In the
presented fragments G.M. Humphry discusses the anatomy, topography, structure,
and function of the ligamentum capitis femoris (LCF) in detail. Mentioning the
experiments of J. Struthers (1847) on removing the floor of the
acetabulum, the author emphasizes his own priority. George Humphry
argues with the brothers W. Weber, E. Weber (1836) over the conditions for
tensioning the LCF in an upright position. According to our observations and
experiments, the tension of the LCF in a single-support position is accompanied
by extension and outward rotation of the hip as the pelvis rotates backward in
the horizontal plane. At the conclusion of the chapter, the author apparently
discusses coxarthrosis, leaning towards the mechanical theory of its pathogenesis.
Humphry GM. A Treatise on the Human Skeleton including the Joints. Cambridge: MacMillan and Company, 1858. [fragments]
Quote pp. 79-80
Their fatty appendages.
Appended to the synovial membranes and situated appendages. on their exterior are, in many joints, masses of soft fat. These were formerly thought to be glands which secreted the synovial fluid. Such a notion has been disproved by the fact that they are found on microscopical examination to consist simply of fat. Their office is to fill up the spaces between the bones, and between the bones and ligaments, in the movements of the joints; for which purpose they usually project more or less into the articular cavity, carrying the synovial membrane before them, at the intervals between the bones (see representations of elbow, ankle, and other joints). They are of large size on the fore part of the knee, may be found of greater or less size in most joints, and evidently perform an important office in facilitating the movements of the joints. The one which, from its conspicuous appearance, has attracted most attention is that at the bottom of the acetabulum. It serves a somewhat different purpose from the same structure in other joints, that, namely, of permitting the play of the ligamentum teres and the slightly prominent extremity of the head of the femur. It is obvious that were there not some provision of that kind the ligament would be squeezed between the articular surfaces during the movements of the joint. These fatty appendages, like the folds just mentioned, are highly vascular, and it is probable that inflammatory affections of the synovial membrane not uncommonly begin and are most obstinately maintained in or near one or other of them.
Quote pp.
411-412
Gleno-humeral
ligament.
Some of the fibres of this coraco-brachial ligament project into the interior of the joint, along the inner edge of the biceps tendon, and are inserted into the inner and upper part of the bicipital groove, at a point nearer the margin of the head than the line of attachment of the rest of the capsular ligament. This bundle of fibres (Pl. XXIX. fig. 1, L), which has been described by Dr Flood, under the name of the Gleno-humeral ligament, corresponds probably with the ligamentum teres of the hip-joint, and with that structure in the frog which has been called the ligamentum teres of the shoulder-joint. The similarity is increased by the fact that the whole circumference of the glenohumeral ligament is sometimes covered by synovial membrane.
Quote pp. 508-509
Head of the thigh-bone.
The head of the thigh-bone is three-fourths of a sphere, with a diameter measuring about an inch and a half. It is a segment of a true sphere; except that just around the dimple for the ligamentum teres its surface bulges a little more than at any other part of the circumference, as represented in Pl. XLIII. fig. 1. This prominence corresponds with the bottom of the cotyloid cavity, where the cartilage is deficient. The edge of the cartilaginous surface of the head of the femur does not present an even line all round, but is prolonged upon the neck, at the fore part, beneath the psoas tendon, and behind, beneath the short rotators of the hip, more than it is above or below. [is rarely injured.] Being included within the acetabulum, and well fitted to it, the head of the thigh-bone is very little exposed to injury; so that, although the neck and other parts of the femur are often broken, I have never seen an instance in which the head had suffered from contusion (1); neither is its shape altered in rickets, although the lower end of the bone is often very much deformed in that disease.
1) In the Musée Dupuytren is a specimen where both acetabula have been broken in by the wheel of a heavily laden cart passing over the side of the pelvis; but the heads of the thigh-bones have escaped injury.
The
Dimple for round ligament.
