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 21
LOCAL STATUS OF THE PATIENT
[i]
In
the "status localis" section of a medical record, the
"local" changes associated with a disease or injury are described. In
our case, this refers to the state of the patient's musculoskeletal system.
This part of the "medical history" reflects the external signs of
pathology in the affected area, identified functional impairments, and the
results of special tests and examinations. Individual findings are referred to
as "signs of disease" or "symptoms", which, in turn,
combine into stable combinations known as "syndromes". As with the
general status (status praesens), information regarding Jacob's local changes
is extremely scarce. Furthermore, throughout the text of the Book of Genesis, these
facts are retold in the third person, having been identified in the prototype
of the biblical character. The records that might have been made by the
physician who examined him are lost forever.
Certain
facts about local disorders can be extracted from a conversation with the
patient about the incident. The most crucial details heard and understood by
the physician are recorded in the medical chart. We did not have the
opportunity to listen to or interview Jacob, nor do we have witnesses to the
accident. Everything that can be evaluated must be drawn from the text of the
Book of Genesis. Our presentation of the "local status", along with
its analysis and synthesis, is expressed in modern language. Concurrently, an
attempt has been made to reflect various medical aspects of a Bronze Age hip
joint injury. In this section, we will try to demonstrate how local changes in
such an injury were previously understood by victims and healers, as well as by
present-day specialists. The interpretation of the description of the first
patient with an injury to the ligament of the head of femur will contribute to
research and the development of new methods for the treatment and prevention of
this treacherous hip pathology.
[ii]
The
medical examination and evaluation of Jacob's prototype were conducted in Egypt
approximately 33 years after the accident. The physician was absent from the
scene of the injury and could not be consulted in the immediate aftermath. Therefore,
the local changes and function of the lower limb girdle at that time are known
to us only from the words of the victim – or rather, the "reteller".
One can surmise that Jacob, having suffered a joint injury, experienced pain in
the hip area (Gen. 32:32). Apparently, it was predominantly localized in the
upper part of the leg. These unpleasant sensations, among other things, became
the cause of limping "on his hip" (Gen. 32:32).
In
our opinion, the patriarch first felt pain at night during the crossing of the
Jabbok River (Gen. 32:23–24). In the bustle of the crossing, these unpleasant
sensations receded "into the background". Being left alone after
crossing to the other bank, Jacob explicitly differentiated the localization of
pain in the projection of the hip joint (Gen. 32:25–26). The pain syndrome
persisted at least into the morning of the new day, as Jacob remembered
precisely which joint his opponent had "touched", and on which hip he
limped (Gen. 32:32–33). Moreover, the opponent was clearly an immaterial
entity, as he touched a deeply situated joint. The joint in question is
demarcated externally by the skin, subcutaneous tissue, fascia, muscles, and
internally by the pelvic bone and abdominal organs (1996СинельниковРД_СинельниковЯР).
Attention
should be drawn here to the fact that Jacob clearly indicates the affected
organ – the "hip joint" (Gen. 32:33). Patients do not always diagnose
the area of pathological changes so accurately within themselves. Pain can be
diffuse, migratory, radiating, or sometimes present as vague sensations and
discomfort. This, combined with limited medical knowledge, makes it difficult
for a patient to describe health problems. The literary Jacob speaks
unambiguously and quite definitively of a hip joint injury (Gen. 32:26, 33). We
do not know whether the right or left joint was damaged. At the same time, it
is clear that nearby biokinematic links were not affected by the injury,
specifically the sacroiliac and knee joints, as well as the pubic symphysis.
After
the injury, the victim was able to perform multiple forward bends of the body
(Gen. 33:3). This means that during the struggle, his lumbar spine was not
injured: vertebrae, intervertebral discs, ligaments, or spinal nerve roots were
unaffected. Accordingly, pain was absent in these mobile articulations. The
injury did not affect the nervous system; otherwise, Jacob would not have been
able to bow seven times (Gen. 33:3). Tension tests for lower limb nerves: the
femoral nerve (hip extension) and the sciatic nerve (hip flexion) were
presumably negative.
