Book - Handbook of Pathological Anatomy 2.3

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Meckel JF. Handbook of Pathological Anatomy (Handbuch der pathologischen Anatomie) Vol. 2. (1812) Leipzig.

Ligaments: I. Trunk | II. Head | III. Extremities   Muscles: I. Trunk | II. Head | III. Extremities   Angiology: I. Heart | II. Body or Aorta Arteries | III. Body Veins| IV. Pulmonary Artery | V. Pulmonary Veins | VI. Lymphatic System | VII. A Comparison of Vascular System   Nervous System: I. Central Nervous System

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This historic 1812 textbook by J. F. Meckel, Professor of Anatomy at Halle, was translated firstly from German Into French (with additions and notes) by Prof. A. J. L. Jourdan and G. Breschet. Then translated again from French into English (with notes) by A. Sidney Doane. Modern Notes: tendon Musculoskeletal Links: Introduction | mesoderm | somitogenesis | limb | cartilage | bone | bone timeline | bone marrow | shoulder | pelvis | axial skeleton | skull | joint | skeletal muscle | muscle timeline | tendon | diaphragm | Lecture - Musculoskeletal | Lecture Movie | musculoskeletal abnormalities | limb abnormalities | developmental hip dysplasia | cartilage histology | bone histology | Skeletal Muscle Histology | Category:Musculoskeletal Historic Embryology - Musculoskeletal   1853 Bone | 1885 Sphenoid | 1902 - Pubo-femoral Region | Spinal Column and Back | Body Segmentation | Cranium | Body Wall, Ribs, and Sternum | Limbs | 1901 - Limbs | 1902 - Arm Development | 1906 Human Embryo Ossification | 1906 Lower limb Nerves and Muscle | 1907 - Muscular System | Skeleton and Limbs | 1908 Vertebra | 1908 Cervical Vertebra | 1909 Mandible | 1910 - Skeleton and Connective Tissues | Muscular System | Coelom and Diaphragm | 1913 Clavicle | 1920 Clavicle | 1921 - External body form | Connective tissues and skeletal | Muscular | Diaphragm | 1929 Rat Somite | 1932 Pelvis | 1940 Synovial Joints | 1943 Human Embryonic, Fetal and Circumnatal Skeleton | 1947 Joints | 1949 Cartilage and Bone | 1957 Chondrification Hands and Feet | 1968 Knee

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Pages where the terms "Historic" (textbooks, papers, people, recommendations) appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms, interpretations and recommendations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

Section III. Of the Ligaments of the Extremities

Chapter I. Of the Ligaments of the Upper Extremities

§ 868. The ligaments of the upper extremities are,

1. Those between the trunk and the upper extremities.
2. Those of the scapula.
3. Those of the elbow-joint.
4. Those of the fore-arm.
5. Those of the wrist-joint.
6. Those of the fingers.

Article First. Ligaments Between The Trunk And The Upper Extremities

§ 869. The upper extremities are attached to the anterior and superior part of the trunk by the clavicles, to which they are united by synovial and fibrous ligaments. The scapula, trunk, and head, are united only by muscles.

The clavicle is articulated, by its anterior extremity, with the clavicle of the opposite side, and also with the first piece of the sternum and the first rib.

I. INTERCLAVICULAR LIGAMENT.

§ 870. The interclavicular ligament ( Lig . inter clavicular e, transversum ) is thin and formed of transverse fibres. Its upper edge is loose and concave ; the inferior is straight or slightly convex, and is mostly attached to the upper part of the handle of the sternum. It extends from the upper extremity of the articular surface of the internal edge of one clavicle to the corresponding part of the opposite clavicle ; so that it unites these bones with each other and with the sternum, and prevents them from moving too far backward.

II. STERNO-CLAVICULAR ARTICULATION.

§ 871. The clavicle and sternum are connected by an interarticular cartilage , two synovial capsules , and a fibrous ligament.

Vol. II. 4

26

DESCRIPTIVE ANATOMY.

A. INTER ARTICULAR CARTILAGE.

§ 872. The interarticular cartilage is generally very soft, almost membranous, extremely thin in its centre, and, on the contrary, very thick in its circumference, so that its two faces are concave. It is attached downward, backward, and inward, by a thick and firm fibrocartilaginous tissue to the facet where the clavicle unites with the sternum ; downward and forward to the clavicle, and to the inner part of the cartilage of the first rib ; upward, forward, and outward, to the margin of the articular facet of the clavicle. It unites intimately forward and backward, with the fibrous ligaments of the sterno-clavicular articulation. It is firmly attached, and admits of but little motion on account of the thickness and breadth of that part of the cartilage which is external to the synovial capsules.

B. SYNOVIAL CAPSULES.

§ 873, The synovial capsules are two, an upper and external , and a lower and internal.

The upper arises from the margin of the anterior part of the anterior articular facet of the clavicle, which is smooth and covered with cartilage, and is attached around the upper face of the thin and internal part of the interarticular cartilage.

The lower arises from the upper part of the lower face of this cartilage, and is attached to the anterior, inferior, and external portion of the articular facet of the handle of the sternum.

Both are small and narrow.

