Ligament

“ Ligaments of the Pelvis.—The ilium and sacrum are articulated at the auricular facet of the ilium and the corresponding rough surface of the sacrum. The joint is an amphiarthrosis, permitting very little movement. A capsular ligament surrounds the articular surface, being attached to the bones about its circumference; it is short and strong. Craniad of the capsule is a thick very short ligament, composed of very strong transverse fibres passing from the rough surface of the sacrum to the corresponding rough surface of the ilium. ”

“ But when ligament and cartilage are both fully developed, they work in opposition to one another, the ligament, by its resistance to compression, preventing any straining of the adductor muscles when the valves are open, and the cartilage, for the same reason, preventing the ventral margins of the shell from closing too rapidly upon one another when the valves are being shut. ”

“ When a vertical section of this ligament is made, no arterial vessel can be singled out, passing from the ligament to the bony substance of the head of the femur; but if you inject the perforating artery, of which the nutritive artery of the femur is a branch, you will obtain a very satisfactory microscopical injection of the interior of the bone ”

“ The suspensory ligament of the fetlock is considered an interosseous muscle, on account of the red fleshy striations which it contains, and from certain relations which it forms with the tendon of the common extensor of the digits or anterior extensor of the phalanges. This ligament (Fig. 75, 26; Fig. 77, 13) , which plays an important part in the standing position as a support of the foot, is a fibrous band situated between the tendons of the flexors of the digits and the principal metacarpal. ”

“ The true ligament is always external, and serves the purpose of binding the two valves of a shell together externally by the posterior dorsal margins. There is another substance, called by Gray the Cartilage, which is elastic and of a condensed fibrous structure, placed within the ligament, either close to it, or at a more interior part of the shell; it is sometimes contained in a pit, formed for its reception, in the centre of the hinge. This substance, being elastic, keeps the valves open, unless drawn together by the counteracting force of the adductor muscles. ”

“ The knee-cap, for instance, which really belongs to the thigh, is attached to it by muscle, but to the shin-bone by a stout ligament. And so with the bones of the arm; they are connected to one another by ligaments; but to the trunk only by muscle, excepting at one end of the collar-bone.
"But this was a very significant fact. Ligament decays much more slowly than muscle, so that in a body of which the muscles had largely decayed the bones might still be held together by ligament. ”

“ Where the arm joins with the hand, there is a ligament, the largest in the human body, which is without muscles, and is called the strong ligament of the Carpus; it has a square shape, and serves to bind and keep close together the bones of the arm, and the tendons of the fingers, and prevent their dilating, or starting out. ”

“ The capsular ligament, except in hydrops, is the seat of connective-tissue overgrowth, and tends to become contracted and rigid. Intra-articular ligaments, such as the ligamentum teres in the hip, are usually worn away and disappear. The surrounding muscles undergo atrophy, tendons become adherent to their sheaths and may be ossified, and the sheaths of nerves may be involved by the cicatricial changes in the surrounding tissues.
_The X-ray appearances of arthritis deformans_ necessarily vary with the type of the disease and the joint affected ”

“ The ligament, then, secures firmness to the joint; it must also have flexibility and smoothness of motion. This is accomplished by a beautiful mechanism the perfection of which is only feebly imitated by the most ingenious contrivance of man. ”

“ Further there is no anastomosis between the vessels of the round ligament and those of the medullary cavity, which must have been the case were the blood-vessels of the former destined to nourish the frame-work of the reticulated interior of the head of the femur. ”

“ Rupture of the tube into the broad ligament is a much less serious accident than rupture into the peritoneal cavity.
If the rupture into the broad ligament is sudden, the woman complains of sudden acute pain in the affected side. The pain may extend to the back and throughout the pelvis. The intensity and extent of the pain depend on the amount of blood that escapes. Sometimes only a small hematoma is found in the broad ligament; at other times the blood burrows around the rectum, and symptoms of pressure may arise. Difficult defecation may follow. Retention of urine may occur. ”

“ Chief reliance is to be placed upon the bony points retaining their normal relationships, and upon the fact that the points of maximum tenderness are over the attachments of one or other of the collateral ligaments. As the tibial collateral ligament suffers most frequently, the most tender spot is usually over its attachment to the medial aspect of the head of the tibia—less frequently over the medial condyle of the femur. ”

“ By Sprain is understood subluxation or partial displacement of a joint, with stretching, and more or less laceration of the articulating apparatus—ligaments, tendons, sheaths, and bursæ, being all involved in the injury. Sometimes small portions of the processes of bone are separated, being torn away, attached to ligament or tendon. All joints, both large and small, are liable to the accident. In the proximal, or in the middle joints of the finger, for example, one or other lateral ligament is stretched or torn; the finger is twisted to a side ”

“ The round ligaments, two in number, are about five inches long and are situated between the layers of the broad ligament, one on each side of the womb in front and below the fallopian tube. They pass forward and outward from the womb through the internal abdominal ring, along the groin canal and out at the external abdominal ring.
I have given a lengthy description of these organs; I think it will repay a careful reading. To understand a disease one should understand the organs that are subject to the disease. ”

“ They all three pass to their termination on the anterior tubercle of the tibia. The external ligament is the strongest, and the internal ligament the least developed.
In the dog, the cat, the pig, and the sheep, the patellar ligament consists of a single band. The articulation is further strengthened on the sides by lateral ligaments—an internal and an external.
With regard to the principal movements, these are flexion and extension, to which may be added movements of rotation of limited extent. In flexion, the leg bends on the thigh; its inferior extremity is directed upwards and backwards ”