The Dimple for the ligamentum teres is situated, not in the line of the axis of the head and neck of the thigh-bone, but below it, in the line of the axis upon which the head rotates during flexion and extension. So that a line drawn transversely through the pelvis, and prolonged through the "dimple," on either side, represents the axis upon which flexion and extension of the thighs take place, and, consequently, the axis upon which the trunk is inclined forwards and backwards upon the thighs. There are two or three foramina for vessels at the bottom of the dimple; the fibres of the round ligament are inserted above these; and the part of the dimple just beneath its upper edge, which is not filled up by the ligament, is occupied by fat (Pl. XLVI. I).
The
acetabulum.
The
cartilaginous surface of the acetabulum is, at every point, exactly applied to
that of the head of the femur, so that there is no interval between them in any
position of the joint; this may be proved by sections made through the joint in
the recent state. It is a broad band disposed in the form of a horse-shoe. Its
width is greatest, and its cartilage is thickest, beneath the part contributed
by the ilium, where the greatest amount of the weight of the body is borne, and
where the pull of the great flexor and extensor muscles of the hip is chiefly
felt; towards this part also the lines of the cancelli in the neck and head of
the thigh-bone (Pl. XXVIII. fig. 1, H) are principally directed. It is
narrowest at the part contributed by the pubes, and is absent, together with
the wall of the acetabulum itself, at the anterior and lower part, where there
is, commonly, no weight sustained and little force applied. It is deficient
also in a circular space, as large as a half-crown-piece, at the bottom of the
acetabulum. This space, which is filled up to the level of the cartilaginous
surface of the cavity by soft fat and synovial membrane, corresponds with the
round ligament, with the dimple in the head of the femur where the ligament is
attached, and with the slight prominence of the cartilaginous surface
surrounding the dimple; and it represents the area traversed by them in the
various movements of the hip. The fat readily yields before the ligament, and,
rising on either side of it, prevents any void space being created when the
latter is shifted from place to place.
Quote p. 510
DESCRIPTION
OF PLATE XLII.
Fig. 1. Transverse ligament and notch of right acetabulum seen from below. A, cut surface of pubes. B, ditto of ischium. C, edge of bone between acetabulum and obturator hole, forming the bottom of acetabular notch. D, fibres of transverse ligament, arising from anterior, or pubic, corner of notch, crossing beneath those (E) which arise from posterior, or ischiatic corner, and becoming blended with (F) the cotyloid ligament [labrum acetabulare], which is continued across the notch in front of the transverse ligament. G, vacant space in notch which is occupied by fat continuous with that in the round ligament.
Quote p. 511
Transverse
ligament.
The cotyloid ligament is not entirely confined to the margin of the acetabulum; for some of its fibres are, as just said, continued across the notch completing the circle of the acetabulum. It is strengthened in this situation by a layer of strong fibrous bundles (D), passing, from the external surface of the pubes, just in front of the anterior or pubic cornu of the notch, downwards and backwards to the posterior or ischiatic cornu; also by deeper bundles € arising from the ischiatic cornu, and crossing the others obliquely. Some of the fibres of both these bundles are continuous with those of the cotyloid ligament; and they combine with it to make the Transverse ligament. The transverse ligament does not fill up the acetabular notch, but merely bridges it over leaving a space (G) beneath it, through which vessels pass to the bottom of the acetabulum and, into which the fat, contained in and about the base of the round ligament, is pressed in certain positions of the joint.
Quote p. 512
DESCRIPTION
OF PLATE XLIII.
Fig. 1.
Transverse section through left hip-joint viewed from above. A, A, acetabulum.
B, great trochanter. C, depression at bottom of acetabulum devoid of car
tilage. D, most prominent part of head of femur. E, E, cut edges of cotyloid
ligament. F, back part of capsule. G, layer of capsule reflected upon back of
neck of femur. H, thin layer passing on to back of neck of femur near great
trochanter. I, fore part of capsule pulled away from front of neck of femur.