C. FIBROUS LIGAMENTS.

§ 874. The synovial capsules are strengthened by fibrous ligaments which are attached principally to the anterior and posterior parts of their circumference, but never form a dense layer.

The anterior fibrous ligament is the stronger, and is formed by perpendicular descending fibres. The posterior is formed of radiated fibres, which are attached partly to the posterior face of the upper part of the handle of the sternum and partly to the cartilage of the first rib, and are united with the anterior and the posterior periosteum of the sternum.

III. OF THE COSTO-CLAVICULAR LIGAMENT, OR THE RHOMBOID LIGAMENT.

§ 875. The space between the sternal extremity of the clavicle, the anterior extremity of the rib and most of its cartilage, is filled by a ligament formed of oblique intercrossing fibres : this arises from the posterior edge of the clavicle, goes obliquely from above downward, and from behind forward, and is inserted in the upper and posterior

SYNDESMOLOGY.

27

edge of the rib and of its cartilage. A band of transverse fibres is often detached from its inner and inferior extremity, which goes to the lower external extremity of the articular facet of the handle to which the clavicle is attached. It is called the rhomboid ligament ( Lig . rhomboideum ), from its form. It unites the bones to which it is attached, retains the clavicle and the first rib in their places, and increases the number of points of attachment of the subclavian muscle.

ARTICLE SECOND.

OF THE LIGAMENTS OF THE SCAPULA.

§ 876. Some of the ligaments of the scapula unite this bone with the clavicle, and others directly or indirectly with the humerus.

I. OF THE LIGAMENTS BETWEEN THE SCAPULA AND THE CLAVICLE.

§ 877. The clavicle and scapula are united by a capsular ligament and by several fibrous ligaments.

A. ACRO MIO -CLAVICULAR LIGAMENT.

§ 878. A capsular ligament ( connexio claviculÅ“ cum acromio) unites the acromion process of the scapula with the humeral edge of the clavicle. We may then term it the ucrorrdb-clavicular ligament (Lig. acromio-claviculare). It is short, very tense, and sometimes double, when an inter-articular cartilage exists between these two bones : this articular cartilage, however, is not constant, and often fuses with them completely.

Very solid and transverse fibres go upward and downward,' but especially upward, over this ligament, which are attached also to the circumference of the interarticular cartilage.

B. CORACO-CLAVICULAR LIGAMENT.

§ 879. The fibrous ligaments are generally two, which are also known as the common ligaments of the scapula, and both unite the clavicle with the coracoid process of the scapula. Wif» cannot however deny but that it would be more convenient to consider them simply as two bands of the same ligament, the fibres of which have not the same direction ; one of them is external, the other internal, and they are uninterruptedly continuous with each other. This ligament is called the coraco-clavicular ligament (Lig. coraco-claviculare ), to distinguish it from the preceding, and is formed by strong thick fibres.

It arises from the outer half of the upper face of the coracoid process, and is composed of ascending fibres. It is attached by its upper ex

28

DESCRIPTIVE ANATOMY.

tremity to the inferior face, and to the posterior edge of the scapular extremity of the clavicle, but it does not extend to the outer end of this bone.

The internal and posterior fibres are shorter and more perpendicular : the anterior and external are longer and more oblique.

The two bands which form this ligament are commonly described, the inner as the common conoid ligament, and the external as the common trapezoid ligament of the scapula {Lig. scapulae communia conoides et trapezoides ).

The conoid ligament arises from the root of the coracoid process, proceeds more from before backward, and is attached to the posterior edge of the clavicle : its blunt summit corresponds to the coracoid process, and its broader base to the clavicle. Its anterior fibres are shorter and more perpendicular than the posterior.

The trapezoid ligament arises from about the centre of the upper part of the coracoid process ; its direction is more transverse, and it is attached more externally than the preceding, to the inferior face of the scapular extremity of the clavicle. The anterior are longer than the posterior fibres.

II. OF THE LIGAMENTS BETWEEN DIFFERENT PARTS OF THE SCAPULA, OR OF ITS PROPER LIGAMENTS.

§ 880. The proper ligaments of the scapula are simply fibrous, and extend, like a bridge, between the two eminences of this bone.

A. ACROMIO-CORACOID LIGAMENT.

§ 881. The acromio-coracoid ligament {Lig. coraco-acromiale , s. anterius , majus , triquetrum) is a thin band formed of horizontal fibres, which converge from before backward. It sometimes arises by two separate bundles from the whole posterior edge of the coracoid process, and is attached to the anterior extremity of the acromion process. It gradually contracts from before backward, and from within outward, and terminates in a very acute summit. The inner and outer edges (the former of which is the longer) are loose. The whole ligament is covered by the scapular extremity of the clavicle and by the deltoid muscle, rests on the anterior part of the suprasphiatus muscle which keeps it in place, and terminates by a thick layer placed under the deltoid muscle ; it projects over the scapulohumeral articulation, and thus prevents the displacement of the humerus upward.

B. COSTO-COR ACOID LIGAMENT.

§ 882. The coslo-coracoid ligament {Lig. coraco-costoideum ), calle also the coracoid {Lig. coracoideum) or the proper small ligament of

(1) Soemmering', loc. cit., p. 42. — Bichat, An. dcser., vol. i. p. 273.

