Henry Gray (18251861). Anatomy of the Human Body. 1918.
tuberosity; it crosses the center of the acetabulum and the upper border of the greater trochanter. Another surface marking of clinical importance is Bryants triangle, which is mapped out thus: a line from the anterior superior iliac spine to the top of the greater trochanter forms the base of the triangle; its sides are formed respectively by a horizontal line from the anterior superior iliac spine and a vertical line from the top of the greater trochanter.
Articulations.The posterior superior iliac spine overlies the center of the sacroiliac articulations.
The hip-joint may be indicated, as described above, by the center of a horizontal line from the pubic tubercle to the top of the greater trochanter; or more generally, it is below and slightly lateral to the middle of the inguinal ligament. The knee-joint is superficial and requires no surface marking. The level of the ankle-joint is that of a transverse line about 1 cm. above the level of the tip of the medial malleolus. If the foot be forcibly extended, the head of the talus appears as a rounded prominence on the medial side of the dorsum; just in front of this prominence and behind the tuberosity of the navicular is the talonavicular joint. The calcaneocuboid joint is situated midway between the lateral malleolus and the prominent base of the fifth metatarsal bone; the line indicating it is parallel to that of the talonavicular joint. The line of the fifth tarsometatarsal joint is very oblique; it starts from the projection of the base of the fifth metatarsal bone, and if continued would pass through the head of the first metatarsal. The lines of the fourth and third tarsometatarsal joints are less oblique. The first tarsometatarsal joint corresponds to a groove which can be felt by making firm pressure on the medial border of the foot 2.5 cm. in front of the tuberosity of the navicular bone; the position of the second tarsometatarsal joint is 1.25 cm. behind this. The metatarsophalangeal joints are about 2.5 cm. behind the webs of the corresponding toes.
Muscles.None of the muscles require any special surface lines to indicate them, but there are three intermuscular spaces which occasionally require definition, viz., the femoral triangle, the adductor canal, and the popliteal fossa.
The femoral triangle is bounded above by the inguinal ligament, laterally by the medial border of Sartorius, and medially by the medial border of Adductor longus. In the triangle is the fossa ovalis, through which the great saphenous vein dips to join the femoral; the center of this fossa is about 4 cm. below and lateral to the pubic tubercle, its vertical diameter measures about 4 cm. and its transverse about 1.5 cm. The femoral ring is about 1.25 cm. lateral to the pubic tubercle.
The adductor canal occupies the medial part of the middle third of the thigh; it begins at the apex of the femoral triangle and lies deep to the vertical part of Sartorius. The popliteal fossa is bounded: above and medially by the tendons of Semimembranosus and Semitendinosus; above and laterally by the tendon of Biceps femoris; below and medially by the medial head of Gastrocnemius; below and laterally by the lateral head of Gastrocnemius and the Plantaris.
Mucous Sheaths.The positions of the mucous sheaths around the tendons about the ankle-joints are sufficiently indicated in Figs. 1241,1242 (see also page 489).
Arteries.The points of emergence of the three main arteries on the buttock, viz., the superior and inferior gluteals and the internal pudendal, may be indicated in the following manner (Fig. 1244). With the femur slightly flexed and rotated inward, a line is drawn from the posterior superior iliac spine to the posterior superior angle of the greater trochanter; the point of emergence of the superior gluteal artery from the upper part of the greater sciatic foramen corresponds to the junction of the upper and middle thirds of this line. A second line is drawn from the posterior superior iliac spine to the outer part of the ischial tuberosity; the junction of its lower with its middle third marks the point of emergence of the inferior gluteal and internal pudendal arteries from the lower part of the greater sciatic