As
we know from the Book of Genesis, Jacob's "hip joint was dislocated"
(Gen. 32:26). It is common knowledge that immediately after a hip dislocation,
patients are unable to move for a long period of time. Meanwhile, having
survived the incident, the victim set out at the head of the caravan in the
morning (Gen. 32:32). He walked on foot for most of the day (Gen. 33:16–17).
The fact of dislocation is stated by Jacob himself. Patients often describe a
joint injury such as a "twisting" or "sprain" in this
manner. In specialized literature, this is close to the concept of
"subluxation", which is accompanied by partial or selective damage to
ligaments. Jacob's walking function was impaired, and pain was localized in the
region of the hip joint, which is described by the phrase: "limped upon
his hip" (Gen. 32:32). Further in the text, it is specified that during
the struggle, the ligament of the head of femur was injured (Gen. 32:33).
Scientific
literature reveals that a dislocation in the hip joint can be a warning sign of
joint instability and portend subsequent osteoarthritis (2005VillarR_SantoriN).
Hip dislocation implies a combination of rotational and translational movements
of the femur relative to the acetabulum at the time of injury. As a result of
damage to the ligamentous and muscular apparatus, walking function is
significantly impaired (1951,1968БабичБК; 1959ШумадаИВ; 1968ЯзыковДК_ВинцентиниКМ; 1973БачинскийЮС_КуновскийБН; 1976ЛатыповАЛ; 1978СвердловЮМ; 1993БуачидзеОШ).
According
to the primary source, a short time after the incident, Jacob retained the
ability to walk (Gen. 32:32). The head of the family moved independently and
also bowed "to the ground", doing so while walking, "until he
came near to his brother" (Gen. 33:3). Based on these facts, we believe
that flexor and extensor movements in the affected hip joint were virtually
painless. In essence, Jacob lacked Lasègue's sign – pain caused by tension on
compromised spinal nerve roots of the lumbar spine and the sciatic nerve.
Furthermore, the ability to bend forward indicates the absence of gross
pathology in the sacroiliac joints, lumbosacral articulation, joints and
intervertebral discs of the lumbar spine, pelvic ligaments, and contractures of
the muscles that strain the fascia lata (2008БакупК).
However,
the term "dislocated" mentioned in the text with respect to the hip
joint gives reason to think of pain during other movements, primarily
supinating (external rotation) and pronating (internal rotation). Pain during
walking at the moment of adduction – that is, bringing the thigh inward during
the stance phase and tilting the pelvis downward toward the non-weight-bearing
side – was also likely present. A pain syndrome in the hip joint associated
with abduction (moving the leg outward during the swing phase) is less
probable.
It
has been known since ancient times that rotational movements can be performed
in the hip joint. Homer noted them in the Iliad: "the steep thigh moves
within the hip in the socket so called" (1960Гомер). This passage was quoted by Galen of Pergamon
(2nd–3rd centuries AD), who noted that the thigh "rotates within the
pelvic bone" (1829KühnCG; 2019АрхиповСВ_ПролыгинаИВ). From our perspective, Jacob experienced pain
when reproducing rotation in the hip joint in the horizontal plane – specifically,
supination and pronation – as well as in the frontal plane, namely adduction.
This pain occurs when the distal part of the ligament of the head of femur
becomes trapped between the articular surface of the femoral head and the
lunate surface of the acetabulum. This can happen in cases of complete damage,
such as a tear along its length, detachment from the proximal attachment site,
or an avulsion fracture of the distal end. Impingement of the ligament of the
head of femur is also possible in cases of irreversible elongation, stretching
under load, following partial damage or dystrophic changes, as well as due to
connective tissue dysplasia, such as in Ehlers-Danlos syndrome (2020RosinskyPJ_DombBG,b).
