Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com
Chapter 18
MECHANISM OF THE BIBLICAL Injury
[i]
Determining
the mechanism of injury plays a significant role in establishing the correct
diagnosis. It is defined by the point of application of force, its magnitude,
direction relative to the damaged element of the musculoskeletal system, and
the resulting deformation within it. A direct mechanism of injury implies the
action of force directly at the site of damage, whereas in an indirect
mechanism, the force is applied at a distance. Reality is exceptionally
diverse; consequently, there may be more than one injuring force. This defines
a combined mechanism of injury, that is, the simultaneous direct and indirect
action of a destructive force. Depending on the magnitude of the damaging
force, injuries are categorized into low-energy, medium-energy, high-energy,
and very high-energy trauma (1990JohansenK_HansenJST). By the direction of the
acting force, injuries caused by rotational movement are distinguished: pronation
(inward rotation), supination (outward rotation), adduction (bringing toward
the midline), abduction (moving away from the midline), flexion (bending), and
extension (straightening); as well as injuries caused by translational movement
– toward the body (compression, crushing), away from the body (rupture,
avulsion), in the transverse direction (transection), as well as various
combinations thereof. This gives rise to forces leading to tensile,
compressive, torsional, shear, and bending deformations. In engineering, a type
of plastic deformation at normal temperature known as "work
hardening" (strain hardening) is recognised. In our opinion, in the
pathophysiology of the musculoskeletal system, this phenomenon resembles the
process of osteophyte formation and the defiguration of the articular end of
the bone.
[ii]
The mechanism of Jacob's injury is described briefly, essentially in the same manner as accepted in modern medical records: "a man wrestled with him... touched the socket of his hip, and Jacob's hip was dislocated as he wrestled with him" (Gen. 32:25–26). Below, we find a key clarification: "touched the socket of Jacob's hip at the tendon" (Gen. 32:33). From the text, it is clear: the action of the "man" was directed directly at the hip joint, specifically at its most important element – the ligament of the head of femur (ligamentum capitis femoris, ligamentum teres femoris). Currently, such an injury would be classified as "intentional" due to interpersonal violence (2018AldridgeE_YonY). According to the primary source, it was inflicted by an unidentified person without the use of weapons or any instruments. From the Book of Genesis, it is clear that the injury is direct, as the unidentified character "touched... the socket of his hip" (Gen. 32:26, 33). Accordingly, the assailant acted upon Jacob's joint without significant effort. Relying on currently accepted terminology, this is appropriately designated as a variant of low-energy trauma. However, a dislocation occurs in the hip joint (Gen. 32:26). Such a type of damage to this articulation is possible only under the action of high energy (1869BigelowHJ; 1951,1968БабичБК; 1959ШумадаИВ; 1962BravEA; 1968ЯзыковДК_ВинцентиниКМ; 1970MatsubaraT; 1973БачинскийЮС_Куновский БН; 1976ЛатыповАЛ; 1978СвердловЮМ; 1990ЮмашевГС; 1993БуачидзеОШ; 1994DreinhöferKE_TscherneH).
The
hip joint is located deep inside the body, and the ligament of the head of
femur is within the joint itself. Touching this anatomical structure without a
surgical instrument or a traumatic tool is impossible. Thus, according to the
Book of Genesis, the "man" who attacked Jacob possessed superpowers
or "utilised" a certain device. From the text, it remains entirely
unclear whether this unidentified individual belonged to the human species or
to a host of angels (Gen. 32:26–27, 29). He managed to reach the hip joint and "touch"
the ligament of the head of femur without causing a skin wound. This latter
action is difficult to perform even after arthrotomy. Today, to achieve this,
the skin, fascia, muscles, and joint capsule with external ligaments are
incised, and the femoral head is dislocated or translationally displaced
outward. This procedure is called "surgical dislocation of the hip"
(2001GanzR_BerlemannU). It forms part of the technique for hip arthroplasty,
total hip replacement, and sometimes acetabular osteosynthesis.
If
the account of Jacob's joint damage is treated as a completely fabricated story
or a hallucination, all questions regarding "inconsistencies"
disappear on their own. At the same time, the current level of development in
medicine and surgical technology does not rule out the fundamental possibility
of touching the ligament of the head of femur without a skin incision. For
instance, it is possible to visualise this structure, touch it with an
instrument, and perform procedures on it via a puncture approach through the
acetabular notch (2025ArkhipovSV). Only a specialist knows where, in what
direction, and how to introduce the instrument, in what position the patient
should be, and what is required for this. Accordingly, what is read in the
primary source is theoretically possible, but only under conditions provided by
the most modern operating room. Nothing of the sort existed near the Jabbok River
on the night of Jacob's injury. The needle scope (arthroscope) had not yet been
invented. Performing a puncture of the hip joint during a struggle, in a
standing position, and without anesthesia appears to us as groundless fantasy.
