On the diagnosis of tubercular joint disease, three papers / A. G. Miller.

Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: On the diagnosis of tubercular joint disease, three papers / A. G. Miller. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    (3.) It is more marked than in any other joint affection. (4.) It specially affects certain muscles and groups of muscles ; each joint having its peculiarities, which are very constant. (1.) In strumous joint disease the whole limb atrophies. This is well known, and I need not dwell upon it. Witness the shrunken and wasted limbs in old-standing hip, knee, shoulder, or elbow disease. There are two points, however, to which I would like to draw attention. The atrophy is not limited to the muscles, but affects the limb as a whole, and in the second place this atrophy of the limb is apt to persist even after recovery of the diseased joint. Of this there are many examples, which must readily occur to the minds of all surgeons. I repeat, the atrophy is of the limb as a whole, muscle and bone alike, and it tends to persist. What is the explanation ? I believe that the cause is a reflex contraction of the arteries of the limb, which interferes with nutrition. I have been led to that opinion by observing, when I have had occasion to amputate for tubercular joint disease, that though there may be many active vessels in the neighbourhood of the disease, the main arteries are always very small. I have often observed the latter about half the size one would expect them to be under ordinary circumstances,—in a primary amputation, for instance. (2.) The atrophy is greater and more rapid than would be caused by mere want of use. This, I think, is now generally admitted and recognised. There are several facts which go to prove this. We have seen, for instance, that when cases present themselves for treatment the limb is still being used to a certain extent; yet there is in such cases always well-marked atrophy. (3.) The atrophy in strumous disease is more marked and rapid than in other joint affections. This statement I cannot prove by statistics; I speak merely from experience. I thoroughly believe this, and more than once a rapid and extreme atrophy has made me suspect tubercle, the diagnosis being sub- sequently confirmed. Muscular and general atrophy are usual in joint affections ; but, I repeat, they are most marked in strumous disease. (4.) The atrophy specially affects certain muscles and groups of muscles. These are, stated generally, as follows:—Hip, glutei; knee, quadriceps extensor; ankle, extensors ; shoulder] scapular muscles; elbow, triceps and biceps; wrist, muscles arising from internal condyle of humerus. I take these merely as examples. The flattening of the hip and loss of the natal fold on the thigh are well-known signs of hip disease. The wasting of the quadriceps extensor in disease of the knee joint is also familiar. When one examines the thigh in such a case, it is wonderful how little seems to lie between the skin and the femur on the front of the thigh. Then in disease B 2