130 CLINICAL APPLIED ANATOMY. 



the posterior and outer aspects of the articulation, this being 

 again the line of least resistance, since the front of the joint is 

 well protected by the brachialis anticus muscle. 



Wrist-joint. In acute inflammatory conditions of the wrist 

 and carpal joints, not infrequently seen in acute rheumatism and 

 gonococcic infection, the actual distension of the joint cavities 

 themselves is frequently masked by the swelling in the tissues 

 around, particularly in the extensor tendon sheaths. It is well 

 therefore to be careful not to overlook the joint lesion, which, as 

 a rule, may be diagnosed by the pain produced by jarring the joint 

 surfaces together without simultaneously throwing into action 

 the flexor or extensor muscles. 



In suppurative synovitis abscesses will make their appearance 

 chiefly about the dorsal aspect which is only covered by a slight 

 amount of soft tissue. 



Joints of the Lower Extremity. Hip-joint. Owing to the 

 great depth at which this joint is placed, distension of its cavity 

 in synovitis is not readily detected, but on comparing the two 

 groins, especially in children, and in thin persons, there will 

 appear to be some fulness on the affected side. Occasionally a 

 similar condition may be made out behind and internal to the 

 great trochanter. 



As a rule the position in which the limb is placed is that of 

 flexion, abduction and external rotation. This is the position of 

 rest, because it is that in which most of the ligaments are relaxed. 



It has also been thought that the position occurs owing to a 

 reflex contraction of the muscles about the joint, together with 

 the fact that the flexors, abductors, and external rotators are 

 stronger than their opponents. 



Pain in synovitis of the hip, and particularly in that form de- 

 pendent upon infection by tubercle, is felt not only in the region 

 of the joint itself but is often referred to the knee, and peculiarly 

 to the inner and posterior aspect of the distal joint. This fact is 

 due to the anatomical reason that at least two nerves supply 

 twigs to both of the articulations, namely the obturator and the 

 anterior crural. It is possible that the referred knee joint pain is 