Under these pathological variants of functioning, the periodically recurring
pain syndrome is associated with movement. During walking, "mechanical
symptoms" are observed, in particular "clicks" and "locking"
of the hip joint (2004ByrdJW_JonesKS). In the latter case, the joint suddenly
stalls – or as patients express it, "jams". Following this, the
person stops, experiencing sharp pain, "shakes" their leg, or
carefully rotates it in the hip joint. By doing so, they intuitively attempt to
"unlock" the joint and only then continue on their way.
An
important point in the narrative is the clarification regarding the description
of the pathological gait: the limping was "upon his hip" (Gen.
32:32). Apparently, this was caused by the presence of a damaged structure
within the hip joint and an accumulation of blood within it. The
intensification of pain could be caused by the episodic intrusion of a fragment
of the ruptured ligament of the head of femur into the joint space, accompanied
by a natural, fleeting stretching of the external ligaments. At the same time,
long-term joint locking did not occur, and the unpleasant sensations coincided
in time with bearing weight on the injured leg. To reduce the intensity of the
pain syndrome, real patients alter their gait and use additional supports:
canes, walking sticks, crutches, or surrounding objects. The staff that Jacob
possessed would have been able to significantly ease walking.
Our
hero needed to walk in order to humbly meet his brother and, if possible, look
up at him from below as he sat upon a camel. By doing this, he intuitively
wished to demonstrate remorse and a subordinate position, while also expressing
fear and a desire to receive forgiveness (Gen. 32:21). Walking ahead of the
caravan, Jacob made it clear that all responsibility for past transgressions
rested upon him and showed his readiness to accept punishment (Gen. 25:31,
27:45, 33:3). Thanks to this, the symptom of limping manifested in the text of
the Book of Genesis. Had Jacob traveled on horseback, we would not have found
an indication of the most crucial sign of lower limb girdle pathology – limping
(2007NofsingerCC_KellyBT). This sign was later included in the evaluation
Harris Hip Score, which became the basis for various modifications
(1969HarrisWH).
We
have briefly analyzed the symptom of limping mentioned in the text alongside
the qualification "upon his hip" (Gen. 32:32). This is the oldest
description of pain and hip joint locking during walking – that is, signs
characteristic of an injury to the ligament of the head of femur. Their
combination in pathology of the ligament of the head of femur was present in
ten out of twenty-three patients examined. The observational-anamnestic Byrd–Jones
symptom occurs in less than 43.5% of cases of ligament of the head of femur
injury (2004ByrdJW_JonesKS). Be that as it may, the Book of Genesis describes
this sign for the first time in history.
During
walking, all rotational movements are performed in the hip joint:
flexion-extension, pronation-supination, and abduction-adduction. There is an
exceptionally small amplitude of translational displacements along the axis of
the femoral neck (2018АрхиповСВ). During the leg swing phase, the femoral head moves outward, and
during the stance phase, inward. The limiters of lateral displacement are the
external ligaments, the joint capsule, and the acetabular labrum, which creates
a suction-seal effect.
After
the injury, Jacob performed seven bows to the ground while walking (Gen. 33:3).
The ability to perform multiple forward bends followed by straightening of the
body indicates the absence of pain during movements of the hip joints in the
sagittal plane. Moreover, flexion and extension are performed with a greater
amplitude than during walking, both in the injured and in the contralateral,
unaffected joint. This indirectly points to a negative "tension sign"
of the nerve roots originating from the lumbar spine and rules out pathology of
the sciatic nerve.
Translational
movements in the hip joint are small – 2 to 3 mm. Therefore, they can be
neglected at this stage of the discussion, merely assuming that they did not
cause pain. Rotation in the frontal plane – hip abduction and adduction – is
significant. Our experimental studies have shown that during abduction, the
distal end of the ligament of the head of femur moves from top to bottom
through the center of the acetabular fossa toward the acetabular notch (2018АрхиповСВ). During the leg swing phase in
walking, reverse movements occur. Accordingly, it should be confidently assumed
that during abduction, no contact was observed between the damaged ligament of
the head of femur and the inner edge of the lunate surface. Thus, in the
immediate aftermath of the injury, hip abduction was painless for Jacob.