SYNDESMOLOGY.

29

the scapula ( Lig . scapulas proprium , posterius , minus , obliquum ), is much smaller than the preceding ; it has the form of a thin square band, and it extends from the root of the coracoid process to the inner end of the upper edge of the scapula or of the rib above the scapular fissure, which it changes into a canal through which the nerves and yessels of the shoulder pass. It often ossifies.

III. HUMERO-SCAPULAR ARTICULATION.

§ 884. The humero-scapular articulation is formed by a synovial capsule and a fibrous capsule, which covers the former. These two capulses are called the large capsular ligament of the humerus {Lig. capsulare ossis humeri magnum).

A. SYNOVIAL CAPSULES.

§ 884. The synovial capsule covers the articular surface of the scapula above, and the head of the humerus below. After leaving these two surfaces, it reflects on itself to form a large and loose sac.

This sac, like all the synovial capsules, is entirely closed; but it covers also the bicipital groove, and even the upper part of the tendon of the long portion of the biceps muscle, for it is reflected from the groove over the tendon, although no opening exists on this part.

B. FIBROUS CAPSULE.

§ 885. All the surface of this synovial capsule is covered by a complete fibrous capsule, which forms a broad and loose sac, open on the two sides. It is attached above to the circumference of the glenoid cavity of the scapula, and below to the neck of the humerus : in both points it is continuous with the periosteum.

Its upper edge is continuous with a fibro-cartilaginous ring, which surrounds the glenoid cavity, and slightly projects above its surface. It is called the glenoid ligament {Lig. glenoideum). It is formed of closely interlaced fibres, and is thicker at its upper portion than in its other parts, since it is there strengthened by a fibrous band coming from the coracoid process. Its internal face is thinner, and even there we occasionally see spaces filled by the tendon of the subscapularis muscle.

It is strengthened above by the tendon of the supra-spinatus muscle, backward by that of the infra-spinatus muscle and of the teres minor muscle.

Below and forward its internal edge presents a slight opening, through which the long tendon of the biceps flexor muscle passes.

The looseness of this ligament allows great freedom of motion in the upper extremities.

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DESCRIPTIVE ANATOMY.

ARTICLE THIRD.

OF THE LIGAMENTS OF THE ELBOW-JOINT.

§ 886. We find at the articulation of the elbow a synovial capsule and several fibrous ligaments.

1 . SYNOVIAL CAPSULE.

§ 887. The synovial capsule ( membrana cubiti capsularis ) unites the lower extremity of the humerus and the upper extremities of the ulna and radius.

Above, after covering the cartilaginous articular surface of the lower extremity of the humerus with which it is blended, it detaches itself forward from the upper part of the two anterior articular cavities ; on the sides from the base of the two condyles along the posterior cartilaginous edges of the pulley and of the lower head ; backward from the upper part of the posterior articular cavity. From these different points it goes toward the radius and ulna, to which its inferior edge is attached. It is much looser and more extensive than on the sides.

The portion attached to the radius descends deeply below the head of this bone to the commencement of its neck ; so that the head, enveloped by the reflected portion of the synovial capsule, is loose and inclosed in its cavity.

From the inferior part of the neck of the radius it goes on the anterior side of the upper extremity of the ulna ; there it lines the lateral sigmoid cavities, and the upper edge of the condyle and the coronoid process of the ulna.

We find considerable masses of articular fat in many places, but principally in the anterior and posterior articular cavities, especially above the pulley, between the heads of the radius and ulna, and within the large upper sigmoid cavity ; consequently, in all those parts most exposed to compression and friction.

From this description it follows that this synovial capsule, between the anterior part of the articular face of the humerus and that of the radius, is much looser than between the posterior and that of the ulna, which is owing to the greater extent of motion of the radius ; for the radius rotates on its axis, while the ulna has only the motions of flexion and extension.

II. FIBROUS LIGAMENTS.

§ 888. The synovial capsule of the elbow-joint is strengthened, on its anterior and posterior faces and on the sides, by fibrous bands, which

SYNDESMOLOGY.

31

may be considered so many distinct ligaments, the lateral , the anterior, and the posterior.

The two lateral ligaments are oblong and formed of longitudinal fibres.

I. INTERNAL LATERAL LIGAMENT.

§ 889. The internal lateral ligament ( Lig . cubiti laterale internium) arises from the inner part of the anterior face of the internal condyle of the humerus, covers the internal part of the synovial capsule, and is attached below to the internal edge of the coronoid process of the ulna.

II. EXTERNAL LATERAL LIGAMENT.

§ 890. The external lateral ligament (Lig. cubiti laterale externum ) extends from the anterior face of the external condyle to the inner portion of the circumference of the head of the radius.

III. ANTERIOR AND POSTERIOR LIGAMENTS.

§ 891. The anterior and posterior fibrous ligaments (Lig. cubiti anterius et posterius) are formed of less regular fibres, and they are broader but weaker than the lateral ligaments.

The anterior is strongest in its centre. It is formed of longitudinal fibres, which are loose at its upper part, oblique in the centre, and more transverse in the lower part.

