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Rigidity or Stiffness of Joints

joint, muscles, anchylosis, position, leg, bony, disease and set

RIGIDITY OR STIFFNESS OF JOINTS.

It has been pointed out that a joint usually acts as the fulcrum or fixed point from which the bony lever operates when moved by cular contraction. If, therefore, from any cause the joint has become so stiff as to be immovable, the function of the parts is destroyed. Now, the stiffness may either be due to disease of the joint itself, or it may be caused by fixture of the joint by contracted muscles or tendons in its neighbourhood.

Anchylosis (from Greek ankulos, crooked) is the term applied to rigidity that has resulted usually from inflammatory disease of the joint. It may occur, without inflammation, in a joint which has been kept in one position for a long time, and in old age it occurs as a natural pro cess in certain of the smaller joints. Anchy losis has been divided into true or false, or complete and incomplete. True anchylosis, or stiffness or immobility of the joint, is said to exist when the gristle of the joint is destroyed and the heads of the bones are connected or consolidated together by osseous or bony matter (p. 74). False anchylosis is where the process falls short of ossification, the stiffness and im mobility depending not on bony union of the connecting surfaces, but either upon adhesions of the synovial membrane or upon a thickening of the parts about the joint.

When the gristle of a joint has been de stroyed by ulceration, and the surfaces of bone exposed, anchylosis, or a bony union, is the most favourable termination that can take place. In such a case care shouk be taken that the joint becomes fixed in the position in which it will be most useful to the patient. Thus, if it be the hip or knee, the straight position will be best; ii the elbow, it should be placed at a right angle. Again, in scrofulous ulceration of the spine, anchylosis is a most favourable result, because as soon as the bony union is formed the morbid or diseased process is ended, and it is the completion of the cure. Thus in hip-joint disease, white swelling, and scrofulous (tubercular) diseases of the spine, anchylosis is often to be regarded as a favour able issue.

Anchylosis, however, in fractures near the joints, should always be prevented if possible; and for this purpose, gentle motion of the joint ought to be bad recourse to before it is too late, as directed in the section on Fractures.

In cases of incomplete anchylosis, where the stiffness only arises from thickening of the parts, much relief may be derived from the use of steam, by placing the stiff joint over the steam of boiling water, at such a distance as to prevent scalding, then drying the part, and rubbing it with neat's-foot or cod-liver oil, or the compound soap liniment, or goose fat. By

perseverance in this plan of treatment com plete restoration of function may be obtained. Cold applications, such as holding the part below a rush of water, or pouring water from a tea-kettle, have likewise been employed; and when the patient has arrived at middle life, this may be used twice a day, and the part dried, and some of the above liniments rubbed on. The flow of cold water should, however, Halm used longer than three or four minutes, as no good will be effected unless a glow of heat is felt in the part after it has been dried.

Surgeons now practise an operation for break ing up the adhesions in cases of false anchylosis, and so restoring the natural movements of the joint.

Contracted Muscles or Tendons may ren der a joint immovable. Sometimes the con traction of a muscle is spasmodic, as in spas modic wry-neck, discussed in the last section. In other cases the contraction of one set of muscles is due to paralusis of the opposing set.

Thus suppose, as in some cases in children due to a nervous affection, that the muscles in front that straighten the leg on the knee have be come paralysed, the flexor or hamstring muscles behind will have it all their own way, and will keep the knee bent, so that the child cannot of its own will extend the leg. Early in the disease, however, a person taking the child's leg in his hand will be able easily to straighten it; but, as soon as he lets it go, it will spring back to its bent position. When the disease has become confirmed the flexor muscles tend to become permanently rigid in their shortened condition, the child never being able to put them on the stretch by straightening the leg. So that, after a time, neither the child nor another person can extend the leg, which re mains fixed in its distorted position.

Such deformities of limbs are of not infre quent occurrence in children, and many, if not the most of them, are easily rectified if early attended to. It is difficult sometimes to say whether the deformity is due simply to spasm of one muscle or set of muscles, or to paralysis of one set, and consequent shortening of the j opposing muscles. The advice of a skilled surgeon should, therefore, be sought to deter mine this as well as the treatment; for in some cases cutting of the rigid muscles will be neces sary, while in others the remedy is to be sought for rather in restoring power to the paralysed muscles.