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ss nucleus - autumn 1996,  Differential Diagnosis 17

Differential Diagnosis 17

Genesis 32:22-32

There have been some remarkable injuries in the history of sports medicine but this is one of the most dramatic. During his gruelling and prolonged wrestling contest Jacob's hip was 'wrenched' (v 25) by his opponent and was almost certainly 'put out of joint' (v 25 RSV) or dislocated. It is not known whether there was a pre-disposing congenital abnormality of the hip (such as an old CDH) which led to this traumatic dislocation, but it is quite possible.

Most commonly hips dislocate posteriorly due to axial loading on the femur with the hip flexed. This may be associated with damage (temporary or permanent) to the sciatic nerve. However posterior dislocations usually require excessive violence, such as that associated with 'dashboard injuries'.

Luke rather favours an anterior hip dislocation, which occurs with external rotation and abduction forces - such as those envisaged taking place during wrestling.

Either way, it would seem that the hip re-located as Jacob would not otherwise have finished the competition nor been able to walk the next morning. The key to the subsequent limp, especially if it was permanent, lies in v32 where we are told that the 'tendon attached to the socket of the (hip) joint' was the part affected. This is the ligamentum teres of the femoral head responsible for part of its precarious blood supply. Therefore Jacob is likely to have developed avascular necrosis and probable subsequent osteo-arthritis.

Being at the end of his tether (Gn 31: 32) Jacob was of course wrestling spiritually in prayer as well. As is often the case after a serious injury he was never the same again - not only because of his painful limp, but most importantly because of his greater understanding and trust in the God who had wounded him in order to bless him.

Differential Diagnosis18

Gn 25:24-25 - What possible medical explanations could account for Esau and Jacob's different appearances at birth? Which is most likely and why? How was Jacob able to exploit the situation?

Luke's opinion in next issue.

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