“ The ideal constitution of a joint depends upon the existence of a certain ratio between the growth of bone and that of ligament. Should the ligaments grow in excess, their redundant length will permit great super-extension, and may even cease to check the movement; but if the bone grow relatively faster than the ligaments, the anterior portion of the latter will the sooner become tense during extension, and where this disproportion is exceptionally great the motion may be checked before it attains physiological completeness, the result being a [54] “hammer finger.” ”

“ Hence any deviation from this line, one way or the other, indicates more or less dislocation of the tibia. There is a pellet of fat under the ligament, which answers a ‘packing’ purpose—sinking in when the knee is bent; rising when the knee is extended, and bulging on either side of the tendon, almost enough to give the feel of fluctuation.
In a well-formed leg the ligamentum patellæ, the tubercle [Pg 51] of the tibia, and the middle of the ankle should be in the same straight line. ”

“ The costo-transverse ligaments bind the ribs to the transverse processes of the thoracic vertebrae. The superior costo-transverse ligament binds the neck of the rib to the transverse process of the vertebra above; the middle or interosseous connects the back of the neck to the front of its own transverse process; while the posterior runs from the tip of the transverse process to the outer part of the tubercle of the rib. The inner and lower part of each tubercle forms a diarthrodial joint with the upper and fore part of its own transverse process, except in the eleventh and twelfth ribs. ”

“ If the joints of the jaw, shoulder, elbow, knee, finger, &c., can be replaced, the same, they think, must be true of all parts, nor can they give an account of why the femur cannot be put back into its place.... They might have known, however, that from the head of the femur arises a ligament which is inserted into the socket of the hip bone ... and if this ligament is once ruptured the thigh bone cannot be retained in place’. ”

“ Thus, we observe, that two very different substances enter into the composition of a joint. The ligament, very unyielding, affords strength, while the cartilage, elastic and moist, gives ease and smoothness of motion. The amount of motion provided for varies greatly in different joints. In some there is none at all, as in the skull, where one bone is dove-tailed into another by what are termed sutures. Others have a hinge-like motion, such as those of the elbow, wrist, ankle, and knee ”

“ The bones, cartilages, ligaments, and synovial membrane are insensible when in health; yet they are supplied with organic nerves, as well as with arteries, veins, and lymphatics.
Observation. The joints of the domestic animals are similar in their construction to those of man. To illustrate this part of the body, a fresh joint of the calf or sheep may be used. After divesting the joints of the skin, the satin-like bands, or ligaments, will be seen passing from one bone to the other, under which may be observed the membranous bag, called the capsular ligament. ”

“ They are employed in straightening the fingers, when the hand is shut. These tendons are confined by the ligament or band, e, which binds them down, around the wrist, and thus enables them to act more efficiently, and secures beauty of form to the limb. ”

“ The femoral or other large artery should then be drawn out by a tenaculum or spring forceps, and tied. The capsular ligament being well opened, and the ligamentum teres divided, the knife should be passed behind the head of the bone thus dislocated, and made to cut its way out, care being taken not to have too large a quantity of muscle on the under part, or the integuments will not cover the wound, under which circumstance a sufficient portion of muscular fiber must be cut away. ”

“ The shape of the ligament is acutely triangular, corresponding to the form of the space which it occupies. Its apex is internal, and close to the pubic spine; its base is external, sharp and concave, and in apposition with the sheath of the femoral vessels. It measures an inch, more or less, in width, and it is broader in the male than in the female—a fact which is said to account for the greater frequency of femoral hernia in the latter sex than in the former, (Monro.) Its strength and density also vary in different individuals. It is covered anteriorly by, P, Fig. ”

“ The pallio-visceral ligament seen from below: torn on the right side to show the rectum and oviduct; cut through on the left side along the dotted line close to d' in the preceding figure.
a. Anus. b. Oviducal aperture. c. Heart. d. Left branchial veins. e. Right branchial veins. f. Oviduct cut through. g. Ovary. h. Rectum. i. Mantle. k k k. Pallio-visceral ligament; k'. its torn portion. The oval "aperture for the siphonal artery" is seen to the left of c', and the right-hand style in Fig. 1 passes through it.
[Pg 45]
On the Tendency of Species to form Varieties ”

“ It is very true that in twisting these ligaments, the animal almost always cries out, but it is because we at the same time stretch some neighbouring parts endowed with sensibility. When this is prevented and the experiment is made with proper precaution, we can twist, distend or tear the ligament, without appearing to give the animal any pain. ”

“ Any abnormal laxity of the ligaments of the joint may render the cartilages unduly mobile, so that they are liable to be displaced from comparatively slight causes, and when so displaced it is not uncommon for one or other to be torn by being nipped between the femur and the tibia. ”

“ The posterior tibial artery may be tied behind the inner ankle, on being laid bare in the following way:—A curved incision (the concavity forwards) of two inches in length, is to be made midway between the tendo Achillis and the ankle. The skin and superficial fascia having been divided, we expose the inner annular ligament, which will be found enclosing the vessels and nerve in a canal distinct from that of the tendons. Their fibrous sheath having been slit open, the artery will be seen between the venae comites, and with the nerve, in general, behind it. ”

“ Between the ankle and the first interosseous space the artery lies comparatively superficial, being here covered only by the skin and fascia and cellular membrane. Two veins accompany the anterior tibial artery and its continuation on the dorsum of the foot. The anterior tibial nerve, a branch of the peronaeal, joins the outer side of the artery, about the middle of the leg, and accompanies it closely in this position, till both have passed beneath the annular ligament. On the dorsum of the foot the nerve will be found to the inner side of the artery. ”