During
maximum hip adduction or downward tilting of the pelvis in the frontal plane,
the distal part of the ligament of the head of femur can come into contact with
the inner edge of the lunate surface. According to our hypothesis, this is
precisely what caused the damage to the aforementioned anatomical structure in
Jacob's prototype (2019ArkhipovSV_SkvortsovDV). Minor compressions in duration
and magnitude, with a gradual increase in the length of the ligament of the
head of femur, lead to the appearance of rounded depressions on the edge of the
lunate surface. Thus, the musculoskeletal system adapts to the changing
dimensions of the intra-articular elements. In an acute case – such as a tear,
detachment, or partial rupture with elongation – the ligament of the head of
femur is capable of becoming impinged during hip adduction. In that case,
during the weight-bearing phase on the leg, a pain syndrome and joint
"locking" would appear, accompanied by a fleeting stretching of the
external ligaments due to the lateral displacement of the femoral head.
Patients who have had such an experience try to keep the pelvis horizontal
while walking or tilt their pelvis and trunk toward the weight-bearing leg
(2012,2023АрхиповСВ).
Therefore, we believe that hip adduction caused pain for Jacob. The victim did
not provoke unpleasant sensations in the hip joint and walked toward his
brother without rushing, keeping his pelvis horizontal. Among other things, at
a fast walking pace, it is impossible to perform multiple bows (Gen. 33:3).
Naturally, he had to make brief stops, bow, and then steadily resume walking so
as not to provoke coxalgia. Jacob had a shepherd's staff (Gen. 32:11). Such a
device makes it possible to reduce the load on the injured joint during walking
and bowing, and consequently, to reduce the unpleasant sensations within it.
Despite
the emotional moments before the meeting, apparently due to pain, Jacob did not
run as Esau did (Gen. 33:4). The explanation: running increases the pain
syndrome. To prevent it, it is wise to move slowly.
When
walking normally, a person's pelvis performs sinusoidal movements, moving
forward in a "tacking" motion. At the moment the leg is swung forward
at the beginning of a step, the thigh rotates outward in the hip joint. Due to
the subsequent forward and outward rotation of the pelvis relative to the
weight-bearing leg, the head of the corresponding femur turns inward within the
joint. Our experiments on mechanical models demonstrated that forward rotation
of the pelvis during the stance phase can occur due to the tension of the
ligament of the head of femur (the autorotation effect). Moreover, the
rotational movement of the pelvis in the horizontal plane is involuntary and
occurs automatically during walking (2018АрхиповСВ). In two normal hip joints, pronation and a
force rotating the pelvis inward occur alternately. Accordingly, during
walking, supination alternates with pronation in the hip joints. A person
practically does not control these movements, but is able to partially slow
them down or accelerate them voluntarily via the supinator and pronator
muscles.
If
the ligament of the head of femur is damaged in one of the hip joints,
automatic inward rotation does not occur. With the appearance of inertial
forward rotation of the pelvis, contact may occur between the injured ligament
of the head of femur and the anterior or posterior part of the lunate surface
of the acetabulum. This explains the onset of pain in the affected joint, even
in the absence of hip adduction and downward pelvic tilt. To reduce its
intensity, patients alter their gait, disrupting the rhythm and symmetry of
movements, and shorten the stance phase on the affected leg. Visually, this
manifests as a limp, which was demonstrated in the primary source (Gen. 32:32).
An additional mechanism allowing pain to be avoided is the patient's desire to
reduce the pace and speed of walking. We see a description of this in Jacob's
words: "I will lead on slowly, at the pace of the livestock... until I
come" (Gen. 33:14). That is, he planned to walk not at the normal speed of
approximately 5 km/h, but twice as slowly. Large cattle prefer to cover 2 to
3.5 km per hour, and only reach a speed of 5 km/h while grazing (2014БаскинЛМ_ЧикуроваЕА). Therefore, we conclude that pain was present
in the prototype of the Old World victim. It caused a change in the gait
stereotype according to the pathological mechanism outlined above.
