relaxed, for it is a very easy matter for contracted muscles in one
thigh to produce an apparent shortening of the limb. Also be very
careful in comparing the length of the two limbs at the heels where
they come together that they are exactly in the median line of the
body, for if they should be to one side or the other, however slightly,
there would be an apparent lengthening of the outer limb as compared
with the limb near the median line. While the patient remains flat
upon the back it is a good plan to compare the anterior spines of the
ilia. It may be readily noticed that one is higher or more depressed
than the other, which will help to confirm the diagnosis. It is a
good plan also to have the patient sit up squarely upon the table and
compare the crests and posterior spines of the ilia; thus one may be
seen to be higher than the other. Then, also, note the angles of the
feet when patient is supine; an everted foot usually means that the
limb is shorter due to the tilted pelvis; the opposite is commonly true
when the foot is inverted. However, this is not an absolute rule. Care
should be taken in differential diagnosis of possible old fracture of
leg, of infantile paralysis, of asymmetry, etc.
There are =three diagnostic points= exclusive of all other signs that
are quite conclusive when coupled with the preceding examination. If
an innominatum is dislocated or subdislocated there will be tenderness
over the symphysis pubis on the side affected, tenderness over the
ilio-sacral articulation on the side affected, and tenderness along
the crest of ilium where the abdominal muscles are attached. When
tenderness is found at these three points it is quite conclusive that
the innominatum is deranged, for at the symphysis pubis and ilio-sacral
articulation tenderness must exist if the innominatum is disturbed,
and by a change in the crest of the ilium the abdominal parietes
will be affected, provided they are not too much debilitated. Marked
tenderness of the external cutaneous nerve as it passes over the crest
of the ilium below the anterior spine will be noticed on the unaffected
side (Dr. Still). There will be, on rectal examination, marked tension
of the tissues on the affected side. Possibly the patient may complain
of pain exclusively in one side along the pelvis and limb which will be
a leading symptom telling which side is affected.
=Additional diagnostic= signs will be rigidity of muscles along the
ilio-sacral articulation and abnormal prominence or depression of the
ilium at its articulation with the sacrum, depending upon which way the
innominatum has slipped. Considerable deviation of the pubic bones may
be noticed. The pubic bone on the side affected may be either thrown
upward or downward.
Radiographs have repeatedly revealed subluxations of the innominate
bones in many instances. This is certainly quite conclusive in
confirmation of the osteopathic ideas in regard to the pelvic bones
becoming dislocated.
Public-domain text, read in full here on John Shaqi.
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