Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
The common origin of bone, cartilage, periosteum, and synovial layer
from one parent tissue of the embryo, accords with the readiness with
which any one of these tissues may be converted into another under
traumatic or pathological influences; and how in ligaments and in
synovial membrane foci of hyaline cartilage may form and, after
increasing in size, undergo ossification.
Joints derive an abundant blood supply through the articular arteries.
The lymphatics, which take origin in the synovial layer, pass to
efferent vessels which run in the intermuscular and other
connective-tissue planes of the limb. The nerve supply is derived
chiefly from the nerves distributed to the muscles acting on the joint
and to the skin over it.
#Sources of Joint Strength.#--The capacity of a joint to resist
dislocation depends upon (1) the shape of its osseous elements; (2)
the strength and arrangement of its ligaments; (3) the support it
receives from muscles or tendons placed in relation to it; and (4) the
relative stability of adjacent structures. While all these factors
contribute to the strength of a given joint, one or other of them
usually predominates, so that certain joints are osseously strong,
others are ligamentously strong, while a few depend chiefly upon
adjacent muscles for their stability.
The hip and elbows are the best examples of joints deriving their
strength mainly from the architectural arrangement of the constituent
bones. These joints are dislocated only by extreme degrees of
violence, and not infrequently--especially in the elbow--portions of
the bones are fractured before the articular surfaces are separated.
The knee, the wrist, the carpal, the tarsal, and the clavicular joints
depend for their stability almost entirely on the strength of their
ligaments. These joints are rarely dislocated, but as the main
incidence of the violence falls on the ligaments they are frequently
sprained.
The shoulder is the typical example of a joint depending for its
security chiefly upon the muscles and tendons passing over it, and
hence the frequency with which it is dislocated when the muscles are
taken unawares. At the same time the great mobility of the scapula and
clavicle materially increases the stability of the shoulder-joint. The
tendons passing in relation to the knee, ankle, and wrist add to the
stability of these joints.
The proximity of an easily fractured bone also contributes to prevent
dislocation of certain joints--for example, fracture of the clavicle
prevents an impinging force expending itself on the shoulder-joint;
and the frequency of Colles' fracture of the radius, and of Pott's
fracture of the fibula, doubtless accounts to some extent for the
rarity of dislocation of the wrist and ankle-joints respectively. The
immunity from dislocation which the joints of young subjects enjoy is
partly due to the ease with which an adjacent epiphysis is separated.
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