Hip joint

“ If a joint is left permanently stiff in an awkward and useless position, the limb may be greatly improved by excision of the joint. Thus, if the knee is left bent and the joint is excised a useful, straight limb may be obtained, somewhat shortened, and, of course, permanently stiff. If after disease of the hip-joint the thigh remains fixed in a faulty position, it may be brought down straight by dividing the bone near the upper end. A stiff shoulder or elbow may be converted into a useful, movable joint by excision of the articular ends of the bones. ”

“ But when we have to rely upon one sense alone, we are sometimes liable to curious deceptions. This is the case with some of the feelings of touch. In hip-joint disease the pain is often referred to the knee, while it is really in the hip. This is because the nerve which conveys sensation from the knee, also sends a branch to the hip-joint. The experiences of those who have lost a limb are familiar. ”

“ The ligament is so strong that it hardly ever ruptures in a dislocation of the hip. As a plumb-line, dropped from the centre of gravity of the body, passes behind the centre of the hip joint, this ligament, lying as it does in front of the joint, takes the strain in Man’s erect position. The other two thickened parts of the capsule are known as pubo-femoral and ischio-femoral, from their attachments. ”

“ The head of the thigh bone is more separated, or prominent and rounder in form, and the cup-like cavity, or socket, into which it fits is much deeper, forming together a deep, true ball-and-socket joint, which is, moreover, reenforced by two strong cords of funicular ligaments, which unite them. It will be easily comprehended, from this hint of the anatomy of the region, that a luxation of the hip joint must be an accident of comparatively rare occurrence ”

“ When the hip-joint has been dislocated, and long delay has made it impossible to restore the parts to their proper places, the head of the thigh-bone, imbedded in the surrounding muscles, becomes fixed in its new position by attachments of fibrous tissue, which afford support enough to permit a halting walk. ”

“ Should the child be unusually backward in walking, and when it does so should limp and feel pain in the knees, it should be examined for any symptom of hip joint disease, of which these are the earliest signs. ”

“ In disease of the hip-joint pain is felt, not in the hip, but, in the early stage of the disease, at the knee. This also depends on nervous communication. The most dreadful consequences daily occur from an ignorance of this single fact. ”

“ In considering the relative size of each portion of the limbs—if, in the walk, there be a greater or less approach to the marching pace, the hip is large; for we naturally employ the joint which is surrounded with the most powerful muscles, and in any approach to the march, it is the hip-joint which is used, and the knee and ancle-joints which remain proportionally unemployed. ”

“ The other bones of the human body sometimes undergo subluxation, and sometimes complete luxation, but the articulations at the hip and the shoulder are subject only to complete luxation, more especially the hip-joint, because it has a deep and round cavity which is further strengthened by a strong brim. The limb, then, being subject to displacement from its cavity by some great violence, many differences arise according to the greater or less degree of the dislocation. ”

“ Complicated cases occasionally occur—as when a patient who has been labouring under hip-joint disease, perhaps not in an aggravated form, falls heavily, and on being lifted up is found to be incapable of moving the joint, the limb at the same time being elongated, and having a distorted appearance. ”

“ All our joints are not hinge-joints.
Your shoulder has a joint that lets your [11] arm swing round and round, as well as move up and down.
Your hip has another that lets your leg move in much the same way.
The hip-joint.
This kind of joint is the round end or ball of a long bone, which moves in a hole, called a socket.
Your joints do not creak or get out of order, as those of doors and gates sometimes do. A soft, smooth fluid, much like the white of an egg, keeps them moist and makes them work easily. [12]
BONES.
What parts of our bodies are jointed together so nicely? Our bones. ”

“ Injuries of all kinds are the more frequent causes of hip lameness. In such cases, lameness may result directly and resolution be prompt, or the claudication become aggravated in time, due to muscular atrophy or degenerative changes affecting the hip joint or nerves. Rheumatism or metastatic infection may be the cause of hip lameness as well as affections of the pelvic bones, lumbar and sacral vertebrae. Hip lameness may also be provoked by melanotic or other tumors.
In the diagnosis of hip lameness, one is guided in a general way by the character of the impediment manifested. ”