However, we perceive the biblical story of impacting the "sinew" as a
precursor to minimally invasive surgical intervention on the ligament of the
head of femur via an approach through the outer orifice of the acetabular
notch.
Based
on the above, let us attempt to present a version of the injury according to
the Book of Genesis and evaluate its plausibility. First, the assailant crafted
a special instrument and brought it to the Jabbok River. Having attacked Jacob
under cover of night, with a practiced motion he introduces it into his
opponent's body, reaches the hip joint, opens its cavity, differentiates the
ligament of the head of femur, and damages it by tearing, compressing, or
transecting it. Previously, the femoral head was extracted from the acetabulum,
or a certain "device" with optics and a cutting instrument was
introduced into the acetabular part of the joint through the acetabular notch.
It is assumed that as a result of such "manipulations" during the
struggle, Jacob's hip joint "was dislocated" (Gen. 32:26). Despite
this severe damage, a few hours later, in the morning, the victim is already
capable of walking independently, merely limping "upon his hip" (Gen.
32:32). After the injury, the patriarch receives no medical assistance, and no
one sees or hears the scene of the fight. A literal interpretation of the
primary source testifies to the obvious impossibility of the described
mechanism.
We
believe that the description of the mechanism of Jacob's injury in the Book of Genesis
is a fiction presented as a vision during a hypnopompic hallucination. A
genuinely similar actual event is unthinkable. First and foremost, we are
confounded by the medical aspect in the form of an indication of a hip
dislocation occurring during the fight (Gen. 32:26). The injury inflicted on
Jacob, in the Hebrew version, is designated as: "יְרֵכ֑וֹ וַתֵּ֙קַע֙" (1978БроерМ_ЙосифонД,a). The verb "יָקַע" means "to be displaced
(dislocated), alienated", while the noun "יָרֵךְ" is translated as "thigh,
hip, flank, side, base" (1907BrownF_BriggsCA). Furthermore, the
dislocation of the "thigh/hip" occurs from "כַּף־יֶ֣רֶךְ", where "יָרֵךְ" is "thigh, hip, flank,
side, base", and "כַּף" is "hollow or flat part of the hand, palm, sole of the foot,
pan" (1907BrownF_BriggsCA).
Consequently,
as applied to the human joint, the description of the injury in Hebrew
literally implies a "displacement of the femur from the socket of the hip",
which in modern terminology corresponds to the acetabulum of the pelvic bone.
This can imply both a dislocation in the hip joint and a partial displacement
of the femoral head from the acetabulum, that is, a subluxation of the hip. In
the rendering from Hebrew under study, we read: "touched the socket of his
hip, and the socket of the hip was dislocated" (Gen. 32:26). The
translator was evidently unaware of the possibility of a subluxation;
otherwise, he would have used the indefinite concept of "displacement"
instead of the more specific "dislocation", which signifies the
complete exit of the femoral head from the acetabulum.
Dislocation
of the femur is classified as a severe injury and results from the application
of significant mechanical force (2006КорниловНВ). Following such injuries, patients fall,
frequently lose consciousness, are unable to move for an extended period,
require urgent medical care, and subsequent specialised treatment. Even
non-specialists are aware that "the most severe dislocation is that of the
hip" (1880ДальВИ).
Meanwhile, on the morning following the injury, Jacob walks independently (Gen.
32:32). Practically throughout the entire first day, the patriarch remains "on
his feet": he travels on foot, performs bends, embraces his brother while
standing, sits down, and stands up (Gen. 33:3–5, 12). His condition is
"satisfactory", as he plans to continue his journey on foot
independently (Gen. 33:14). Esau, in their conversation, never once draws
attention to any inability of his twin brother to walk and suggests setting out
again immediately, saying: "let us take our journey, and let us go"
(Gen. 33:12). On that same day, closer to evening, Jacob reaches the place
called "Succoth", builds "a house for himself", and constructs
"booths" for his livestock (Gen. 33:17). The aforementioned tasks are
categorically impossible to perform within twenty-four hours after a
dislocation of the hip joint.
What
occurred could not have led not only to a dislocation, but also to fractures of
the pelvic bones or the femur. Neither massive tissue destruction nor traumatic
amputation is described. An episode of crushing or compression of a body part
of Jacob is not recorded. A real threat to his life emanated exclusively from
his brother, whereas on the part of the angel it was virtual (Gen. 32:12, 31).
