions are generally found in the ilio-cecal
and sigmoid regions. In the various acute =obstructions= from
invagination, tumors, twists, adhesions, spasticity, knots, etc., many
times one is able to readily locate the seat of the disturbance. There
is one point to specially emphasize; that is, do not overlook prolapsed
regions of the intestines; such occur frequently and are a source of
considerable distress, especially constipation. Simple manipulation
will never do much good, neither will spinal treatment or injections,
as a rule. A specific treatment must be given and, that is, after
locating the exact point of prolapse, to reach carefully beneath the
fold and replace it.
In emaciated subjects the =kidneys= can be readily located, and in
a few instances when they are diseased one can feel the contracted
tissues about them. Be very careful not to injure the =capsule= about
the kidney. Do not punch or gouge them in the least; but locate the
kidneys by a careful inhibitory palpation.
=Lumbar and Pelvis.=—The intimate relation between the lumbar spine
and pelvis make a consideration of them as a region necessary. Outside
of ordinary curvatures involving both the dorsal and lumbar regions
there are certain conditions which involve but one structure and
require careful differential diagnosis to determine whether the lumbar
or pelvis is at fault. In the former the fifth vertebra is a weak
point and is most frequently at fault. The deviations are usually a
sidebending and frequently accompanied with some rotation. Occasionally
a malstructure of the lower lumbar or pathologically relaxed ligaments
will approximate the spines and be misleading as to the real condition.
A rotation or lateral tilting of the fifth lumbar may have the effect
of elevating the crest of the ilium so that the innominatum would
appear involved. There will be a difference in the length of the legs,
angles of feet when patient is lying on the back, anterior spines out
of line and tenderness of the muscles attached near them. However,
other diagnostic points of innominate lesions, i. e., tenderness of
symphysis and sacro-iliac articulation, and prominence of the posterior
spine, will be lacking. Marked deviation of other lumbar vertebræ may
produce practically the same effect, but the lesion will be so apparent
that there will be no doubt as to the cause.
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