404 SURGICAL APPLIED ANATOMY. [Chap. xix. 



by branches of the same nerves. In the hip, branches 

 from the (1) anterior crural enter at the front of the 

 capsule ; (2) branches from the obturator at the lower 

 and inner part of the capsule; and (3) branches from 

 the sacral plexus and sciatic nerve at the posterior 

 part of the joint. In the knee, branches from the 

 (1) anterior crural (nerves to vasti) enter at the front 

 of the capsule ; (2) branches from the obturator at 

 the posterior part of the capsule ; and (3) branches 

 from the internal and external popliteal divisions of 

 the great sciatic nerve at the lateral and hinder 

 aspects of the joint. 



Pain, therefore, in the front of the knee, on one 

 or both sides of the patella, has probably been re- 

 ferred along the anterior crural nerve, and pain at 

 the back of the joint along the obturator or sciatic 

 nerves. 



In hysterical individuals joint disease may be 

 imitated by certain local nervous phenomena, the 

 articulation itself being quite free from structural 

 change. This affection most commonly shows itself 

 in the hip or knee, and the " hysterical hip," or 

 "hysterical knee," takes a prominent place in the 

 symptomatology of hysteria. It is not quite easy to 

 understand why these two large joints should be so 

 frequently selected for the mimicry of disease. Hilton 

 has endeavoured to explain the fact upon anatomical 

 grounds, having reference to the nerve supply of these 

 joints in relation to the nerve supply of the uterus. 

 The uterus is mainly supplied by an offshoot from the 

 hypogastric plexus, and by the third and fourth sacral 

 nerves. Now, the hypogastric plexus contains fila- 

 ments derived from the lower lumbar nerves ; and from 

 the same trunks two nerves to the hip and knee 

 (the anterior crural and obturator) are in great part 

 derived. The great sciatic also contains a large 

 portion of the third sacral nerve. This common 