There are no indications in the text regarding any skin wounds inflicted upon
Jacob in the area touched by the "man" (Gen. 32:26, 33). We find no
mention of the use of weapons or a traumatic object. Nor is there a description
of an attack by a wild beast or an aggressive domestic animal in the narrative.
External bleeding is not featured, which allows us to deny the penetrating
nature of the injury sustained.
As
established earlier, there was no physical attack on the part of the
unidentified person. Accordingly, Jacob's injury cannot be interpreted as
"intentional" due to interpersonal violence. There are no grounds to
assume that Jacob encountered a massive movable or immovable obstacle during
the crossing – a tree, a rock, or an animal. In either case, a large obstacle
could be noticed and bypassed. The victim does not report falling from a great
height either. Directly in the area of the presumed crossing, we observed no
steep bank slopes, nor did Jacob climb any trees. The primary source does not
note his fall from a camel's saddle, for the crossing through the
"stream" was accomplished on foot (Gen. 32:23). Based on the essence
of the narrative, the injury was not the result of a "contusion",
since it is specified that the opponent "touched" him (Gen. 32:26, 33).
A powerful blow with a hard blunt object to the area of the hip joint is not
mentioned.
The
authors of the Book of Genesis implied a human hip dislocation. This assertion
is proven by the mere mention of it by the writers. There is no reason to
believe that their contemporaries did not dislocate their hips during the
construction of temples or pyramids. At the same time, we have been unable to
identify written evidence of a hip joint dislocation in writings prior to the
New Kingdom of Ancient Egypt or later than the Old Babylonian period of
Mesopotamia.
In
one of the translations of the Epic of Gilgamesh (late 3rd millennium BCE), we
discern an allusion to an open hip dislocation in a bull, performed by the
mighty Enkidu: " he wrenched off the Bull's hindquarter and flung it in
her face" [the goddess Ishtar's] (1989KovacsMG). In the Babylonian Poem of
the Righteous Sufferer, the historical figure Shu-meshre-Shakkan, who lived
during the reign of Nazi-Maruttash (1307–1282 BCE), recounts a dislocation of
the leg joints as a result of convulsions (2022HätinenA). Such an occurrence is
possible with respect to the hip joints. E. Stanley (1841) appears to have been
the first to scientifically describe a pathological dislocation of both hip
joints caused by a disease of the spinal cord and probably the brain in a
bedridden patient. Chronic neurological hip dislocation is also a serious
musculoskeletal complication in non-ambulatory patients with cerebral palsy
(2026CosticiE_CosticiPF).
The
oldest written evidence of a fracture-dislocation of the hip is present in the
poem Iliad, composed around the 8th century BCE. Homer realistically describes
an open fracture-dislocation of the hip joint: "...a stone in his hand
took the son of Tydeus, / A dreadful weight, such as two men could not lift, /
Of men such as now live – yet he swung it easily alone; / With this stone he
struck Aeneas on the hip, where the steep / Thigh turns in the joint, called the
cup: / The stone shattered the cup, tore the thigh tendons, / And ripped off
the skin. The struck hero / Fell upon his knee, leaning with his mighty hand /
Against the earth, and dark night covered his eyes" (2008Гомер). The poet vividly and accurately
depicted a direct high-energy injury to the hip joint with a direct mechanism
of damage. Along with a transacetabular fracture, the Trojan War hero is
described as having a rupture of the hip joint ligaments, a degloving wound of
the thigh, and traumatic shock.
In
the Iliad, the poet also told of the warlike "Amazons" (1960Гомер). Diodorus Siculus (1st century
BCE) in the Library of History writes that the female representatives of this
mythical tribe, in male infants, mutilated their legs and arms to render them
unfit for military service (2000Диодор). Hippocrates of Cos (born ca. 460 BCE) in his treatise On Joints
clarified the legend: the Amazons "in their male offspring, while still in
infancy, sometimes dislocate the knees, sometimes the hips, to make them lame".
In the same treatise, the physician for the first time classifies hip
dislocations and distinguishes between those occurring as a result of trauma,
disease, and "in the womb" of the mother (1941Гиппократ). By distinguishing dislocations
inward, outward, backward, and forward, Hippocrates of Cos implied different
mechanisms of injury, and regarding the "Amazon technique", he
presumably assumed forced supination.
According
to ancient Greek myths, the god Hephaestus was born "weak and lame",
and among other things, was cast down from Olympus to the earth by his mother
(2004КунНА). "Lame
Hephaestus", who "sluggishly moved his crippled legs", is first
mentioned in the Iliad (1960Гомер). This god is mentioned by Hesiod (8th–7th centuries BCE) in the poem
Works and Days as the "lame one of both legs" (1999ГаспаровМЛ). Two diseased legs and a gait
abnormality since childhood point in favor of congenital bilateral hip
dislocation. The pathology may have been aggravated by a fall from a height. In
congenital dislocation of the hip joint and in catatrauma, the mechanism of hip
dislocation is indirect – that is, under the slow influence of a rotating
destructive force in the former case, and under a rapid axial load along the femur
in the latter.