As
is evident from the Book of Genesis, Jacob suffered an injury to the ligament
of the head of femur. Detecting its injury remains difficult to this day, even
with the application of modern diagnostic tools such as magnetic resonance
imaging and computed tomography. Its pathology can be reliably judged only on
the basis of arthroscopic diagnostic data or arthrotomy. Our clinical
experience demonstrates that an isolated injury to the ligament of the head of
femur is initially "missed" even by specialists in musculoskeletal
trauma. Furthermore, patients rarely seek immediate medical care in such cases.
Perceiving the injury as an insignificant "sprain", they often engage
in self-treatment. If they do not receive medical assistance, they may refrain
from consultations altogether for a long time. Later, osteoarthritis of the hip
joint develops, whereupon the clinical picture worsens and becomes
"clear" to the diagnostician.
Initially,
Jacob attached no proper significance to his injury. Hip dislocation did not
occur. The trauma affected only the ligament of the head of femur (Gen. 32:33).
Overall, this is a minor injury, considering the small dimensions of the
anatomical structure. According to literature sources, its average length is
2–2.5 cm. Persistent pain, restricted mobility, contractures, and leg
shortening develop after a considerable period of time (2012,2023АрхиповСВ). Real patients begin to lead
nearly their former lifestyle a day or two after the incident. Sometimes they
experience no pain at all and note no pronounced restriction of movement in the
joint. Progressing gradually, complications lead to severe functional
impairment.
In
the Book of Genesis, it is stated that Jacob traveled on foot hours after the
injury (Gen. 32:32). The condition of his musculoskeletal system allowed him to
walk and bow (Gen. 33:3). Given the minor nature of the pain syndrome, the
patriarch planned to continue his journey, albeit "slowly" (Gen.
33:14). On the day of the injury, he moved from the meeting site with his
brother to a new campsite, "built himself a house" and "made
booths" (Gen. 33:17). Based on the facts presented by the authors, it is
clear that a small anatomical element was damaged. No significant impairment of
daily activity was observed on the day of the injury.
[iii]
During
the first day after the injury, Jacob led his usual lifestyle, pasturing and
caring for animals. The patriarch owned herds of goats, sheep, camels, cows,
and donkeys (Gen. 32:15–16). The large and small cattle in his household were
dairy livestock (Gen. 32:16, 33:13). This implied the need for regular milking
and milk processing. In order to protect the animals from inclement weather,
especially the young and weak, Jacob and his workers constructed
"booths" (Gen. 33:17). For nighttime, it was necessary to erect
enclosures and guard the herds against predators. In addition, the head of the
family built dwellings, at least for his immediate relatives: his wives and
children (Gen. 33:17). Such activity presumes substantial physical exertion.
Consequently, the injury sustained earlier did not significantly restrict the
victim in the immediate term.
In
the year following the injury, Jacob's caravan crossed the Jordan River
(1913CharlesRH). His health permitted him to ford the river and reach Shechem
(Gen. 33:18). The crossing took place presumably near the modern Jordanian city
of Damia. From this oldest ford on the Jordan to present-day Nablus (Shechem),
the distance is approximately 45 km when following the valleys. Here Jacob
bought land, pitched tents, and erected an altar (Gen. 33:19–20). Formerly,
field sanctuaries were built of whole, unhewn stones (Ex. 20:25; Deut. 27:5–6).
This means that for at least another year, Jacob felt satisfactory.
Later,
our hero made a journey to Luz (Bethel), where he built an altar (Gen. 35:5–6).
