THE LOWER LIMB 447 



temal abdominal ring, of which the crest forms the base. The angle 

 cannot usually be felt. The ischio-pubic ramus can be felt extending 

 from the tuber ischii at the back of the limb to the lower part of the 

 symphysis pubis. The saphenous opening is situated below and 

 external to the pubic spine, and it extends downwards for about 

 i^ inches below the inner third of Poupart's ligament. At the 

 lower extremity of the opening the superficial femoral or saphenous 

 lymphatic glands may be felt. The most prominent part of the 

 head of the femur will be felt immediately below Poupart's liga- 

 ment, at a point just external to its centre. 



The great trochanter is situated about 4 inches below the anterior 

 superior iliac spine, and about 4 inches behind a line let fall vertically 

 from it. Its outline is more or less obscured by the muscles which 

 cover it, but the following guides may serve to locahze the pro- 

 minence : 



Holden's Guide. — The top of the great trochanter is pretty nearly 

 on a level with the pubic spine in the recumbent posture. 



N^laton's Line. — This is a line drawn from the anterior superior 

 iliac spine to the most prominent part of the tuber ischii. It co- 

 incides with the top of the great trochanter, and- runs through the 

 centre of the acetabulum. 



Bryant's Test- Line. — The subject being in the horizontal position, a triangle 

 (ilio-femoral) is constructed in the following manner : draw two lines from the 

 anterior superior spine of the ilium, one being vertical and traversing the outside 

 of the hip to the horizontal plane of the body, and the other impinging on the 

 tip of the great trochanter. Then construct the base by drawing a line from, 

 and at right angles to, the vertical line to the trochanter. The base represents 

 Bryant's test-line for shortening of the neck of the femur. * Any shortening of 

 this line, on comparing it with the same taken on the uninjured side, indicates 

 with precision a shortening of the neck of the thigh-bone.' 



The position of Scarpa's triangle is indicated by a slight depression 

 which exists below Poupart's ligament. The outline of the adductor 

 longus muscle is easily seen when the limb is firmly abducted. If 

 the prominence thereby produced is followed upwards, the narrow 

 round tendon of origin of the muscle is readily felt at a point on 

 the body of the os pubis below and internal to the pubic spine. 

 The rectus femoris gives rise to a median vertical prominence on 

 the front of the thigh. The well-marked prominence over the lower 

 fourth of the thigh on its inner aspect is due to the vastus intemus 

 muscle. When the knee is flexed, the narrow round tendon of the 

 adductor magnus can be felt as it descends, posterior to the vastus 

 internus, to reach the adductor tubercle of the femur. 



Knee. — The outline of the patella is readily felt along with that 

 of the ligamentum patellae, which passes from the lower pointed 

 end of the patella to the tubercle of the tibia. 



The internal condyle of the femur forms a large prominence looking 

 inwards. On its inner surface the blunt internal tuberosity is easily 

 felt. At its upper and back part the adductor tubercle can be felt, 

 when the knee-joint is flexed, with the narrow round tendon of the 

 adductor magnus taking insertion into it. The upper border of the 



II 