According
to Herodotus's Histories (5th century BCE), General Miltiades, "leaping
down from the wall, dislocated his hip. Others, however, assert that he only
injured his knee" (1972Геродот). Here, a typical catatrauma is observed, with the probability of
either a dislocation or a fracture-dislocation in the hip joint via an indirect
mechanism.
By
the end of the first millennium BCE, ancient Greek medicine was well acquainted
with hip dislocations and the causes of this pathology. Heraclides of Tarentum
(3rd–2nd centuries BCE) in his book On External Therapy lists Greek physicians,
besides Hippocrates of Cos, who described the reduction of a hip joint
dislocation: Diocles, Philotimus, Evenor, Nileus, Molpis, and Nymphodorus
(1829KühnCG; 2020ArkhipovSV_ProlyginaIV). Aulus Celsus (1st century CE) in De
Medicina noted that ancient doctors engaged in the treatment of hip dislocation
included Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus, Heraclides [of
Chalcedon?], as well as Diocles, Philotimus, and Heraclides of Tarentum
(1831CelsusAC). We have noted that the encyclopedist omitted the arthrologists
of the 2nd–1st centuries BCE: Hegetor of Alexandria and Apollonius of Citium,
who undoubtedly discussed hip dislocation (1965KolleschJ_KudlienF). In Galen's
Fourth Commentary on Hippocrates' On Joints (2nd–3rd centuries CE), it is
stated that Ctesias of Cnidus, a relative and contemporary of Hippocrates of Cos,
reduced hip dislocations (1829KühnCG; 2020ArkhipovSV_ProlyginaIV).
A brief review of the oldest concepts regarding the causes and mechanisms of hip dislocation shows that a significant force is required for this type of injury. The extremely rare case of pathological dislocations in a character of the Babylonian Poem of the Righteous Sufferer (late 2nd millennium BCE) was associated with a prolonged illness. Intentional dislocation of the hip joint by a human was discussed in relation to the mutilation of newborn male children by mothers from the legendary tribe of Amazons, who presumably flourished in the first millennium BCE. In the tomb of the nomarch Amenemhat (Ameni) at Beni Hasan (12th Dynasty, 20th–18th centuries BCE) and Baqet III (11th Dynasty, 22nd–20th centuries BCE) from the same necropolis, there are wrestling scenes depicting an attempt to lift/wrench and hyperabduct the leg at the hip joint of a defeated athlete (1893GriffithFL,a,b; 2004РакВИ). The only early written source reporting a hip dislocation inflicted by manual action is the Book of Genesis. Whether its contents were borrowed by the compilers of the Amazon myths remains to be discovered.
From
our point of view, in Jacob's case, injuries of medium, high, and very high
energy, as well as a direct mechanism of injury, should be rejected. The cause
of the pathology of the hip joint was a low-energy impact. Utilising
medico-legal terminology, the injury in the biblical fight caused "slight
harm to health" (2007ВитерВИ_ХаликовАА).
Most likely, it developed via an indirect mechanism. The group of such hip
joint injuries is small: contusion, sprain, subluxation. Often, these are not
remembered as notice-worthy episodes of everyday life and labor.
Low-energy
damage with both direct and indirect mechanisms is possible in a fall from
standing height. In Jacob's case, it could have occurred either with a load in
his hands or without one, on the bank or in the water, face forward, onto his
back, or to the side. At the same time, partial support on one or two hands, as
well as on one or both knees, is not ruled out. Of the listed types, only in
the case of a fall "on the side" is a contusion of the hip joint
region probable, but not of the ligament of the head of femur. The latter is
located in a special osseocartilaginous cavity – the acetabular canal, the
walls of which protect the ligament of the head of femur from direct force
(2004Архипов-БалтийскийСВ,a).
In
our primary source, notable phrases are present: "let me go" and "I
will not let you go" (Gen. 32:27). Their presence indirectly testifies in
favor of the fact that the injury occurred when Jacob was carrying a child to
the other bank. If the hypothesis is correct, then no fall, and consequently no
contusion, was observed.
