The differential diagnosis between tubercular and hysterical hip disease is sometimes easy but, on the other hand, sometimes exceedingly difficult, especially if the test examination under ether can not be resorted to; while the importance of a correct decision is always great, both from the medicolegal and the clinical standpoints.
Gilles de la Tourette, in an excellent review of the subject, gives a number of diagnostic signs—left side involved oftener than the right; pain, spontaneous or induced by pressure and motion, not only about the joints but at various points along the affected limb; relatively great development of cutaneous hyperesthesia; absence of nocturnal paroxysms; the presence of hysterical edema about the affected joint and limb; involvement of the knee muscles in the rigidity; coldness of the affected parts; finally, the presence of other well-marked hysterical signs—most of which are approved by my own experience. To this list the sign indicated
PUTNAM JJ. ABSOLUTE INCREASE OF MEASUREMENT FROM THE ANTERIOR SUPERIOR SPINE TO THE MALLEOLUS AS A SIGN OF HYSTERIC HIP DISEASE. JAMA. 1901;XXXVI(18):1237–1239. doi:10.1001/jama.1901.52470180019001d
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