Fig. 2. Back view of right hip-joint. A, acetabulum. B, great trochanter. K, spine, and L, tuber, of ischium. M, pubes. N, tendon of rectus femoris. O, zonular band. P, edge of capsule lightly connected with hinder part of neck of femur, Q, fibres of superior accessory ligament, interlacing with those of rectus tendon, passing into back of capsule and continuous with zonular band.
Quote p. 514
DESCRIPTION
OF PLATE XLIV.
Hip joint in extended position, viewed from the front, with the fore part of the acetabulum (A, A, A) reflected from B, B, B. C, part of reflected cotyloid ligament. D, reflected front of capsule. E, part of superior accessory ligament reflected. G, cut edge of ditto. F, cut edge of cotyloid ligament. H, thin part of acetabulum; the fat which should cover it has been removed. I, posterior band of ligamentum teres, arising from (K) the ischiatic corner of the notch. The wavy disposition of its fibres shows that it is not tense. L, fibres passing from fore part of capsule upon neck of femur.
Limits
extension of the thigh and lateral inclination of the pelvis.
Nearly all the fibres of the superior accessory ligament are like those of the anterior ligament, put on the stretch when the thigh is extended, and contribute with them to antagonise the action of the glutæi and other extensor muscles, and to give steadiness to the joint. They act also in a more direct manner than the anterior ligament in limiting adduction of the thigh, or, more properly speaking, in limiting lateral inclination of the pelvis upon the thigh, such inclination as is caused by the weight of the body bearing upon the sacrum when we rest upon one foot. In proportion as the pelvis is bent upon the thigh so does the range of its lateral inclination at, the hip, become more free; and the limit to that movement is set either by the fibres of this ligament or by those of the round ligament which now come into play. First, when the hip is a little bent, the office is performed by the enormously thick bundles of the superior accessory ligament, which pass from the trochantral ridge to the upper edge of the acetabulum; and in the «stand-at-ease» position of drill, when the soldier rests upon one leg, with the hip a little bent, the pelvis and trunk are as it were, slung upon this ligament, the muscles being left almost entirely at rest. As the flexion increases the office is transferred, more and more, from these strong anterior fibres to the hinder and weaker fibres of the ligament, which pass to the upper and posterior surface of the acetabulum and to the hinder part of the capsule; and when the flexion has reached to a certain degree (when the thigh is bent to somewhat less than a right angle), assistance is rendered by the Ligamentum teres. [in the latter aided by «round ligament»]
Quote p. 516
DESCRIPTION
OF PLATE XLV.
Vertical
section from side to side through left hip-joint, with thigh extended upon
pelvis and adducted, and with toes directed straight forward. A, cut edge of
crest of ilium. B, tuber ischii. C, thin part of acetabulum. D, round ligament
springing from hinder corner of notch and ascending in a waving line to dimple
in head of femur. E, E, cut edge of capsule. It is thickened near acetabulum
above, and near its attachment to femur, below, by the addition of the anterior
accessory ligament (F, F). Some of its fibres are reflected, with synovial
membrane at G, G, upon upper and under surfaces of neck of femur. H, rectus
tendon turned back. I, upper cut edge of cotyloid ligament. K, lower edge of
same, with some of its fibres continued into round ligament.
The capsule is relaxed above and below, because its fibres, which run from the ilium downwards and outwards to the femur, are cut obliquely in the section.
Quote p. 517-518
Ligamentum teres.
The offices
of the Ligamentum teres have been variously stated; but never, I think, quite
correctly. They are rather difficult to ascertain with precision, because the
ligament, lying in the interior of the joint, is entirely hidden from view; and
when once the capsule has been cut, or a section of the joint has been made, it
is not easy to retain parts in their proper position while the bones are moved
upon one another. [Best mode of exposing it to view.] The best opportunity of
observing the ligament is afforded by removing with a trephine, from the bottom
of the acetabulum, the portion of bone which is not covered by cartilage. This
may be easily effected from the inside of the pelvis, after one os innominatum
has been taken away; and it should be done while the capsule remains entire.