A
low-energy indirect damage to the hip joint in the form of a sprain or
subluxation is possible in a case where a person "stumbles" or
"misstepped" – for instance, on a step, the edge of a bank, a pothole
in the ground, or a stone. "To misstep" means to step awkwardly or
stumble, for example: "he misstepped and fell" (2006ОжеговСИ_ШведоваНЮ). A similar interpretation is: to step
awkwardly or unsuccessfully, with a usage variant being: "he misstepped
and dislocated his leg" (2014УшаковДН). One of the most common low-energy joint
injuries with an indirect mechanism is called "twisting" or
"spraining" by patients and physicians. "To twist" a leg is
explained as: having misstepped, to injure or strain from an awkward step or
movement (2006ОжеговСИ_ШведоваНЮ). In other words,
"twisted" is the same as "turned out", but "not
completely". Sometimes patients describe this in the words:
"partially twisted", "came out of the joint a little",
"popped out and then went back into place". Talkative individuals add
that in doing so they "pulled" or "strained" a
"ligament", "tendon", "muscle", or "joint".
In medical language, the aforementioned corresponds to the concept of
"sprain" or "distortion" (from Latin distorsio) of flexible
anatomical structures. From a morphological standpoint, a ligament sprain is
not an elongation, as a layperson might imagine, but partial damage to the
entire structure, a portion of it, or individual fibers.
In
the hip joint, two internal and four external ligaments are distinguished,
woven into the joint capsule (1996СинельниковРД_СинельниковЯР). Most of them suffer from tensile force, with
the exception of the transverse acetabular ligament. Thus, establishing the
diagnosis of a "sprained ligament" of the hip joint implies minor
damage to one or more ligaments: the iliofemoral, pubofemoral, and
ischiofemoral ligaments, the zona orbicularis, the ligament of the head of
femur, and the joint capsule. The cause is usually a forced movement in the hip
joint exceeding the natural range of motion. The transverse ligament present in
the hip joint is "strained" only in a fracture of the acetabulum, as
well as damage to the acetabular labrum.
A
distinction should be drawn between "twisting/spraining" and
"subluxation". To designate the latter, physicians use synonyms:
"subluxation", "partial dislocation", "incomplete
dislocation", "partial displacement of the articular end of the bone",
and "incomplete luxation". "Subluxation" as a nosological
form is characterized by a persistent partial separation of the articular
surfaces. Due to the anatomical features of the hip joint, traumatic
subluxation within it is possible only if damage occurs to the bones forming
the articulation. Even Hippocrates of Cos in his treatise On Joints, discussing
the features of hip and shoulder dislocations, noted: their "heads are
completely round and smooth, and the sockets in which they are placed, being
round, are adapted to accommodate the heads, and this does not allow the head
to come out halfway, since, due to its round shape, it either slips outward or
returns back to its place. The mentioned bones fall out completely and do not
fall out otherwise" (1941Гиппократ).
Theoretically, a traumatic subluxation of the hip – that is, a partial displacement of the head from the acetabulum by a minor degree – can occur as a transient event ending in spontaneous reduction. Fixing the fact of such an injury is virtually impossible. Persistent cases of hip subluxation are the result of degenerative-dystrophic diseases, bone defects, neuromuscular disorders, or the presence of a foreign or natural intra-articular body in the joint space.
[v]
The
Book of Genesis reports that as a result of the injury, Jacob sustained damage
to "the sinew which shrank, which is upon the
hollow of the thigh" (1922LeeserI, Gen. 32:33). We have established
that this refers to an injury to the ligament of the head of femur located
inside the hip joint. In accordance with an indirect mechanism, it could be
injured during a movement whose range exceeded the natural limit. The hip joint
allows the leg to rotate in the frontal, horizontal, and sagittal planes. This
is accomplished through flexion and extension, inward and outward rotation
(pronation/supination), and abduction and adduction. These types of rotational
movements are reproduced by changing the position of the thigh, the pelvis, or
both the thigh and pelvis simultaneously.
Translational
movements are normally possible only in the lateral direction along a line
perpendicular to the plane of the acetabular inlet, which approximately
coincides with the long axis of the femoral neck (1994НеверовВА_ШильниковВА; 1998GarbeS; 2004Архипов-БалтийскийСВ,a). Other longitudinal
displacements are prevented by the walls of the acetabulum. Physiological
translational displacement of the femoral head outward is negligible and
normally occurs during walking in the swing phase of the stride under the
weight of the lower limb and the relaxation of the external ligaments due to
flexion. The barrier to significant displacement is the capsule of the hip
joint, the external ligaments, and the acetabular labrum. During longitudinal
displacement of the femoral head, the low elasticity of the above-mentioned
anatomical elements initially shunts the elongation of the ligament of the head
of femur. To achieve separation of the articular surfaces in the hip joint, a
traction force of no less than 400 N must be applied (1990ArvidssonI). An
effort exceeding 40 kg in an experiment is applied with an extended thigh, that
is, under tension of the external ligaments of the hip joint. The relative
weight of the lower limb constitutes 18.1% of total body mass (1988МорейнисИШ). That is, stretching of the
articular ligaments by the weight of the carried leg will be observed at a body
mass exceeding 220 kg. Translational movement in the hip joint is a component
in the onset of subluxation. It is usually spontaneously resolved due to the
elasticity of the ligaments, increased muscle tone, and weight-bearing on the
leg.