The posterior is not well marked, except on the sides, where it is strongest -and composed of bands which converge downward ; in other parts it is hardly seen.

ARTICLE FOURTH.

OF THE LIGAMENTS OF THE BONES OF THE FORE-ARM.

§ 892. The bones of the fore-arm are united in most of their length, but not in the same manner, nor do the agents of union form a continuous whole. We find at the upper part two fibrous ligaments, in the centre a fibrous ligament, and below a synovial capsule.

I. SUPERIOR REGION.

I. ANNULAR LIGAMENT.

§ 893. The annular ligament of the radius (Lig. radii annulare) is very strong, and arises from the anterior and posterior extremities of the lateral sigmoid articular cavity of the ulna. It is formed of horizontal and circular fibres, and loosely surrounds the neck of the radius. Be

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DESCRIPTIVE ANATOMY.

hind the sigmoid cavity it forms a circle, lined by the synovial membrane of the elbow-joint, in which the head and the neck of the radius move. Its fibres interlace above with those of the anterior, posterior, and external lateral ligaments ; but it terminates downward in a loose edge.

This ligament strengthens the synovial capsule ; it confines the motions of the upper part of the radius and keeps it in place.

II. KOlIJNl) LUiAMEM’.

§ 894. The round or oblique ligament, called also, but very improperly, the transverse ligament {Lig. antibrachii, s. cubiti teres , s. membrana obliqua , s. transversa), is a thin but strong band, broadest at its upper part, situated on the anterior face of the bones of the fore-arm : it descends obliquely from the tubercle of the ulna to the internal face of the radius, and is attached below its tubercle.

Its uses are to limit the motion of supination in the radius.

II. MIDDLE REGION.

INTEROSSEOUS LIGAMENT.

§ 895. The interosseous ligament {Lig., s. membrana antibrachii int&rossea ) unites the two bones of the fore-arm in most of their length. It occupies the deepest region of the fore-arm, being situated between the extensor and the flexor muscles. Its upper part commences below the tubercle of the radius. It is attached in its whole extent to the external edge of the ulna, and to the internal edge of the radius, and extends almost to the lower extremity of the bones of the fore-arm ; so that its lower part is much broader than its upper.

It is formed of parallel fibres ; these descend from the radius to the ulna, and are much stronger at its upper than at its lower part. In several places, particularly above and below, we observe foramina for the passage of the interosseous vessels.

III. INFERIOR REGION.

SYNOVIAL CAPSULE.

§ 896. The inferior extremities of the bones of the fore-arm are united by a very loose and very broad synovial capside {membrana capsularis sacciformis extremitatum inferiorum cubiti ), which is strengthened only by some straight and isolated fibres. This capsule arises on the ulna from the semilunar cavity and on the radius from the corresponding eminence.

SYNDESMOLOGY.

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ARTICLE FIFTH.

OF THE LIGAMENTS BETWEEN THE FORE-ARM AND THE

WRIST.

§ 897. The articulation of the bones of the fore-arm with those of the wrist( 1 ) presents a thin and loose synovial capsule and some very strong fibrous bands, which cover its external surface.

1. SYNOVIAL CAPSULE.

§ 898. The synovial capsule arises above from the edge of the triangular and cartilaginous articular surface at the lower extremity of the radius, and from a fibro-cartilage which terminates this articular surface forward ; below, from the cartilaginous circumference of the superior or antibrachial articular facet of the scaphoid, the semilunar, and the pyramidal bones, consequently from the bones of the upper range of the carpus, except the pisiform bone, and also fills the spaces between these- bones. Prolongations, called mucous ligaments (liga*menta mucosa), go from several of its parts, among which we distinguish that w'hich proceeds from the union of the first two bones of the carpus to the projection which arises between the two portions of the articular surface of the radius. These prolongations increase the extent of the surface which secretes synovia.

IL INTERARTICULAR CARTILAGE,

§ 899. The intcrarticular cartilage ( cartilago triangularis interme » dia extremitatum ossium antihrachii) (§ 898) is a small triangular fibro-cartilage ; its base looks inward, and its summit outward ; it is loose at its external edge, and its internal edge is attached to the anterior edge of the lower articular surface of the radius ; and it is situated between the lower edge of the ulna and the semilunar bone. Its upper face is covered by the synovial capsule, and the inferior by the synovial membrane of the articulation of the fore-arm with the carpus, so that it belongs to neither ; but as it evidently concurs to form the articular surfaces of the bones of the fore-arm, which correspond to the carpus, we must study it here, instead of describing it when treating of the articulation of the bones of the fore-arm, as is generally done.

(1) The carpal ligaments in the back and the palm of the hand, and also the proper carpal ligament in the palm of the hand, are not mentioned here, as they serve not to unite the bones, but only to retain the tendons in their places. They will be described in myology.

VOL. II.

5

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DESCRIPTIVE ANATOMY.

III. FIBROUS LIGAMENTS. ,

§ 900. We may describe, as is most usual, four principal fibrous ligaments, which strengthen the synovial capsule of this joint ; the palmar , the dorsal , the radial , and the ulnar. The first two arc larger and particularly broader than the others.

