The Practice and Applied Therapeutics of Osteopathy Charles Hazzard, D. O. 1905      CHAPTER XXIII   DISLOCATIONS, DEFORMITIES, JOINT AFFECTIONS, ETC.  
 
    This class of troubles furnishes the Osteopath with very numerous cases.  The marked success of osteopathy in curing spinal curvature; setting old dislocations; overcoming chronic pain, stiffness, etc., in joints; overcoming the various effects of injuries to any part of the body; curing synovitis, ankylosis, etc., makes this line of practice a very satisfactory one.
    The curing of spinal curvature without the use of braces or mechanical appliances; the removal of plaster casts, jackets, .splints, bandages, and all things of that kind, causing the natural resources of the parts to be depended on, is a novel and successful feature of Osteopathy.
    The setting of old dislocations is not much attempted by other lines of practice.  Great success is met in this line. It is evident by a glance at the case reports that egregious blunders are repeatedly made by the most skilled physicians in many cases of this and similar sorts.  "Tubercular joints," "ruptured ligaments," "fractured bones," and various other serious conditions are often found by the Osteopath to be partial or complete dislocations, slips, strains, etc., which are curable.
    CASES: A few typical cases of deformity, etc., in each of the various parts of the body subject to these conditions are here presented.  Great numbers of these cases are upon record, but it will be sufficient to confine this list to a few examples.
    (1) A pronounced double lateral curvature, in a young lady, involving the whole dorsal region, with single vertebral lesions at 10th and 11th dorsal, and 4th and 5th lumbar.  The spine was very sensitive, but this condition was overcome by three or four treatments.  After twelve treatments the patient, considerably benefited, went away upon a visit, remaining several months.  Upon her return it has found that the curvature and spinal condition were materially improved.  Seven more treatments cured the condition entirely.
    (2) Double lateral curvature of girl of twelve.  The curvature was to dorsal; to the left from the 9th dorsal was cured by four months treatment.
    (3) A posterior curvature in the dorsal region, in a young boy, general health was poor.  After two weeks treatment the spinal brace was removed, and after two months treatment the curvature had entirely disappeared.
    (4) Pott's disease of eighteen years standing, in a young lady of twenty-eight.  It came on gradually after a fall at the age of eight, having developed to completeness in two years.
    Casts were worn for two and a half years, during which time two abscesses discharged, one just below the anterior superior spine on the left, the other in the right limb just below the groin. For years the abscesses would alternately heal and break.  The posterior angular projection involved the vertebral from the 4th dorsal to the sacrum, the apex being at the 10th dorsal.  She came under treatment at the age of twenty-eight.  Both abscesses were discharging freely; after three months treatment a third abscess appeared, and the patient appeared to grow worse.  After this she began to improve and the curvature began to yield.  Two abscesses healed.  Gradually the curvature, was reduced until scarcely noticeable, and the 3rd abscess was nearly healed.  The general health was perfect.  The patient's height had been increased two and a half inches.
    (5) A thyroid dislocation of the hip set in one treatment.
    (6) A dislocation of the hip of three years standing; the patient had been upon crutches ever since the accident producing the injury.  The hip was set in three treatments, and the patient had no use for crutches thereafter.
    (7) A dislocation of the hip of four years standing in a case which had been thrown from a buggy.
The femur had been fractured at the same time.  The hip was set in three months treatment.
    (8) Tuberculosis of the hip and spine, so-called, in a girl of sixteen, of four years standing.  The best physicians had pronounced it tuberculosis of the hip.  The hip was found to be slightly dislocated downward and forward, and there was vertebral lesion of the 3rd and 4th lumbar.  The hip was set and the case entirely cured in four months.
    (9) A case diagnosed by the physician as hip joint disease.  The patient had been confined to his cot for ten months.  A partial dislocation of the hip was found and set in three months treatment, curing the case.
    (10) Partial dislocation of hip and knee joints.  The patient had worn a laced leather stocking from the ankle halfway to the thigh for eleven months.  He walked with a crutch.  The case had been diagnosed as "rupture of the internal lateral ligament of the knee" by two prominent Chicago physicians.  The dislocations were set in nine treatments.
    (11) A case which had been diagnosed as a "complicated fracture of the neck of the femur," of five years standing.  Specialists had confirmed this diagnosis.  The injured limb was three inches shorter than the other.  Osteopathically the case was diagnosed as a dislocation and was cured.
    (12) Tuberculosis of the knee, so-called, in a boy.  The joint was put in a cast.  There was constant pain in it.  A slip of the hip joint was found, and its adjustment cured the case.
    (13) Torticollis due to contraction of the sterno-mastoid muscles.  By four treatments the muscle was relaxed, and the condition was cured.
    (14) Torticollis of many years standing, caused by injury to the neck.  The muscles were extremely rigid, and the cervical vertebra were badly curved and twisted.  There was constant pain in head, neck, and eyes.  The case was greatly relieved permanently by the treatment.
    (15) Injury of the knee and shoulder joints in a bicycle accident.  The knee condition had been diagnosed as rupture of the ligaments.  By three weeks treatments the shoulder and knee were entirely cured.