As
our studies have shown, the ligament of the head of femur is tightened during
adduction, supination, pronation, and extension of the thigh (2004Архипов-БалтийскийСВ,a; 2012,2018АрхиповСВ). The most dangerous positions for
it are supination, pronation, and adduction. These positions in the hip joint
are achievable by rotation in the horizontal and frontal planes of both the
pelvis and the thigh. In extreme positions of supination, pronation, and
adduction, the distal end of the ligament of the head of femur approaches the
inner margin of the lunate surface. Excessive load in these positions first
elongates the ligament of the head of femur. Under the action of a minor force,
its elongation is reversible (elastic elongation); under the action of an
excessive force, it is irreversible (partial or complete damage, plastic
elongation). If tearing, partial rupture, or avulsion of the ligament of the
head of femur does not occur, the distal end of the structure comes into
contact with the inner margin of the lunate surface and is damaged upon contact
with the bone. Accordingly, the ligament of the head of femur can be injured
under the action of forces that lead to tensile and shear deformations, as well
as during their simultaneous initiation.
According
to our hypothesis, during the night crossing on foot across the river, Jacob's
prototype sustained a closed low-energy injury to the ligament of the head of
femur via an indirect mechanism. It became the result of an
"accident" – that is, an unintentional spontaneous event. The range
of such incidents is limited to the following enumeration: "misstepped",
"stumbled", "ran into", "lost balance",
"slipped", "twisted" the leg, "fell". Each of the
listed incidents is capable of causing a transient, uncontrolled movement in
the hip joint exceeding the normal range of motion.
When
walking, Jacob could have "stumbled" or "tripped" over
uneven ground, a stone, a fallen tree trunk, a root protruding from the earth,
or a previously dropped object. In this case, involuntary inhibition of flexion
would occur in the hip joint of the leg advanced forward. Movements in the
specified articulation in the sagittal plane, even with a large amplitude, are
not critical for the ligament of the head of femur. During walking, the
cumulative magnitude of "flexion-extension" usually amounts to
approximately 40° (2016LunnDE_StewartTD). The distal end of the ligament of the
head of femur in such a movement travels along an arc inside the acetabular
fossa. A forced stop at any point along the trajectory will not become a
traumatic event. This applies to both hip joints in the event that one of the
legs is halted upon colliding with an obstacle.
The
crossing of the Jabbok stream appears to be assumed by the authors in autumn – during
the rainy season. The soil and grass at this time are damp, as are natural
objects on the ground: stones, fallen tree trunks, and their roots. Boulders in
and near the water were undoubtedly wet. Such surfaces are generally slippery.
An awkward placement of the supporting foot on them is capable of leading to
slipping with a loss of body balance. In this event, any forced rotational
movement is possible in the hip joint. Of these, flexion, extension, and
abduction are not critical for the ligament of the head of femur.
High-amplitude pronation and supination are unlikely. Abduction of the leg in
the hip joint is especially dangerous; however, the contralateral lower limb
acts as a limiter to the medial displacement of the thigh of the slipped
supporting leg. In a case where uncontrolled adduction is combined with flexion
or extension, the natural obstruction from the medial side is bypassed. Then
the ligament of the head of femur is subjected to intense stretching, and its
distal end comes into contact with the inner margin of the lunate surface (2018АрхиповСВ; 2019ArkhipovSV_SkvortsovDV). As a
result, we expect a tear, partial rupture, avulsion, as well as transection of
the ligament of the head of femur from the femoral head via an adduction
mechanism of injury.
During
slipping, stumbling, or loss of body balance, the projection of the centre of
gravity extends beyond the boundaries of the support area. Consequently, a fall
occurs. If it takes place sideways, the leg is rapidly adducted at the hip
joint. This significantly increases the tensile force acting on the ligament of
the head of femur and elevates the probability of injury via the aforementioned
adduction mechanism, causing both tensile and shear deformations. A fall
forward, supported on the hands or knees, or backward onto the back, is less
likely to lead to an injury of the ligament of the head of femur.
