SURFACE LANDMARKS : THE LOWER EXTREMITY. 



671 



Fig. 633. 



Poupart's  

 ligament 



Sartorial 



Rectus - 

 femoris 



- Femoral 

 artery 



-Scarpa's 

 triana-le 



—Adductor 

 / muscles 



Quadriceps 

 tendon 



Patella- 



Tubercle of tibia- 



Subcutaneous- 

 surface of tibia 



-Vastus 

 internus 



eating the position of the iUo-tibial band of fascia between the insertions of the tensor 

 fasciae latae and gkiteus maximus and the external tibial tuberosity. More pos- 

 teriorly a distinct longitudinal depression corresponds to the external intermuscular 

 septum, between the vastus externus and the short head of the 'biceps. At the 

 lower third of the thigh this groove indicates the line of nearest approach of the shaft 

 of the femur to the surface. Elsewhere it is 

 usually so covered by muscular masses that 

 it is not to be felt, even indistinctlv. The 

 corresponding internal septum— between the 

 vastus internus and the adductors and pecti- 

 neus — produces no surface marking. 



(<5) Posterior crural region. The ham- 

 strings, descending from beneath the lower 

 edge of the gluteus maximus, cannot at first 

 be separately identified. Lower, a very slight 

 depression may mark the interval between 

 the semimembranosus and the semitendino- 

 sus, and the biceps tendon becomes a salient 

 rounded cord. 



When the limbs are straight with the 

 knees together there should be but a slight 

 interval between the thighs, and that only 

 where the sartorius muscles curve back to 

 lie along the inner surface of the limb. In 

 women, owing to the greater quantity of sub- 

 cutaneous fat, the thighs may be in contact 

 all the way down {Thomson). 



3. The Knee. — On the anterior sur- 

 face the quadriceps tendon and the ligamen- 

 tum patellae are made more prominent by 

 strong extension of the leg, and on each side 

 of the ligament the little eminence made by the 

 protrusion of the soft subpatellar fat becomes 

 visible. The angle made by the axes of the 

 tendon and ligament should be noted (page 

 418). 



The outline of the patella is easily felt 

 and can usually be seen. Above it is a slight 

 depression. At its sides are two concavities 

 — the inner of which is a little more marked, 

 as the inner border of the patella is the 

 more prominent — which in fat persons may 

 disappear, as they do, together with the su- 

 prapatellar depression, in synovitis of the 

 knee-joint (page 413). Both anteriorly and 

 laterally the landmarks have been sufficiently 

 described (pages 367, 390). 



Posteriorly the popliteal space — the ham 

 — is slightly convex during extension of the 

 leg and deeply concave when it is flexed. 

 The boundaries, the relations of the ham- 

 string tendons, of the ilio-tibial band externally and of the sartorius tendon internally 

 have been described (pages 409, 646). At the lower portion of the space the con- 

 verging fleshy bellies of the gastrocnemius may be felt. 



4. The Leg. — The landmarks relating to the tibia (page 390) and fibula (page 

 396) have been described. Between these bones the belly of the tibialis anticus causes 

 a distinct prominence, to the fibular side of which is the narrower and less-marked 

 elevation due to the extensor longus digitorum. Below the middle third of the leg 

 these muscles are tendinous, but by dorsal flexion of the foot and of the toes (exten- 



Muscles 

 of calf 



Ankle- 

 joint 



Abductor 

 and flexor 

 bre\is hal- 

 lucis 



Antero-median surface of right leg, showing 

 modelling on living subject. 