    (16) Tubercular knee in a boy six years old.  The knee was swollen, and the temperature was 103 F.  The case was much benefited by three weeks treatment, and was well on the way to recovery.  The 10th and 11th dorsal, 1st, 2nd, 3rd, and 4th lumbar vertebrae were posterior.
    (17) A long standing pain in the shoulder, which had been examined and treated by eminent physicians both in Europe and America without relief.  Lesion was found in crowding together of the 2nd and 3rd dorsal vertebrae.  After one treatment the patient suffered no further pain.
    (18) Partial dislocation of the head of the humerus, of some months standing, causing a painful condition which had been treated as rheumatism.  The case was cured by setting the bone.
    (19) Fibrous ankylosis of the elbow-joint due to being kept in splints too long after fracture of the humerus.  The condition was of eight weeks standing.  By the treatment, use of joint was gradually perfectly restored.
    (20) Broken down arches of the feet in a man of twenty-eight, due to rheumatism which had settled in the ankles.  The astragalus was markedly dislocated to the inner side.  For two years the patient had worn braces to support the arch of the instep.  By the treatment the bones were replaced and the arches were rebuilt into their natural condition.  The case was cured in six weeks.
 

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TREATMENT OF DISLOCATIONS, DEFORMITIES, AND JOINT AFFECTIONS

    While the treatment of each of these conditions will be discussed separately, some general remarks apply to them collectively.  The mark success of Osteopathy in cases of this kind is largely due, at bottom to an intimate knowledge of nerve and blood supply of the affected part, patience and skill in manipulation, and the ability to relax, strengthen, or build up tissues, open a joint and direct the circulation to it, and in all respects to thoroughly prepare parts concerned to be returned to the normal state.  In the recent case this preparatory treatment does not take long.  In the chronic one, which represents a considerable majority of this class, this preparation may necessarily extend over many months.  It is here that patience and skill play an important part.  Often the preliminary work done in getting all parts ready to be restored to normal is the most important and most distinctively osteopathic part of the process.  When parts are once prepared, as for example in the setting of a hip, the final maneuver used to replace the bone in position is practically the same as a surgeon would use for the purpose.
    These remarks apply with almost equal force to both dislocations and deformities.  Yet in the latter case the correction of position of bony parts is continually going on, pari passu with the process of the treatment.  In case of joint affections this process of treatment constitutes the whole course of procedure, yet it not infrequently occurs that the replacing of a slipped bony part is a portion or the whole of the treatment of a joint affection.
    TREATMENT OF SPINAL CURVATURES AND OF POTT’S DISEASE: The treatment of the various forms of spinal curvature and of Pott's disease are upon much the same lines.  In all the preliminary work as described is of the utmost importance.  It constitutes much of the course of treatment, but bony parts are drawn and pressed back into place all the while.
    Spinal curvatures are rarely painful, but when they are the first step in the treatment is to carefully relax all spinal tissues, deep and superficial; to increase or correct circulation in them; and in these ways to gradually work out the soreness and to strengthen them.
    In any case of curvature this sort of treatment constitutes the first step in the procedure.  To this end one may use any or all of the treatments described under I, II, II, IV, and V, in Chap. II.  In this way the spine is gradually strengthened throughout; the muscles and ligaments are given greater strength to hold the ground gradually gained, now and later, in the form of the slow restoration of bony parts toward the normal position.
    Likewise, during this process of treatment, the intervertebral discs, which have been altered in shape by pressure atrophy, are gradually freed of unequal pressure and are returned into proper shape by properly distributed pressure and by the blood circulation.
    After a short preliminary treatment, or at once if the case allows, attention is directed to the replacement of bony parts.  It is a good rule in spinal curvatures to begin at the lowest vertebra involved and make an attempt at each treatment to set it back into place.  When this has been accomplished, the while it is going on, the next vertebra, then the next, and the next, and so on, is attempted.  Much may be gained in this way.
    Suspension of the patient in the osteopathic swing, or in the special apparatus devised for the suspension of curvature patients, is a great help to the practitioner in the treatment.  By this device the weight of the patient's body is used to help draw the bony parts back into place during the various special treatments employed for that purpose.  In this way very rapid gains have been made in straightening the curve.
    Various special movements may be successfully applied to the reduction of the bony parts.  The treatments described under VI, VII, VIII, IX, X, X (a), XI, XII, XVII, AND XVIII, in Chap. II, may be used and combined as desired.  This style of treatment should be combined all the time with that described as the first step in the process f treatment.  The treatment must be most persistent and assiduously applied, the practitioner using a considerable degree of force to put parts back into place.  But violence must be avoided.
    During the course of the treatment all spinal braces, jackets, casts, and artificial supports or corrective mechanisms of every sort are laid aside, either gradually or at once as the patient may be able to do without them.  In this way one gets rid of their irritating local effects and of their detrimental influence upon the general health, while at the same time the parts are taught to depend upon their own strength, a matter essential to a cure.
    Due attention must be given to complications and to the general health.