There Jacob also set up a "pillar of stone" (Gen. 35:14). Then his
caravan moved to Migdal Eder, passing Ephrath, and reached Hebron (Gen. 35:16,
19, 22, 27). After this, Jacob settled "in the land of his father's
sojourning, in the land of Canaan" (Gen. 37:1). He traveled extensively, according
to our calculations, until approximately 1633–1632 BCE, when he reached 44–45
years of age. By this time, his children had grown up and worked for the
benefit of the family: pasturing livestock and harvesting wheat (Gen. 37:2, 7,
12). Consequently, from the moment of the injury in 1640 BCE, for 7 to 8 years,
Jacob led an active lifestyle, migrating and pasturing livestock.
As
the authors inform us, the patriarch made the journey to Egypt in a wagon (Gen.
45:19, 27, 46:5). Apparently, by this time – namely by 1607 BCE – walking
function had deteriorated. This restriction developed approximately 33 years
after the hip joint injury was sustained.
Cases
of long-term (2 to 12 years) discomfort, pain, and aching in the hip joint,
accompanied by periodic clicking in patients with dystrophic pathology of the
ligament of the head of femur, are well known (1997GrayAJR_VillarR).
Furthermore, it is noted in literature that patients with congenital or
iatrogenic absence of the ligament of the head of femur, as well as those with
its injury, can be asymptomatic (2014deSaD_AyeniOR; 2016MayesS_CookJ). From the
context, it is clear that they nonetheless end up consulting orthopedic
surgeons. Patients who have suffered a complete rupture of the ligament of the
head of femur are described as non-weight-bearing incapable: the affected joint
is unstable, has a restricted range of motion, and exhibits mechanical symptoms
(2012PhillipsAR_FernD).
Dislocation
in the hip joint and isolated damage to the ligament of the head of femur can
cause instability and subsequent osteoarthritis (2005VillarR_SantoriN).
Patients with this disease and degenerative changes in the ligament of the head
of femur experience prolonged pain in the buttocks, thighs, or groin, which
intensifies during walking, and exhibit restriction of hip abduction and
rotation (2009SampatchalitS_ResnickD). A number of patients complain of an
impaired ability to stand or move and are forced to use auxiliary support
(2012,2023АрхиповСВ).
The listed symptoms of developing hip osteoarthritis could have been observed by the ancient Egyptian physician who consulted Jacob's prototype. According to the text of the Book of Genesis, his literary counterpart walked independently long after the old injury (Gen. 47:7, 10). Apparently, the patriarch used a staff (Gen. 32:11). Such a device significantly facilitates locomotion. By observing which hand the patient uses to hold the support, a medical specialist can determine the side of the pathological process (1994БеленькийВЕ_КуропаткинГВ; 2005Архипов-БалтийскийСВ). Knowing this pattern, the physician examining Jacob would have been able to identify from a distance which specific joint was affected in the victim. Experienced patients hold the cane in the hand opposite to the diseased hip joint. The diagnostician obtained additional information by observing walking without auxiliary support, during which the trunk excessively sways toward the affected hip joint.
[iv]
In
the long-term period following an injury to the ligament of the head of femur,
Jacob's prototype exhibited manifestations of hip osteoarthritis, termed
coxarthrosis for brevity. This degenerative-dystrophic disease invariably
develops following an injury to the ligament of the head of femur, sometimes
passing through an intermediate stage: chondrolysis, aseptic (avascular)
necrosis, or osteochondropathy. The interrelationship of these nosological
forms was noted as early as the beginning of the last century (1936ДитерихсММ). In the first scientific paper
dedicated to isolated injuries of the ligament of the head of femur, it was
shown that such injury is typically associated with osteoarthritis or another
dystrophic pathology of the hip joint (1997GrayA_VillarRN).