"Twisting"
the leg in the hip joint during walking is an unusual injury. Such an
occurrence is characteristic of individuals actively engaged in sports,
dancing, as well as ballet and circus performers. Twisting occurs upon loss of
control over high-amplitude rotational movement of the thigh and pelvis. Forced
adduction, supination, and pronation of the thigh, tilting of half of the
pelvis downward, as well as its rotation in the horizontal plane are hazardous.
Such movements condition the tensioning of the ligament of the head of femur.
Under a minor acting force, the elongation is reversible. In this process, the
distal end of the ligament of the head of femur leaves the confines of the
acetabular fossa. Normally, the articular surfaces of the hip joint are in
complete contact. Between them, only in certain sectors is a microscopic
slit-like gap present (1979ВоронцовАВ; 1991НеверовВА_ШильниковВА; 1991ШильниковВА). The dimensions of the gap are
extremely small compared to the thickness of the ligament of the head of femur.
Therefore, its distal end, upon colliding with the inner margin of the lunate
surface, is severed from the head of the femur as if by a guillotine – either
completely or partially. Excessive stretching of the ligament of the head of
femur is capable of causing a partial tear, that is, a rupture of portions and
fibers along its length, as well as a partial avulsion of the distal end.
It
is more probable that Jacob's prototype misstepped while crossing the river.
The accident occurred at night, under poor visibility, in haste, and, as we
suggest, while carrying a child aged six to eight in his arms. Walking along
the bank or through the stream, Jacob stepped on the edge of a damp object: a
stone or a tree root. This could also have been a small depression in the bank
soil or on the riverbed. Under such circumstances, the foot of the
forward-placed leg unexpectedly slips downward. The ipsilateral half of the
pelvis vigorously tilts in the same direction. It is thought that this occurred
at the beginning of the double-support phase of gait. In the hip joint of the
trailing leg, extension and passive pronation are being completed. The abductor
muscle group decreases its activity in maintaining the pelvis (1990WinterDA;
2007СкворцовДВ). The
primary elements stabilising its position prove to be the ligaments, including
the ligament of the head of femur (2018АрхиповСВ). The loss of support from the second leg, the
forward shift of the centre of gravity, and the inertia of body movement induce
a rapid downward and forward tilt of the pelvis during an imbalance in the
activity of the adductor and abductor muscles. In the hip joint of the trailing
leg, uncontrolled adduction occurs with a tensile force acting on the ligament
of the head of femur. The perniciousness of the presumed concurrence of
circumstances lies in the fact that during internal rotation and extension,
this structure is already taut. The abductor muscles virtually do not
participate in supporting the pelvis, and the joint itself functions like a
class three lever, which is stabilised mainly by the reaction forces of the
ligaments, primarily the ligament of the head of femur (2018АрхиповСВ; 2008,2019ArkhipovSV,b).
The
situation appears to have been exacerbated by the carried child weighing
approximately 20 kg. The action described above tautened the ligament of the
head of femur in the hip joint of the trailing leg to the limit. Conditions
were established for traumatic contact between the distal end of the ligament
of the head of femur and the inner margin of the lunate surface. Thus was realised
the adduction-pronation mechanism, which damaged the ligament of the head of
femur, inducing in it simultaneous tensile and shear deformations. This could
have been an "adduction-pronation-extension" mechanism if it is
assumed that the hip joint at the moment of injury was in a position of
extension. At the moment of damage, a situation arose resembling the shearing
action of a metal-cutting guillotine machine or shears cutting a pre-tensioned
wire.
With
a victim's body weight of 58.70 kg and an additional load of 20 kg, the dynamic
component in the aforementioned gait phase amounts to 34.54 kg (50.98%), and
the acting weight equals 1,002.58 N. The maximum force developed by the
abductor muscle group turns out to be 28.50 kg, or 279.3 N. Taking the moment
arm of body weight as 0.1099 m, the moment arm of the abductor muscles as 0.04
m, and the moment arm of the ligament of the head of femur as 0.038 m, a
tensile force of 2,606.92 N or its equivalent of 266.01 kg will act on this
structure (baseline data drawn from 2009KapandjiAI; 2012PauwelsF;
2019ArkhipovSV,a,b). Without the additional load of 20 kg, the force acting on
the ligament of the head of femur would equal 1,749.74 N or 178.54 kg
(2019ArkhipovSV,a). Consequently, when carrying a child weighing 20 kg, the
tensile force acting on Jacob's ligament of the head of femur increases by
857.18 N, which is equivalent to 87.47 kg.
During
our expedition to Jordan in 2014, on the northern bank of the Jabbok River, at
the site of the presumed crossing, we discovered a distinctive large stone
featuring a defect whose shape resembled the inner part of a human left foot.