I. FIBROUS PALMAR LIGAMENT.

§ 901. The fibrous palmar or the anterior ligament (Lig. accessorium articuli cubito-carpalis, s. lacerti adscitilii palmaris , with the Lig. accessorium obliquum el rectum) is composed of mostly horizontal bands, which leave the lower extremity of the palmar face of the radius and the styloid process of the ulna, go a little outward, meet, and unite, being attached to the palmar face of the pyramidal and the semilunar bones. These bands form particularly the oblique accessory ligament (Lig. accessorium obliquum , Weitbrecht.)

Besides, from the posterior part of the palmar face of the inferior edge of the radius arise strong perpendicular fibres, which are attached above the preceding to the upper edge of the palmar face of the pyramidal and semilunar bones, thus forming the straight accessory ligament (Lig. accessorium rectum).

These fibres are generally interrupted in parts.

II. FIBROUS DORSAL LIGAMENT.

§ 902. The fibrous dorsal ligament (Lig. fibrosum dorsale articuli cubito-palmaris), or the rhomboid ligament (Lig. rhomboideum ), is formed of several very strong bands which are also interrupted from place to place ; these arise from the external edge of the articular face of the radius, go obliquely from before backward, and are attached to the dorsal face of the pyramidal bone. Their posterior part is the thickest, and there the fibres are most compactly arranged.

III. FIBROUS ANTERIOR OR RADIAL LIGAMENT.

§ 903. The fibrous anterior or radial ligament (Lig. radiale articuli cubito-carpalis) arises from the summit of the styloid process of the radius, unites at its upper part with the anterior bands of the dorsal ligament, and terminating rather pointedly, is attached to the anterior asperity of the radial face of the scaphoid bone.

IV. FIBROUS POSTERIOR OR ULNAR LIGAMENT.

§ 904. The fibrous posterior or ulnar ligament (Lig. cubitale articulé cubito-carpalis) is longer and stronger than the preceding, and arises from the summit of the styloid process of the ulna, and, united

SYNDESMOLOGY.

35

with the posterior part of the dorsal ligament, is attached to the dorsal face and to the ulnar side of the pyramidal bone.

ARTICLE SIXTH.

OF THE LIGAMENTS OF THE CARPAL BONES.

§ 905. The ligaments of the carpal bones comprise those which unite the two ranges and those which unite the separate bones of the same.

I. OF THE LIGAMENTS BETWEEN THE TWO RANGES.

§ 906. The two ranges of carpal bones are connected together by a synovial capsule and by fibrous ligaments.

I. SYNOVIAL CAPSULE.

§ 907. The short and close synovial capsule extends from the first three bones of the upper range to the four bones of the lower, unites with their cartilaginous faces and also sends small culs-de-sac between the adjacent bones, which are covered by the fibrous ligaments, by which the surfaces are kept in continual contact.

II. FIBROUS LIGAMENTS.

§ 908. The fibrous ligaments which exist only externally are very similar to those of the radio-carpal articulation, as respects situation, number, and proportional size.

The palmar ligament is short, but broad and triangular. Its central fibres are transverse, its anterior and posterior fibres are oblique ; all converge towards the base. They arise from the pyramidal and scaphoid bones, and are attached below to the trapezoides and the os magnum.

The dorsal ligament is weaker than the preceding. It is formed of transverse fibres, and partly of those which are a little oblique. It is attached above to the dorsal face of the three anterior bones of the upper range, and below, to the upper region of the dorsal face of the four bones of the lower range.

The anterior lateral ligament is formed of perpendicular fibres which extend from the radial side of the scaphoid bone to the os trapezium.

The posterior lateral ligament is situated between the base of the unciform process of the unciform bone and the outer, edge of the pyramidal bone.

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DESCRIPTIVE ANATOMY,

III. LIGAMENTS BETWEEN THE PISIFORM BONE AND THE ANTERIOR RANGE.

§ 909. Besides these ligaments we find two others which are oblique ; the upper is smaller, the lower is stronger ; these go from the anterior extremity of the pisiform bone to the unciform bone : the second is attached to the inferior face of the body of this last bone, and the other to the summit of its unciform process.

II. OF THE ARTICULATION OF THE DIFFERENT CARPAL BONES.

J. SUPERIOR OR ANTIBRACHIAL RANGE.

A. ARTICULATION OF THE CORRESPONDING FACES.

§ 910. The four bones of the upper range of the carpus are articulated with each other differently, and do not possess the same degree of motion.

The corresponding faces of the three anterior bones are united superiorly by short, firm, and solid fibres, which cover the culs-de-sac of the synovial membrane (§ 9t)7) ; these are called transverse or interosseous ligaments (Lig. transversa, s. interosseal). The fourth on the contrary is attached to the pyramidal bone by a very loose capsule, the dorsal face of which is covered by transverse fibres.

B. ACCESSORY LIGAMENTS,

§ 911. Beside the interosseous ligament (§ 910) we also see, in several parts of the corresponding faces of the carpal bones, fibres, which go from one of these bones to another ; these are called the dorsal and the palmar ligaments of this range. These ligaments are formed of transverse fibres. They unite with each other and also with the supplementary fibres of the synovial capsule, and are stronger in the palm of the hand than on the back.

