Surface Markings 449 



sertion of the gluteus maximus, and may be traced upwards to the 

 front of the iliac crest. 



Below the spine of the pubes is the cord-like tendon ot the adductor 

 long'us (p. 453) ; it is often extremely prominent in hip-joint disease, 

 but it very rarely needs division. Sometimes this tendon is par- 

 tially ossified (rider's bone}. Along the inner side of the thigh is the 

 rounded mass of the adductors longus, brevis, and magnus, covered 

 on their inner surface by the broad, ribbon-like gracilis. This group 

 of muscles is supplied by the obturator nerve. In a thin subject the 

 rigid and slender tendon of the adductor magnus may be detected 

 running to its insertion in the adductor tubercle on the upper part of 

 the inner condyle. Sometimes in men who spend much time on 

 horseback the insertion of this tendon is ossified into a rider's bone. 

 The tendon of the gracilis, which lies near that of the adductor magnus 

 is distinguished from it by the fact that it passes beyond the femur 

 and on to the tibia. 



The spur-like projection of bone which gives attachment to the 

 tendon of the adductor magnus marks the level of the top of the 

 epiphysis, and also that of the highest part of the trochlear surface. 

 (Holden.) 



Above the patella is a depression in which is the flat tendon of the 

 rectus femoris, and, deeper still, much of the quadriceps extensor. 

 Towards the outer side is the prominent ridge on the front of the 

 external condyle, bounding the trochlear surface. This ridge, which 

 should be carefully examined, is apparently quite subcutaneous, but, in 

 addition to the skin, it is covered by fascia lata, and by the expansion 

 from the vastus externus to the patella. An incision on to it opens 

 the synovial membrane of the knee-joint. The outline of the articular 

 margin of the external condyle may easily be made out below and 

 behind the outer border of the patella. This definite ridge is irregu- 

 larly covered by osteophytes in chronic osteo-arthritis, and in suspected 

 cases of that disease is always to be inspected. 



On the inner side is the inner condyle of the femur ; it is larger 

 than the outer, but it does not project so markedly beneath the skin, 

 being covered by the fleshy mass of the vastus internus. 



The tuber osities of the femur are the rounded projections upon 

 the sides of the condyles. They are behind the vertical axis of the 

 joint ; the lateral ligaments are attached to them, so that in their 

 descent they may be kept clear of the femur. Being behind the 

 vertical axis, the lateral ligaments check over-extension of the joint. 

 Below the joint are the tuberosities of the tibia. The level of the 

 articulation may be recognised by keeping the finger firmly pressed 

 below the tuberosity of the femur, and slightly bending or straighten- 

 ing the knee. In the crevice is the semilunar fibro-cartilage. 



On either side of the patella is a depression which is quickly 

 effaced when effusion occurs in the synovial membrane of the knee ; 



G G 



