Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.
- Henry Gray
- Date:
- 1883
Licence: Public Domain Mark
Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![especially on tlie femur, is exposed to examination by tlie touch with the knee in flexion. The condition of the synovial membrane and the cartilage, there- fore, can be ascertained. The trochlear groove is especially well defined.] 111. Popliteal Tendons.—The tendons forming the boundaries of the popli- teal space can be distinctly felt when the muscles which bend the knee are acting. On the outer side, we have the biceps running down to the head of the iibnla. On the inner side we feel three tendons, disposed as follows:—nearest to the middle of the popliteal space is the semitendinosus, very salient and traceable high up the thigh; next comes the thick round tendon of the semimembranosus; still more internally is the gracilis. The sartorins, which forms a graceful muscular prominence on the inner side of the knee, does not become tendinous until it gets below it. [A very interesting experiment may be tried on the ligamentous action (as Prof, Cleland calls it) of these muscles. Standing with the back fixed against a wall to steady especially the pelvis, the knee can be made alm*ost to touch the belly. But note that the knee is flexed. Eepeat the experiment, the knee being kept rigid, and when the heel has been but slightly raised a sharp pain in the ham follows any effort to carry it higher. Flexion of the rigid leg from the vertical line to a right angle increases the distance from the tuber ischii to the tuberosities of the tibia by some six or eight centimetres, an amount of stretching these muscles cannot undergo. ITence the compulsory flexion of the knee in flexion of the hip. The same thing is seen in the wrist. Flex the wrist with the fingers extended, and again with the fingers in a fist. The first movement can be carried to 90'-^, the second only to 30°, or in some up to 60°. Making a fist had already stretched the flexors, and they can be stretched but little further. Many surgeons make errors in the leg, but especially in the forearm and hand, and inflict injury as well as needless pain by forgetting these facts while making passive movement. It must be noted, however, that in children there is less danger of this over- stretching, for from childhood to old age there is a progressive invasion of the extensible belly by the inextensible tendon in the muscles generally. Hence the ease with which children, even when seated, can lift the heel (without moving the pelvis) and make the hips the point of an acute angle.] 112. Popliteal Bursa.—The precise position of this bursa in the popliteal space, which sometimes enlarges to the size of a hen's egg, is between the ten- don of the inner head of the gastrocnemius and the tendon of the semimem- branosus, just where they rub one against the other. The bursa is from one and a half to two inches long. When enlarged, it makes a swelling on the- inner side of the popliteal space, which bulges and becomes tense when the knee is extended, and vice versa. I examined 150 bodies with a view to ascertain how often this bursa communicates with the synovial membrane of the knee. There was a communication about once in five instances. This should make us cautious in interfering too roughly with the bursa when enlarged. 113. Popliteal Artery.—The popliteal artery can be felt beating and can be compressed against the back of the femur, close to which it lies. But pres- sure, sufflcient to stop the blood, should be firm, and should be made against the bone nearer to the inner than the outer hamstrings. The line of the artery corresponds with the middle of the ham. It lies under cover of the fleshy belly of the semimembranosus, and the outer border of this muscle is the guide to it. An incision down the middle of the ham would fall in with the vessel just above the condyles. 11-1. Peroneal Nerve.—The peroneal nerve runs parallel with and close to the inner border of the tendon of the biceps. It can be felt in thin persons. There is a risk of dividing it in tenotomy of the biceps, unless the knife be carefully introduced from within outwards. Below the knee the nerve can be 62](https://iiif.wellcomecollection.org/image/b21055105_0981.jp2/full/800%2C/0/default.jpg)