II. INFERIOR OR METACARPAL RANGE.

§ 912. The corresponding faces of the os magnum and of the unciform bone, of the os magnum and of the trapezoides, are united by transverse and very tense interosseous ligaments, which are seen at their anterior portion. The strongest are situated between the first two bones.

We also observe in this range transverse dorsal and palmar ligaments, which are formed for the most part of several distinct bands ; these extend from the different small bones of the anterior range to the bones adjacent, and usually to those of the succeding range: we generally number three on each side ; they are continuous with the fibrous ligaments of the articulation between the two ranges.

S YN DESMOLO G Y.

37

ARTICLE SEVENTH.

OF THE LIGAMENTS OF THE C ARP 0-M ET A CARPAL ARTICULATION.

§ 913. The five metacarpal bones are united by synovial membranes and external fibrous ligaments with the bones of the anterior or inferior carpal range, and also by bands of fibres with the pisiform bone.

I. SYNOVIAL CAPSULE.

§ 914. The synovial capsule of the first metacarpal bone is loose and broad ; it arises from the edge of the articular surface of the trapezium. The others are for the most part only prolongations of the common synovial capsule (§ 907).

II. FIBROUS LIGAMENTS.

§ 915. The synovial capsule of the first metacarpal bone is strengthened on the radial side by the tendons of the abductor muscles, and also on its edge by longitudinal fibres, which extend from the os trapezium to the first metacarpal bone. These fibres it is true do not exist every where, but they are strongest on the dorsal face ; and as they are almost entirely deficient in some places, we usually number four ligaments in this articulation, the dorsal, the palmar , and two lateral ligaments, the external , and the internal.

§ 916. The fibrous ligaments of the four other metacarpal bones are divided into dorsal and palmar.

The dorsal ligaments are composed of oblique and perpendicular thin fibres, which are generally united in bands ; these go from the dorsal faces of the anterior range of the carpal bones to the upper extremity of the dorsal faces of the metacarpal bones.

The palmar ligaments on the contrary are composed of more horizontal, and in part of more oblique fibres, which are mostly interlaced with the inferior palmar ligaments of the metacarpal bones. They extend from the palmar face of the anterior carpal range to the palmar face of the posterior extremity of the metacarpal bones.

The strongest of all these ligaments goes from the anterior extremity of the posterior face of the trapezium to the base of the third metacarpal bone, and is attached to its anterior edge.

We find also some superficial bands which extend from the summit of the unciform process of the unciform bone, from within outward, to the base of the fifth metacarpal bone.

§ 917. A very strong round ligament arises from the inferior extremity of the pisiform bone, and goes directly to the base of the fifth

3S

DESCRIPTIVE ANATOMY.

metacarpal bone, and which, passing under the band extended from the unciform bone to the fifth metacarpal bone, goes obliquely to the base of the third and the fourth, where it unites with the large ligament described above (§ 909).

ARTICLE EIGHTH.

OF THE ARTICULATION OF THE METACAPAL BONES WITH EACH OTHER.

I. SYNOVIAL CAPSULE.

§ 918. The metacarpal bones of the second, third, fourth, and fifth fingers touch each other at their posterior extremities by smooth and cartilaginous surfaces, over which passes a synovial membrane, which is sometimes only a simple prolongation of the synovial capsule, situated between the posterior and the anterior ranges of the carpal bones (§ 910), but which sometimes also forms several distinct sacs.

The metacarpal bone of the thumb is entirely insulated from the others.

II. FIBROUS LIGAMENTS.

§ 919. The fibrous ligaments are situated between the posterior and the anterior extremities of the metacarpal bones. The posterior are of three kinds, the dorsal , the palmar, and the lateral ; the anterior are single.

I. POSTERIOR FIBROUS LIGAMENTS.

§ 920. The dorsal ligaments are four ; one between every two metacarpal bones.(l) All are composed of transverse fibres. They increase very much in breadth and power from the thumb to the fifth finger ; the first is however larger than the second. Sometimes they are divided into two bands, an anterior and a posterior ; jhe latter is broader.

The lateral ligaments are the narrowest of all. They are usually formed of several distinct bands, and .descend below the former from the upper edge of the ulnar side of the metacarpal bone, to the lower edge of the radial side of the next bone ; at the same time they turn a little forward.

The inferior or palmar ligaments are the strongest. They arc formed of transverse fibres and extend in this direction between the inferior faces of the bases of the adjacent metacarpal bones.

The lateral and palmar ligaments are sometimes deficient between the first and second metacarpal bones.

(1) Generally, only Ihree arc admitted, the ligament between tlic thumb and finger being considered deficient ; but nice dissections convince us that this opinion is erroneous.

SYNDESMOLOGY

39

II. ANTERIOR FIBROUS LIGAMENTS.

§ 921. There are three anterior fibrous ligaments formed of transverse fibres ; they are very tense, and extend between the inferior faces of the heads of the second, third, fourth, and fifth metacarpal bones, where they are continuous with the tendinous fibres. They are much larger and more movable than the preceding.

ARTICLE NINTH.

OP THE METACARPO-PHALANGEAN AND PHALANGEAN LIGAMENTS.