When the piece of bone has been thus cut out, and the fat which lies upon it
has been dissected away, the ligament is seen in its whole length, and its
condition in the various positions of the joint can be observed (1).
The round ligament consists of two bands, a posterior, moderately thick and strong, and an anterior, thin and weak. These are attached, respectively, to the ischiatic and pubic margins of the acetabular notch; they are connected together by areolar and fatty tissue, and by a synovial sheath; and they are inserted together into the bottom of the dimple in the head of the femur, so as to form one triangular ligament. It will be observed, on looking at a thigh-bone (particularly a recent thigh-bone), that the outline of this dimple is not circular but rather of trefoil shape, or three-cornered (Pl. XLVI. fig. 5), the lower edge being nearly flat. Each of the lower two corners corresponds with one of the bands of the ligament; and the hinder one is the larger and deeper, in accordance with the greater size of the posterior band; the upper corner is occupied only by fat.
1) I had resorted to this means of ascertaining the use of the round ligament, and had demonstrated it to my pupils, before seeing, from a brief report of a paper read by Dr Struthers, Ed. Med. Journal, April, 1847, that he had, by a similar process, arrived at somewhat similar results. [J. Struthers indicated 1847]
DESCRIPTION
OF PLATE XLVI.
Figs. 1, 2, 3, and 4, are views of ligamentum teres in different positions of the hip, obtained by cutting out a circular portion of the bottom of the acetabulum. A, A, cut edge of ilium. B, ditto of pubes. C, spine of ischium. D, tuber ischii. E, femur. F, lower surface of the capsule. G, opening into acetabulum beneath transverse ligament. H, ligamentum teres; I, small pad of fat lying upon it, and assisting to fill up dimple in head of femur. The pelvis is in the erect position in all. In fig. I the thigh is extended and adducted; ligamentum teres is not tight. In fig. 2 the thigh is bent; and ligamentum teres is still relaxed. In fig. 3 the thigh is bent and adducted; the fibres of ligamentum teres are straight and tight. In fig. 4 the thigh is bent and rotated outwards; the fibres of ligamentum teres are now also tight. In the last two positions the small pad of fat (represented at I, in figs. 1 and 2) is carried out of sight. Fig. 5. A view of the dimple in the head of the femur, shewing its triangular form.
Quote p. 519-523
Use to
limit inclination of the pelvis in flexed position of the joint.
When the hip is bent the lower two corners of the dimple are brought opposite to the edges of the acetabular notch; that is to say, the respective points of attachment of the two bands of the ligament are brought opposite to each other. This, together with the fact that the bands do not occupy the corners of the dimple at all times, but only when they are on the stretch, at other times lying upon any part of the lower edge of the dimple, indicates that the bent position of the hip is that in which the ligament is tense, and is, therefore, the position in which it is called into service. The inference, thus drawn from the anatomy of the parts, is quite confirmed by the observation of the ligament through the trephine hole just mentioned (Pl. XLVI.). In the extended position of the joint (fig. 1) the ligament is seen to be quite loose; and it cannot be rendered tense by any adduction or rotation of the thigh. If, however, the thigh be bent upon the pelvis (fig. 2), and be then adducted (fig. 3); or if, when bent, it be rotated outwards (fig. 4); or, which amounts to the same thing, if the opposite side of the pelvis be inclined downwards, the ligament is rendered tense, and its two bands are drawn tightly over the two corners of the dimple in the head of the femur, which are now opposite to the two edges of the acetabular notch.
Round
ligament is compressed into acetabular notch in certain positions of the joint.