We gained the impression that the "impression" arose as a result of a
shoe sole slipping. The analogy of the observed flaw (a result of erosion?) was
imaginatively "completed" to the shape of a foot, as is customary
among artists. This unusual object was tentatively named by us the "stone
of stumbling". Such a boulder could have served as the cause of an
unintentional injury to a person walking along the bank with a burden. Having
accidentally stepped on the stone with his left foot, the corresponding foot
slipped downward. At that moment, acute pain pierced the opposite joint.
Involuntarily, the hands clasped the "precious load" tighter. The
traveler paused for a time, overcame the unpleasant sensation in the right hip
joint, and moved forward once more, now limping.
Jacob's
prototype had reached 37 years of age at the time of the injury. At this age,
the strength of biological tissues begins to decline. Consequently, the risk of
damage to the ligament of the head of femur increases compared to youth. In our
firm conviction, the victim sustained a transection of the distal end of the
ligament of the head of femur from the femoral head. Moderate pain following
the injury persisted until a period of rest. Having completed the river
crossing, the exhausted man remains alone and falls asleep while resting.
Following the trauma, blood accumulates in the joint with the damaged ligament
of the head of femur. This is due to the fact that arterial and venous vessels
run inside the injured anatomical structure, from which jet-like bleeding is
sometimes observed. Tension hemarthrosis develops with stretching of the joint
capsule, which intensifies the pain. The severity of hemarthrosis may decrease,
as in a normal hip joint there are communications with synovial bursae (1963КовановВВ_ТравинАА). The excess portion of synovial fluid drains
into them during movements. The blood that has extravasated into the joint
partly flows into the aforementioned cavities, which reduces intra-articular
pressure. For this reason, victims note a gradual decrease in pain intensity
and begin to use the limb after a certain period.
In our view, a writer with a medical education presented how, in the pre-dawn hypnopompic hallucination of Jacob's prototype, muscle memory of holding a child during the crossing, the image of an aggressive brother, and a transient accident became intertwined. A vision emerged featuring a wrestling scene and an inspiring dialogue. A religious mindset initially interpreted the opponent as a humanoid demon. Then the brain "helpfully" substituted him with an angel capable of bestowing blessings and majestic names. Upon fully awakening, the victim recalls the narrative seen in his subconscious and utters in astonishment: "I saw an angel face to face, and my life is preserved" (Gen. 32:31). Subconsciously, the reader extrapolates: the angel drove away the attacking demon who had damaged the patriarch's joint. Having awakened, Jacob cautiously flexes and extends his leg in the damaged hip joint. The pressure inside the joint cavity decreases, and the pain subsides. The patriarch rises and heads toward the encampment, limping. In the morning, a sequence of pathological processes is initiated that irreversibly leads to osteoarthritis in the hip joint with the damaged ligament of the head of femur. Running, walking, squatting, and physical exercises – including those prescribed by physical therapists – in a standing position accelerate the destruction of cartilage surfaces and subsequently the articular ends of the bones.
Title & Contents / Chapter 1 / Chapter 2 / Chapter 3 / Chapter 4 / Chapter 5 / Chapter 6 / Chapter 7 / Chapter 8 / Chapter 9 / Chapter 10 / Chapter 11 / Chapter 12 / Chapter 13 / Chapter 14 / Chapter 15 / Chapter 16 / Chapter 17 / Chapter 18 / Chapter 19 / Chapter 20 / Chapter 21 / Chapter 22 / Chapter 23 / Chapter 24 / Chapter 25 / References / Notes
Russian-language version:
Титул и оглавление / Глава 1 / Глава 2 / Глава 3 / Глава 4 / Глава 5 / Глава 6 / Глава 7 / Глава 8 / Глава 9 / Глава 10 / Глава 11 / Глава 12 / Глава 13 / Глава 14 / Глава 15 / Глава 16 / Глава 17 / Глава 18 / Глава 19 / Глава 20 / Глава 21 / Глава 22 / Глава 23 / Глава 24 / Глава 25 / Список литературы
Author of the publication
Arkhipov S.V. – Independent Researcher, MD, PhD, Orthopedic Surgeon, Medical Writer, Finland.
Correspondence: Sergey Arkhipov, e-mail: archipovsv @ gmail.com
Publication history
October 23, 2026 - online version of the book is published.
Suggested citation
Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Abstract and Table of Contents. Manuscript. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-18.html
Note
Keywords
hip joint, hip dislocation, osteoarthritis, ligament of the head of femur, ligamentum teres, ligamentum capitis femoris, Minoan Eruption, Bronze Age, Ancient Medicine, Ancient Egypt, Edwin Smith Papyrus, Biblical Chronology, Genesis, Genesis Protograph, Bereshit
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
Comments
Post a Comment