§ 922. The anterior extremities of the metacarpal bones, and the posterior extremities of the bones in the first phalanx, and also the three phalanges, are united exactly in the same manner by synovial capsules and accessory ligaments. .

I. SYNOVIAL CAPSULES.

§ 923. The synovial capsules are loose and broad, especially on the dorsal face of their circumference. At their upper portion, that which looks towards the fore-arm, they extend much farther on the inferior extremity of the upper of the two bones, between which they are found, so that beside the cartilaginous portion they embrace a considerable part which presents no cartilage.

The synovial capsule of the metacarpo-phalangean articulation is much looser and broader than are those of the phalangean articulations.

II. FIBROUS LIGAMENTS.

§ 924. Each of these articulations is confined by three strong ligaments, two lateral and an inferior ligament.

I. LATERAL LIGAMENTS.

§ 925. The two lateral ligaments, the external , and the internal , are rhomboidal, and formed of oblique fibres. They extend from the two rough depressions, at the two extremities of the head of the upper bone to the same depression in the base of the lower. Being attached directly to the lateral faces of the synovial capsule, they prevent it from separating on the sides.

II. INFERIOR LIGAMENT.

§ 92G. The inferior , internal , or anterior ligament is situated on the palmar face of the synovial capsule, and is intimately connected with

40

DESCRIPTIVE ANATOMY.

it.. It is composed of transverse fibres. Its tissue is fibro-cartilaginous. It forms a very thick square layer, which is more broad than long, and bi-concave, the upper face of which looks towards the articulation, and the lower to the flexor tendon.

The upper part of the synovial capsule has no special fibrous ligament, but it is strengthened by the tendon of the extensor muscle of the fingers.

III. UNGUAL LIGAMENTS,

§ 927. The ungual ligaments ( Lig. unguium, s. lateralia subtensa ) are fibrous oblong and rounded bands, situated on both sides of the bones in the third phalanx, and extend from the lateral tubercles of the base to those of the summit. These ligaments are united to the lateral edges of the roots of the nails, and serve to render them firm, and to enlarge the surface on which the nervous tissue of the fingers is expanded.

Chapter II. Of the Ligaments of the Inferior Extremities

§ 928. The ligaments of the lower extremities are,

1. Those of the pelvis, and those which unite either the lower extremities to the trunk, or the upper parts of the lower extremities with each other.
2. The ligaments of the ilio-femoral joint.
3. The ligaments of the knee-joint.
4. The ligaments of the leg.
5. The ligaments of the tibio-tarsal joint.
6. The ligaments of the tarsus.
7. The ligaments of the tarso-metatarsal joint.
8. The ligaments of the metatarso-phalangean and phalangean

joints.

Article First. Of the Ligaments of the Pelvis

§ 929. The bones of the pelvis are connected by fibro-Cartilages and by fibrous ligaments ; but there are no apparent synovial capsules. The fibro-cartilages are the principal and most extensive modes of union. The fibrous ligaments only strengthen the joint formed by the fibro-cartilages ; some pass upon these articulations, others go to other parts, so that they assist to form the walls of the pelvis, to increase the surfaces for the insertion of the muscles, and to protect the vessels and nerves.

I. FIBRO-CARTILAGIKOUS LIGAMENTS.

§ 930. The articulations of the first kind are the sacroiliac symphyses, and the symphysis pubis.

I. SACRO-ILIAC SYMPHYSIS.

§ 931. The sacro-iliac symphysis (symphysis sacro-iliaca ) unites the sacrum with the iliac bones.

The mode of articulation is not the same in all parts.

The smaller anterior and ear-shaped part of each of these two bones is covered with a smooth cartilage. These two cartilages touch ; but they are rarely united, at least completely. They are very distinct from each other and smooth in youth ; but as age advances they become rougher. We even find between them a fluid, which is thicker and less liquid than synovia.

The two bones are very differently articulated at their larger posterior part. The bones there have no cartilage, are very rough, and separated very far from each other, especially upward and backward, and are united by a very dense, strong, felt-like, fibro-cartilaginous, irregular mass, formed particularly of transverse fibres ; this mass is never torn, even when the bones are forcibly separated in this point, but detaches itself from one bone and remains fixed to the other.

We may consider this posterior part of the sacro-iliac symphysis as a particular ligament. This has been done by Bichat, who terms it the sacro-iliac ligament (Lig. sacro-iliacum ) . (1 )

II. SYMPHYSIS PUBIS.

§ 932. The symphysis pubis is situated between the upper parts of the descending branches of the pubes.

The upper convex portion of the descending branch of the pubis is covered by a thin cartilage, which diminishes from above downward. This cartilage is entirely covered upward, downward, forward, and backward by a very thick layer of ligament, formed of transverse fibres, which are strongly developed at the lower part of the symphysis, and which are continuous with the periosteum and with the tendons of the adjacent muscles. This mass is generally thin on its internal face, but often also projects longitudinally, a difference not dependent on the sex, although sex has no influence upon it.