In the bent position of the thigh, with the other side of the pelvis inclined downwards, the round ligament is drawn its full length into the acetabular cavity; and the enclosed in its synovial sheath, areolar and fatty tissue, are drawn up with it. But when the rotation of the thigh or pelvis is effected in an opposite direction, or when the thigh is abducted in the erect posture, the ligament is driven, in wrinkles, down to the lower part of the acetabulum; and its areolar and fatty tissue are compressed into the notch, and are made to project externally beneath the transverse ligament. Thus we learn that one of the uses of this notch is to afford room for the components of the round ligament in certain positions of the joint.
Torn in
dislocation.
Anatomical and experimental observation combine, therefore, to shew that the office of the ligamentum teres is the same with that of the hindmost fibres of the superior accessory ligament, viz. to prevent too great inclination of the pelvis in the bent position of the hip. That the assistance it affords is far from being superfluous is proved by the fact that the hip-joint is more frequently dislocated by a strain in the direction which these ligaments are intended to resist than in any other. The accident is commonly caused by the sufferer being thrown violently upon one knee with the hip bent; the upper and back part of the capsule, together with the hinder fibres of the superior accessory ligament and the ligamentum teres, are torn, and the head of the femur, driven from the acetabulum, is lodged upon the dorsum of the ilium or in the neighbourhood of the sciatic notch.
It does
not limit adduction of thigh in the erect position.
Weber (1) considers that the ligamentum teres co-operates with the thick anterior fibres of the superior accessory ligament, to restrain adduction of the thigh in the erect position; because a vertical section, carried through both hip-joints when the thighs are extended, divides the ligamentum teres in its whole length, shewing that it takes a vertical direction. It does not appear to have occurred to him to open the joint from the pelvis in the way I have described, or he would have seen that, though the hinder fibres of the ligament are nearly vertical when the joint is extended, they are not then tense, and that they cannot be made tense by any attempt at adduction or rotation, till the joint is bent, which proves, with certainty, that it is in the bent position of the joint only that the ligament comes into use. Weber remarks that when the joint is straight, no adduction is possible because this ligament is tight. It is true that adduction in that position is very limited; this is not, however, in consequence of the tension of the round ligament, but because many of the fibres of the capsule are then on the stretch. Indeed, if this ligament prevented adduction of the thigh in the extended position, as Weber says that it does, it would do the same in all other positions of the joint, because its attachment to the dimple of the femur being in the line of the transverse axis of rotation of the thigh upon the pelvis, it would necessarily be tense in the flexed and extended position of the joint alike. Hence adduction would be altogether impossible in all positions.
1) Gehwerkzeuge, s. 144.
Condition
as seen in vertical section of joint.
To assure myself further of the condition of the ligament in the erect posture, I made a vertical section through the joint when the thigh was extended upon the pelvis with the toes directed straight forward; and found that although the section was parallel with the fibres of the ligament they were not tense, neither could they be made so till the joint was bent (Pl. XLIV. XLV.).
Always
torn in dislocation.
The ligamentum teres is torn in each variety of dislocation, even in the dislocation into the obturator hole. For though, when the joint has been opened after death, the head of the thigh-bone can be removed from the socket and laid in the obturator hole without dividing the ligament, yet the force which causes a dislocation is always sufficient to rend the ligament from its dimple in the femur. The separation takes place the more easily because the drag upon it in this displacement is made, downwards, in the direction in which it is not calculated to offer resistance. In the other dislocations of the hip, the force is applied in an opposite direction; and the ligament is not separated from the dimple, but is rent across a little below it.
May be
absent.
Although a valuable assistant to the other ligaments, it may be wanting, without any especial weakness of the joint being observed to result from its absence. Perhaps the deficiency in such cases is compensated for by additional strength in the upper part of the capsule, or in those fibres of the accessory ligament which are associated in function with the ligamentum teres. I have remarked the ligament to be comparatively thick in fœtal and early life, especially near the head of the femur, and to be comparatively thin in some elderly persons; but I have not made sufficient observations to be sure that it undergoes any regular decrease in size in advancing years.