“ To this is added, that the child can not lie well on the sensitive and swollen hip; with right side hip-joint inflammation it turns on the left. As the diseased and bent thigh does not then rest on the mattress the same is placed on the healthy limb for support and for protection from movements, in the same manner as we lay one leg on the other in a healthy condition when we sleep on our side. ”

“ In the American Provings, symptom 917, "Painful soreness in the left hip-joint, immediately after taking a dose of Apis 2, afterwards debility, unsteadiness, trembling in this joint," is the only symptom that seems to indicate the curative power of Apis in this distressing malady. What experienced physician has not often seen the hip show such symptoms of disease, particularly after violent frights and anguish? ”

“ When standing in the erect position, the hip-joint only permits the limb to move forwards, the knee-joint backwards, and the ankle-joint neither backwards nor forwards. When the body or limbs are inclined obliquely, or slightly flexed, the range of motion is increased. The greatest angle made at the knee-joint is equal to the sums of the angles made by the hip and ankle joints when these joints are simultaneously flexed, and when the angle of inclination made by the foot with the ground equals 30°. ”

“ In case the limb is turned forward from the hip, and the fetus so wedged into the passage that turning is impossible, the case is very difficult. I have repeatedly succeeded by cutting in on the hip joint and disarticulating it, then dissecting the muscles back from the upper end of the thigh bone. ”

“ The pain which is felt at first a little behind the hip-joint steadily increases in severity and extends along the course of the nerve and its branches in many instances as far as the toes. The specially painful points are about the knee and ankle joints; besides which a feeling of numbness is experienced throughout the whole limb. In severe cases all movement of the limb aggravates the pain, and the patient is obliged to remain in bed. In prolonged attacks the limb may waste and be drawn up and fixed in one position. ”

“ Changes of the nature of chronic arthritis are liable to occur in and around the joint in old and rheumatic subjects; and atrophy or paralysis of muscles may follow, if their nerves are implicated.
Old-standing Dislocation.—It is impossible to lay down any time-limit for attempting reduction in old-standing dislocations of the hip. Manipulation may succeed in cases of some months' standing, and may fail when the bone has been out only a few weeks. In certain cases, even after reduction has been effected, there is a marked tendency to re-displacement. ”

“ From exercise, then, the fleshy parts on the hand and fore-arm are not atrophied in weasel-armed persons, and by these means the arm, too, gains flesh. But in dislocation inward at the hip-joint, whether from birth or from childhood, the fleshy parts, on that account, are much more atrophied than those of the hand, because the patients cannot exercise the leg. ”

“ They poise the body by means of a staff on the sound side, and grasp the affected limb with the hand above the knee so as to carry the body in shifting from one place to another. If the parts below the hip-joint be used, the bones below are less atrophied, but the flesh more. ”

“ The joint is wobbly or flail-like from stretching and destruction of the controlling ligaments, and is devoid of sensation. In other cases, wearing down and total disappearance of the ends of the bones is the prominent feature, attended with flail-like movements and with coarse grating. Dislocation is observed chiefly at the hip, and is rather a gross displacement with unnatural mobility than a typical dislocation, and it is usually possible to move the bones freely upon one another and to reduce the displacement. ”

“ It is chiefly observed in old persons, especially men (senile arthritis) , affects frequently a single joint, and chiefly the hip, but occasionally the knee, shoulder, or spinal column, either as a consequence of special injury or of the wear and tear of life, or exposure to cold and wet, or even of what seemed to be simple acute or subacute articular rheumatism or gonorrhoeal rheumatism. When not the result of injury, two or three joints may suffer, both hips or knees, or hip and some of the vertebræ, hip, knee, and ankle of the same limb, and so on. ”

“ Abnormal attitudes of the limb occur earlier, and are more pronounced in cases in which pain and other irritative symptoms of articular disease are well marked, and are best illustrated by the attitudes assumed in disease of the hip. They are due to reflex or involuntary contraction of the muscles acting on the joint, with the object of placing it in the attitude of greatest ease; they also disappear under anæsthesia. With the lapse of time they not only become exaggerated, but may become permanent from ankylosis or from contracture of the soft parts round the joint. ”