Human anatomy; Medicine -- Study and teaching; Palpation
94. =Furrow at the bend of the thigh.=--When the thigh is even slightly
bent, there appears a second furrow in the skin below that at the
crural arch. This second furrow begins at the angle between the
scrotum and the thigh, passes outwards, and is gradually lost between
the top of the trochanter and the anterior superior spine of the ilium.
It runs right across the front of the capsule of the hip-joint. For
this reason it is a valuable landmark in amputation at the hip-joint.
The point of the knife should be introduced externally where the furrow
begins, should run precisely along the line of it, and come out where
it ends; so that the capsule of the joint may be opened with the first
thrust. In suspected disease of the hip pressure made in this line,
just below the spine of the ilium, will tell us if the joint be tender.
Effusion into the joint obliterates all trace of the furrow, and makes
a fulness when contrasted with the opposite groin.
95. =Saphenous opening.=--In most persons there is a natural depression
over the saphenous opening in the fascia lata, where the saphena vein
joins the femoral. The position of this opening is just below the inner
third of Poupart’s ligament, and about an inch and a half external
to the spine of the pubes. This is the place where the swelling of
a femoral hernia first appears: therefore it ought to be carefully
examined in cases of doubt.
96. =Femoral ring.=--The position of the femoral ring, through which
the hernia escapes from the abdomen, is on a deeper plane, about half
an inch higher than the saphenous opening, and immediately under
Poupart’s ligament. As the plane of the ring is vertical in the supine
position of the body, the way in which we should try to reduce a
femoral hernia is by pressure, applied first in a downward direction,
afterwards in an upward. The intestine protruded has to pass back under
a sharp edge of fascia, namely, the upper horn of the saphenous opening
(known as Hey’s ligament). At the same time we bend the thigh, to relax
the fascia as much as possible.
A good way to find the seat of the femoral ring with precision is the
following:--Feel for the pulsation of the femoral artery on the pubes;
allow half an inch (on the inner side) for the femoral vein; then comes
the femoral ring.
In performing the operation for the relief of the stricture in femoral
hernia the incision through the skin should be about an inch and a half
external to the spine of the pubes. Its direction should be vertical,
and its middle should be just over the femoral ring.
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