Internal derangements of the knee-joint : thesis submitted for graduation as M.D. of Edinburgh University, April 1886 / by W. Scott Lang.

  • Lang, Walter Scott.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Internal derangements of the knee-joint : thesis submitted for graduation as M.D. of Edinburgh University, April 1886 / by W. Scott Lang. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    applied, will not be often obtainable. It may occur from pro- longed kneeling and suddenly attempting to straighten the limb, or it may occur by striking the foot against a stone when the toe is turned outwards. The limb must always be more or less flexed. It cannot possibly occur when the limb is extended and rigid. Symptoms.—Tlie knee is kept in a semi-flexed position, and there is inability to completely extend it. There will probably be pain on pressure over the superior margin of the inner tuberosity of tlie tibia, especially if improper attempts have been made to extend the limb forcibly. On attempting to extend the limb, an irregular prominence will be felt to appear between the internal condyle and the head of the tibia, about inch internal to the inner border of the ligamentum patellae. Attempts to extend the limb cause severe pain at this spot, and a painful sensation as if something were being jamtned between the opposing bony surfaces. It feels as if a sort of wedge were being put under the internal condyle as it attempts to roll forward on the tibia in extension. Flexion is not interfered with. The rounded margin of the semi- lunar cartilage can be felt to project unduly on the inner aspect of the joint. (Even in a perfectly sound knee, the rounded margin of the internal semilunar cartilage can be felt on the head of the tibia, and it can be distinctly felt to recede when the knee is flexed, and to come forward on extension on the antero-internal aspect of the joint.) Although the authors already quoted make no attempt to dif- ferentiate these internal derangements of the knee-joint, they had evidently met with cases similar to the one above described, for Hey writes, op. cit., p. 332 et seq.,—“ The patient himself cannot freely bend, nor perfectly extend the limb in walking.” And Smith, in Lancet, 20th September 1851, writes still more pointedly,—“ In consequence of some slight fall, slip, or sprain, the mechanism of the knee-joint becomes so far deranged that the fidl extension of the limb is rendered impossible.” Sir A. Cooper also writes {Surgical Dictionary),—“ The patient becomes incapable of perfectly extending the leg. There may be no pain at the instant the accident occurs, so long as no attempt is made at complete extension.” Hey refers to luxations of both the internal and external cartilages, and had met with cases of each variety; but the two latter quotations evidently point to a luxation of the anterior part of the internal semilunar cartilage. In Lancet, 1855, vol i. p. 448, Mr Syme describes a case, and confirms Hey’s observation, but he does not say whether the internal or external cartilage was the one affected. Again, in Lancet, 1856, vol. i. p. 11, Mr W. T. White describes a case which was evidently a subluxation of the internal semilunar cartilage, for it corresponds closely with the description of a typical case already given both as to causation and symptoms. It is unnecessary, therefore, to multiply clinical cases which all B