0802-Connective Tissue Disorders I: The Bony Skeleton

Lecture presented by Professor Omar Hasan Kasule, Sr

Disorders of the bony skeleton are deformations leading to restricted movements that limit the range of possible physical movements in salat and hajj.


Neck problems: The sideways movement of the neck in tasliim may be limited. Putting the head on the floor during prostration may cause pain.


Back problems: Pain and restricted movements of the vertebral column make bowing more difficult. Standing for prolonged periods may also be difficult. Prostration may be completely impossible. It is required that the back be straightened after bowing, istiwa al dhahar fi al ruku’u[i]; this is not possible in cases of back pathology. Back pain may also interfere with sexual function.


Upper limb: Raising the hands in takbir may be restricted in cases of fractures and arthritis. Pointing with the finger is difficult after traumatic injury and arthritis. Pointing with the index finger is required in tashahhud[ii]. It is forbidden to point with more than one finger[iii] or to intertwine fingers[iv].


Lower limb: The prophet described the method of bowing, kaifa yakuun al ruku’u[v]. In lower limb pathology bowing can be restricted. Prostration is also difficult since it requires flexion at both the hip and the knee joints. Tawaaf in hajj may be difficult with lower limb pathology. Use of an artificial limb is no bar to hajj and tawaaf. Patients can support themselves on a stick or a pillar during salat[vi]. Congenital dislocation of the hip.


Knee problems: The prophet described the manner of sitting in salat, kaifa yakuun al juluus[vii]. Sitting is required between every two prostrations, al juluus bayna kulli sajdatayn[viii] as well as in the last raka’a[ix]. Restricted bending of the knees interferes with sitting properly. Knee problems may make tawaaf and sa’ay in hajj difficult.


Ankle problems: The prophet taught the proper way of placing the feet in sitting down, la yasaffu bayna qadamayhi[x]. These may not be possible with ankle problems.


Feet problems: A pilgrim may wear sandals if he has disease that makes it impossible to walk barefoot around the kaaba. If shoes are needed for orthopedic conditions they can be worn in hajj and salat.


Fractures & sprains: Wudhu may not be possible with open wounds and compound fractures and resort is made to tayammum. Pain due to sprains and fractures may limit movements in salat. Movements will not be possible at all when the limbs are immobilized. When a pilgrim has a fracture or becomes lame for any other reason, he is discharged from the rites of hajj and has to repeat the hajj later[xi].


Orthopedic fixation: Orthopedic fixation of some joints like the hip or knee joints may limit the range of movements possible in salat. In hajj tawaaf may have to be done in a wheelchair. Wudhu can be made on a limb stump preferably washing. Id washing is difficult the stump can be wiped with a wet hand. If a leg is in a cast, the rest of the organs are washed with water and tayammum is carried out for the limb in a cast.

Fractures are treated by traction to reduce and stabilize the fracture. Internal fixation (osteosynthesis) uses  pins, plates, and wires to fixate bone. Bone transplantation has challenges of ensuring blood supply and overcoming immune rejection. Amputation is carried out for arterial disease leading to gangrene, gross injury that cannot be repaired, and tumors.


Osteomyelitis: Pain may limit movements in salat. If there is a discharging wound, tayammum will be needed instead of wudhu.


Osteoporosis: care has to be taken in movements in salat and hajj to avoid fractures. Treatment of osteoporosis with hormone and mineral replacement is obligatory for postmenopausal women so that they can lead a normal life.


Malignant neoplasm: Care is exercised in salat and hajj to avoid pathological fractures that are common in bones with neoplastic disease.

[i] (KS320 Bukhari K10 B120, Abudaud K2 B143, Tirmidhi K2 B81, Nisai K11 B88, Ahmad 4:22, Ahmad 4:23, Ahmad 4:119, Ahmad 4:122, Ahmad 5:310, tayalisi H61)

[ii] (KS320 Muslim K15 H147, Abudaud K11 B56, Tirmidhi K45 B104, Nisai K12 B79, Nisai K13 B30, Nisai K13 B36, Nisai K13 B37, Nisai K13 B38, Nisai K13 B39, Ibn majah K5 B27, Darimi K2 B83, Nisai K13 B92, Ahmad 1:339, Ahmad 2:119, Ahmad 3:470, Ahmad 4:316, Ahmad 4:318, Ahmad 4:319, Ahmad 5:297, Tayalisi H785)

[iii] (KS 320)

[iv] (KS320 Nisai K13 B37)

[v] (KS319 Abudaud K2 B139)

[vi] (KS321 Abudaud K2 B172)

[vii]  (KS319 Muwatta K3 H49, Muwatta K3 H51, Muwatta K3 H52, Ahmad 2:47, Ahmad 2:265, Ahmad 2:233)

[viii] (KS320 Abudaud K2 B138, Tirmidhi K2 H153, Nisai K12 B88, Nisai K12 B89, Ahmad 1:428, Ahmad 1:436, Ahmad 1:460) (KS320 Abudaud K2 B138, Tirmidhi K2 H153, Nisai K12 B88, Nisai K12 B89, Ahmad 1:428, Ahmad 1:436, Ahmad 1:460)

[ix] (KS319 Nisai K13 B29., Muwatta K9 H80)

[x] (KS320 Nisai K11 B13)

[xi] (KS182 Tirmidhi K7 B96, Nisai K24 B100, Ibn Majah K25 B83, Darimi K5 B57, Muwatta K20 H103, Muwatta K20 H154, Muwatta K20 H155, Ahmad 3:450)

ŠProfessor Omar Hasan Kasule, Sr. February, 2008