442 SURGICAL APPLIED ANATOMY. [Chsp. xix. 



the ligamentum teres during flexion. Rotation inwards 

 is limited during extension by the ilio-femoral ligament, 

 and during flexion by the ischio-femoral ligament and 

 inner part of the capsule. 



Hip joint disease. Owing to its deep position 

 and its thick covering of soft parts, this articulation is 

 able to escape, to a great extent, those severer injuries 

 that are capable of producing acute inflammation in 

 other joints. Acute synovitis is indeed quite rare in the 

 hip, and the ordinary disease of the part is of a dis- 

 tinctly chronic character. It follows also, from the 

 deep position of the articulation, that pus, when it is 

 formed in connection with disease, remains pent up, 

 and is long before it reaches the surface. Suppuration 

 In this region, therefore, is often very destructive. 

 When effusion takes place into the joint, the swelling 

 incident thereto will first show itself in those parts 

 where the hip capsule is the most thin. The thinnest 

 parts of the capsule are in front and behind ; in front, 

 in the triangular interval between the inner edge of 

 the Y ligament and the pectineo-femoral ligament, 

 and behind, at the posterior and lower part of the 

 capsule. It is over these two districts that the 

 swelling first declaims itself in cases of effusion into 

 the joint, and as these parts are readily accessible to 

 pressure, it follows that they correspond also to the 

 regions where tenderness is most marked and is 

 earliest detected. 



In chronic hip disease, certain false positions are 

 assumed by the affected limb, the meaning of which 

 it is important to appreciate. These positions may 

 be arranged as follows, according, as nearly as possible, 

 to their order of appearing. 



(1) The thigh is flexed, abducted, and a little 

 everted ; and associated with this there is (2) apparent 

 lengthening of the limb and (3) lordosis of the 

 spine ; (4^ the thigh is adducted and inverted, and 