    The practitioner must bear in mind the changed relations assumed by the ribs both with respect to each other and with respect to the vertebrae.  Treatment must be applied during the course of treatment, to the adjusting of these ribs.  The various special methods described in Chap. VII may be used.
    This method of treatment applies to SCOLIOSIS, LORDOSIS, KYPHOSIS, and their combinations.
    In case of POTT's DISEASE the same general plan of treatment is followed.  In case the destructive process in the bones and discs has ceased, and cure by deformity has followed by bony ankylosis of the vertebrae, one cannot straighten the spine, but much may be done to correct the general health.  Yet, as in the case reported above (see case reports), it often happens that after years of deformity the spine has been materially straightened.
    In this disease the destructive processes can be quite stopped often, or greatly limited; general health is bettered, and pain is relieved.
    In these cases thorough attention to the general health is necessary.  Also bowels, kidneys, liver, and skin must be kept well stimulated to aid in carrying off the septic products of the disease.  In case of the appearance of abscess, it must be drained when it has come to a head.  Such quantities of pus cannot be absorbed, and the abscess should not be allowed to break.  After drainage the abscess may be entirely healed by the treatment.
    Various swerves in the spine, or departures from the normal curves, are frequently met with. They are often called curvatures, but are not properly so regarded.  Yet they may predispose to curvatures.  They may be readily righted by the treatments given above.
    Pott's disease requires a long and patient course of treatment.  This is often true of the ordinary curvatures, but very frequently a single month, or a few months, of treatment will show surprising results.
    The TREATMENT OF DEFORMITIES proceeds upon much the same general plan of treatment as described for curvatures.  All the surrounding parts must be relaxed, strengthened and prepared by a course of treatment directed to the complete restoration of circulation to the parts and tissues involved.  When the preparation is completed the practitioner proceeds by exaggeration of lesions, traction, pressure, rotation, etc., applied to the bony part to force it back into place.
    It often happens that in apparent deformity of a bony part, as of a joint, while pain and abnormal position and condition of the tissues is apparent at the joint, the real cause may be an obstruction in the nerve and blood supply of the joint somewhere above or at the spine.  Thus apparent deformity of a knee has with much frequency been found to be due to a luxation of the hip joint or of spinal vertebrae.
    A deformity, as an enlargement of a joint, may be not real but apparent by reason of atrophy of the surrounding tissues.  Then the cause must be sought elsewhere for the wasting of the tissues.  But the surrounding tissue often waste in cases of joint disease or deformity.
    It sometimes happens, as in the case of "hysterical joints" that there is no real diseased condition of the suspected.
    Muscular and ligamentous deformities are often the results of some preceding or existing disease.  In such cases treatment must be made accordingly.  Locally one must direct treatment to the affected tissues to relax and restore them.
    On the other hand these muscular and soft tissue deformities are surprisingly often found to be due to a vertebral lesion, or other lesion, at the origin or in the course of the nerves supplying the part.  In such case the treatment must embrace the removal of lesion as the real cause, and corrective work upon the deformed tissues.  It sometimes happens in the treatment of these cases that the spinal lesion is treated to the exclusion of the local treatment upon the affected part, or that treatment is mistakenly directed to a spinal lesion not responsible for the condition.  One will learn that he must judge of the relative importance of treatment directed to one situation or the other.
    Sometimes a minute luxation of a joint itself is the cause of the trouble.
    In cases of deformity due to deposits in and about joints, as in chronic rheumatism, the circulation is built up and kept stimulated to absorb the deposit.  In such cases it is necessary to adapt some motion to thoroughly stretching or spreading the joint in order that the renewed blood supply may freely circulate in the joint
    Various special treatments applicable to the treatment of deformities will be found described in the general treatments for the upper and lower limbs.
    The TREATMENT OF DISLOCATIONS is fully described in Chap.  X.
    Concerning the TREATMENT OF JOINT AFFECTIONS little need be added to what has been said in describing the treatment of deformities (see also the treatment of rheumatism.) Pain in a joint is often to be due to a spinal lesion or to a lesion in a related joint.  A very common occurrence is to discover the cause of a so-called tubercular knee, or of a swelling or synovitis of the knee joint, in a luxation of the hip joint.
    In all cases of joint affections one must look closely for lesion to nerves or vessels supplying the joint from the origin down, and remove it as the cause of the trouble.  To this must be added local manipulation of the joint and its parts in order to correct proper circulation.
    Plaster casts and bandages are at once removed to aid in securing freedom of blood circulation.
One must not forget that apparently very serious disease has often been found by osteopaths to depend upon a slight slip of the bones or cartilages of the joint affected.  Treatment, upon the principles laid down will usually suffice to slip these back into place.
    In strains, sprains, and inflammations of a joint one must free the local and the connected circulation to take down the inflammation.  If applications are used, hot are better than cold.
    In chronic affections it is usually necessary to treat from the spine out to the joint in question, besides removing all bony lesions, adjusting all tissues, etc.
    Moderate use of a joint is usually advised, at discretion.  The use builds up a natural condition.
Cases of bony ankylosis are incurable without breaking.  Ligamentous ankylosis may be cured.  If any motion at all exists in a joint there is good reason for belief that it may be increased, possibly fully restored.