Sources of Joint Strength
—The capacity of a joint to resist dislocation depends upon (1) the shape of its osseous elements; (2) the strength and arrangement of its ligaments; (3) the support it receives from muscles or tendons placed in relation to it; and (4) the relative stability of adjacent structures. While all these factors contribute to the strength of a given joint, one or other of them usually predominates, so that certain joints are osseously strong, others are ligamentously strong, while a few depend chiefly upon adjacent muscles for their stability.
The hip and elbows are the best examples of joints deriving their strength mainly from the architectural arrangement of the constituent bones. These joints are dislocated only by extreme degrees of violence, and not infrequently—especially in the elbow—portions of the bones are fractured before the articular surfaces are separated.
The knee, the wrist, the carpal, the tarsal, and the clavicular joints depend for their stability almost entirely on the strength of their ligaments. These joints are rarely dislocated, but as the main incidence of the violence falls on the ligaments they are frequently sprained.
The shoulder is the typical example of a joint depending for its security chiefly upon the muscles and tendons passing over it, and hence the frequency with which it is dislocated when the muscles are taken unawares. At the same time the great mobility of the scapula and clavicle materially increases the stability of the shoulder-joint. The tendons passing in relation to the knee, ankle, and wrist add to the stability of these joints.
The proximity of an easily fractured bone also contributes to prevent dislocation of certain joints—for example, fracture of the clavicle prevents an impinging force expending itself on the shoulder-joint; and the frequency of Colles’ fracture of the radius, and of Pott’s fracture of the fibula, doubtless accounts to some extent for the rarity of dislocation of the wrist and ankle-joints respectively. The immunity from dislocation which the joints of young subjects enjoy is partly due to the ease with which an adjacent epiphysis is separated.
The mechanical axiom that “what is gained in movement is lost in stability” applies to joints, those which have the widest range of movement being the most frequently dislocated.
The injuries to which a joint is liable are Contusions, Wounds, Sprains, and Dislocations.
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