Wanting
in some animals.
It is
generally present, and sometimes is very strong, in those animals, as the horse
and ox, in which the hinder extremities are inclined inwards from the pelvis,
and in which such assistance, as the round ligaments afford, is required to
limit the degree of that inclination. When, on the other hand, the lower
extremities descend more vertically, or are inclined a little outwards, it is
commonly absent, as in the elephant, the seal, and the tortoise. In the orang outan
it is very small, or wanting altogether. In the chimpansé and other monkeys it
is present. In the frog, as before stated, a similar structure is found in the
shoulder as well as in the hip-joints.
To sum up what has been said respecting the offices of the various ligaments of the hip: - Extension of the joint is arrested, at the erect position, by the anterior accessory ligament; and, by the antagonising assistance of this ligament, the extensor muscles are enabled to hold the pelvis steady in that position. Flexion is limited, not by any particular ligament, but by the muscles and by the bulk of soft parts in front of the joint (1). The inclination of the opposite ilium upwards (which corresponds with abduction of the thigh) is limited by the inferior accessory ligament. The inclination downwards in the erect, and slightly bent, positions of the joint (which corresponds with adduction of the thigh) is limited by the anterior fibres of the superior accessory ligament; and by the hinder fibres of the same ligament, as well as by the ligamentum teres, when the joint is more bent. The inclination of the opposite side of the pelvis forwards in the erect posture (which corresponds with rotation of the thigh inwards) is limited by the hinder part of the capsule; and the inclination of the same backwards (which corresponds with rotation of the thigh outwards) is limited by the fore part of the capsule.
1) Weber found that, in the dissected joint, flexion could be carried to 139°, whereas, in the living person, it was limited to 86° by the presence of the muscles and other soft parts. His experiments shew the range of adduction, or abduction, to amount to 90°, and that of rotation to 51; it is greatest in the half-bent position of the joint.
Synovial
membrane.
The Synovial membrane covers the fibrous tissue of the neck of the femur, is reflected from it upon the interior of the capsule (Pl. XLV. G), and is again reflected from the latter upon the exterior of the cotyloid ligament. It also covers the round ligament and the fat at the bottom of the acetabulum.
Disease
frequent and persistent in the hip.
Owing to the extent, the vascularity, and the inflections of the synovial membrane, as well as the variety and range of movements of the hip, this joint is often the seat of inflammation, causing the well-known symptoms of «hip disease», which, in young persons, lingers so long in each of its several stages. In the middle-aged it is common, but is more acute and more quickly followed by ulceration of the cartilages. In elderly persons it is apt to assume the characters of «chronic rheumatic arthritis», and is productive of a slower removal of the cartilages, and of those various alterations in the shape of the head of the femur and of the acetabulum which have been so often described. When once disease has been fairly established in the hip, whatever the period of life may be, the free use of the joint is rarely regained. Hence we find so many examples of ankylosis of the hip; more, I think, than of any other joint. The obstinate manner in which disease adheres to the structures of the hip is probably explained by the great pressure upon the articular surfaces, caused by the weight of the body and by the contractions of the powerful muscles which are required to wield the long and heavy lower extremity upon the trunk, as well as to move and support the latter upon the thigh. The hip is, perhaps, also more frequently the seat of congenital malformation than any other joint (1).
1) See Cycl. Anat. Art. Hip-joint.
External links
Humphry GM. A Treatise on the Human Skeleton including the Joints. Cambridge: MacMillan and Company, 1858. [books.google , wellcomecollection.org]
Authors & Affiliations
George Murray Humphry (1820–1896) was
an English surgeon, gerontologist and medical writer, professor of physiology
and anatomy at the University of Cambridge. [wikipedia.org]
Keywords
ligamentum capitis femoris, ligamentum teres, ligament
of head of femur, anatomy, role, significance, experiments, topography, animals
.
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