Coxarthrosis
is characterized by impaired symmetry in maintaining a single-leg orthostatic
posture, reduced stability, tremor (involuntary muscle contractions) of the
supporting lower limb, and a preferential weight-bearing reliance on the healthy
leg (1994СмирновГВ;
1997КорниловНВ_ЭпштейнГГ). Various gait disturbances are
noted with this disease: limping, Duchenne's sign, and an increase in the
duration of the double-support phase of the step (1983ЭпштейнГГ_НекакловаАЗ; 1995НегрееваМБ; 1997КорниловНВ_ЭпштейнГГ; 2003ВолокитинаЕА; 2009ВолошинВП; 2010ДранусоваНС). The range of motion in the hip joint and
adjacent mobile articulations decreases. Contractures develop in them, lumbar
hyperlordosis forms, along with a fixed pelvic tilt. It has been observed that
during coxarthrosis, an additional number of muscles are recruited in the
execution of certain gait phases, accompanied by an increase in their
electrical activity (1997КорниловНВ_ЭпштейнГГ).
Normally, gait is characterized by exceptionally precise repeatability of its
individual components (2003ДубровскийВИ_ФедороваВН; 2007СкворцовДВ).
In
cases of long-standing coxarthrosis, dystrophic changes are observed in the
osteochondral structures and ligaments, including the ligament of the head of
femur (1936ДитерихсММ;
2009БарбакадзеЛА). A
characteristic finding in this disease is the absence of the ligament of the
head of femur, and its degenerative alteration is considered a symptom of hip
osteoarthritis (1959МихельманМД, 1997GrayAJR_VillarR). Various forms of pathology of the ligament of
the head of femur in coxarthrosis are detected at all stages (1990КоржАА_ТаньнутВА; 2009SampatchalitS_ResnickD; 2012BombelliR).
Cases showing the formation of femoral head subluxation during ossification of
the ligament of the head of femur have been identified, which may represent one
of the mechanisms of coxopathy development (1993InoueK_NishiokaJ). Femoral
subluxation is generally accompanied by thinning of the articular cartilage and
is a characteristic change in coxarthrosis (2010Leydet-QuiliciH_LafforgueP). In
elderly and senile individuals exhibiting signs of involutive coxarthrosis, the
ligament of the head of femur is dystrophically altered and possesses reduced
strength (1972ПодрушнякЕП).
The
introduction of hip arthroscopy allowed for more frequent identification of
pathology of the ligament of the head of femur, including during coxarthrosis
(1995HempflingH; 2004ByrdJW_JonesKS; 2006ByrdJW; 2008RühmannO;
2008TiborLM_SekiyaJK; 2008WengerDR_MiyanjiF; 2009BharamS; 2009RoyDR;
2010NordRM_MeislinRJ; 2011SimpsonJM_VillarRN). Arthroscopically, it has been
established that in the early stages of this pathology, the ligament of the
head of femur is either damaged or dystrophically altered, and occasionally
absent (1998ByrdJW; 2001МалаховаСО; 2004ОрлецкийАК_ОгаревЕВ; 2006RühmannO_BohnsackM).
Animal
studies have demonstrated that even at the asymptomatic stage of hip
osteoarthritis, changes are noted in the ligament of the head of femur (2003MandeJD_GathumbiPK).
It has been observed that removal of a dystrophically degenerated ligament of
the head of femur leads to disease progression within two years
(1997GrayAJR_VillarR). Along with changes in the ligament of the head of femur
during coxarthrosis, the acetabular fossa – the area in which the ligament
moves during articulations – is transformed (2004Архипов-БалтийскийСВ,a; 2008ArkhipovSV;
2009SampatchalitS_ResnickD). Currently, the ligament of the head of femur is
identified as a potential source of pain and "mechanical" symptoms in
the hip joint region: clicking, locking, impingement, and giving way
(2008TiborLM_SekiyaJK; 2009BardakosNV_VillarRN).
In
pathological conditions leading to coxarthrosis, changes are always present in
the ligament of the head of femur. In particular, in congenital hip
dislocation, sclerosis, elongation, thinning, hypertrophy, damage, and absence
of the ligament of the head of femur were identified (1949ЗацепинТС; 1985ИваницкийМФ; 2002ГрибоваИВ; 2002КралинаСЭ). Dystrophic changes in it are
noted in tuberculous coxitis (1995АриэльБИ_ШациллоОИ). The ligament of the head of femur is damaged
in traumatic hip dislocation, fractures of the acetabulum and femoral head,
femoral neck fractures, slipped capital femoral epiphysis, contusion, and
forced rotation in the hip joint (1980ТалькоИИ_ЯковлевИС; 1998ByrdJW; 2001МалаховаСО; 2002БуачидзеОШ_ЗубиковВС; 2004ОрлецкийАК_ОгаревЕВ; 2006RühmannO_BohnsackM). Elongation,
thinning, and trauma to the ligament of the head of femur have been recorded in
hip dysplasia, paralytic hip dislocation, and pathological hip dislocation
(1949ЗацепинТС; 1956ЗацепинТС). Rupture of the ligament of the
head of femur can be of traumatic origin, for instance in hip dislocation, as
written as early as the 3rd–2nd centuries BCE by Heraclides of Tarentum
(1829KühnCG; 2020ArkhipovSV_ProlyginaIV). Complete damage occurs in aseptic
necrosis of the femoral head, Legg–Calvé–Perthes disease (osteochondropathy of
the femoral head), multiple epiphyseal dysplasia, and arthrogryposis (2001МалаховаСО; 2004ОрлецкийАК_ОгаревЕВ; 2005WettsteinM_MouhsineE;
2008YamamotoY_UsuiI). F.P. Markizov considered damage to the vessels of the
ligament of the head of femur to be a cause of aseptic necrosis of the femoral
head (1939МаркизовФП).
An injury of this nature is improbable without a violation of its own
integrity. In animal modeling of coxarthrosis, transecting the ligament of the
head of femur resulted in the recording of dystrophic changes in the hip joint
characteristic of this disease, as well as femoral head hypertrophy
(1985AndohK).
Distortion
of hip joint biomechanics in coxarthrosis is an undeniable fact. In connection
with this, individual methodologies for evaluating its function include
biomechanical indicators: the WOMAC index, the Lequesne algofunctional index,
M. D'Aubigné criteria (1954), and the W.H. Harris scale (1969HarrisWH; 2009БлюмЮЕ; 2009НегодаеваЕВ; 2009ПухтинскаяПС; 2011ХудайбергеновМА). Despite the continuous
improvement of diagnostic techniques, there remains a need to clarify the scope
and informative value of examinations required for diagnosing pathology of the
ligament of the head of femur, as well as its markers as initial signs of
dystrophic processes in the hip joint. To record such pathological changes, we
developed a special Screening Diagnostic Chart for Hip Joint Pathology (2012,2023АрхиповСВ).
Our experimental and clinical studies show that pathology of the ligament of the head of femur in the form of damage or functional impairment (dysfunction) is a leading cause of subsequent dystrophic changes in the hip joint. Therefore, when considering the biomechanics of the hip joint and the clinical picture of coxarthrosis, the condition of the ligament of the head of femur must be taken into account. We compared the clinical symptoms of coxarthrosis and hip joint biomechanical impairments with the fact of pathology of the ligament of the head of femur and noted a direct relationship between them. It was revealed that damage to this structure is a crucial link in the pathogenesis of a group of degenerative-dystrophic diseases of the hip joint across various ages, as well as its congenital conditions: osteoarthritis, cystoid remodeling, aseptic (avascular) necrosis of the femoral head, hip dysplasia, congenital dislocation and subluxation of the hip, and osteochondropathy of the femoral head known as Legg–Calvé–Perthes disease (2004Архипов-БалтийскийСВ,a; 2018АрхиповСВ). Deformity of the acetabulum and the proximal femur – such as coxa vara, coxa valga, coxa magna, as well as anteversion and retroversion of the proximal segment – is frequently associated with pathological changes in the ligament of the head of femur.
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. Chapter 21. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-21.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
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