(1) W. Hunter, Remarks on the symphysis of the ossa pubis ; in the London Med . Ohs. and Enq., vol. ii. p. 321-339. — Tenon, Mémoire sur les os du bassin de lafemme, in the Mém. de l'Institut , vol. vi. Paris, 1806, p. 149-201. This memoir points oui very clearly the varieties in the arrangement of the symphysis.

This fibrous layer always renders the articulation much firmer, and is even the principal agent of it. Its firmness however is less than that of the fibro-cartilaginous layer in the sacro-iliac symphyses, since it is generally ruptured when the bones of the pubis are forcibly separated.

The internal arrangement of the joint is not every where the same. Many anatomists admit that the two articular cartilages of the pubis are always united, others assert that they are always separated ; some think, that in the first case, they form a single cartilage. We have reason to think however that the last arrangement never exists, and that when a single cartilage only appears, there are, in fact, two, separated by a layer of fibro-cartilage, which intimately unites with them in their whole length, and is connected forward and backward with the fibrous layer already described ; at least we have never found a single cartilage, and this arrangement is always seen when the cartilages are united. The mass of fibro-cartilage is inversely as that of cartilage.

The arrangement we have described is not general. At all periods of life, without distinction of age, sex, or any other circumstance, we find the two articular cartilages perfectly separated from each other by a greater or less space, and to a greater or less extent of their height, and united only at their lower extremity by a cartilage, or more properly by a fibro-cartilage, which may be removed without any suspicion of violence. If, sometimes, they are completely united, they are also often entirely separated at their posterior part. The first mode of articulation is most common in the male, and the second in the female ; hence the sexes differ, if not constantly, at least primitively and really ; for it is not the consequence of pregnancy and parturition, since it is found also in females before they have attained the age of puberty.

II. FIBROUS LIGAMENTS.

§ 933. Some of the fibrous ligaments of the pelvis are extended over the fibro-cartilages already described, and others attach the bones of the pelvis to its different parts. The former are supplementary , the latter proper ligaments.

I. SUPPLEMENTARY FIBROUS LIGAMENTS.

§ 934. The supplementary fibrous ligaments of the sacro-iliac symphysis are two, a posterior and an anterior.

A. LONG POSTERIOR LIGAMENT OF THE PELVIS.

935. The long posterior ligament of the pelvis (Lig. pelvis posticum , s. ossis ilci longum , s. superficialis) extends almost perpendicularly, although a little from without inward, from the posterior extremity of the iliac crest to the summit of the transverse process of the fourth false sacral vertebra. It is very strong, and its form is oblong.

B. SHORT POSTERIOR LIGAMENT OF THE PELVIS.

§ 936. The short ‘posterior ligament of the pelvis {Li g. pelvis, s. ilei posticum breve , s. profundmn ) arises directly below the preceding ; it follows the same direction with it, but is shorter and narrower. It is attached to the summit of the transverse process of the third false sacral vertebra.

§ 937. Besides these two ligaments, we also see arise from the posterior part of the internal face of the iliac crest some irregular fibres, which are for the most part oblique and flat, which intercross and proceed from below upward, from without inward, and from behind forward. They unite in several bands, placed one after another from above downward, on the posterior face of the lateral parts of the upper false vertebræ of the sacrum. They concur with the preceding ligaments to strengthen the sacro-iliac symphyses posteriorly.(l)

The latter fibres lead to the anterior pelvic ligaments, which strengthen the sacro-iliac symphysis anteriorly.

C. UPPER ANTERIOR PELVIC LIGAMENT.

§ 938. The upper anterior pelvic ligament ( Lig. pelvis anticum superius) is composed of oblique fibres, which ascend from the commencement of the posterior third of the iliac crest to the transverse processes of the last two lumbar vertebræ. Its form is triangular ; it is very thin, and usually perforated for the passage of vessels and nerves, especially when it ascends to the transverse process of the fourth lumbar vertebra.

D. LOWER ANTERIOR PELVIC LIGAMENT.

§ 939. The lower anterior pelvic ligament {Lig. pelvis anticum inferius ) arises from the same point as the preceding, but a little lower and a little farther back. It ascends obliquely from before backward, and is inserted in the transverse process of the fifth lumbar vertebra. It sends fibres downward and forward, which are inserted in the cartilage between the last lumbar and the first sacral vertebra.

XI. PROPER FIBROUS LIGAMENTS.

§ 940. The proper fibrous ligaments are three on each side, and serve less to keep the bones in their position than to complete the parietes of the pelvis, by a substance which is solid, but is yielding to a certain extent. Two of them are situated behind, one on each side of the pelvis ; the third is found forward. The posterior two unite two hones, which are separated in the normal state ; the anterior is extended between the different parts of one and the same bone.

(1) The lateral posterior ligament of ihe pelvis (Lig. laterale posticum assis ilei) will not be described in this place, but in myology.

A. SACKO-SCIATIC LIGAMENT.

§ 941. The sacro sciatic ligament, the large posterior pelvic ligament, or the external posterior pelvic ligament ( Li g . pelvis posticum magnum, s. tuberoso-sacrum ) arises from the posterior and inferior iliac spine, from the posterior part of the external face of the inferior portion of the iliac bones, from the lateral edges, and from the outer part of the posterior face of the inferior portions of the sacrum and coccyx, goes obliquely forward, downward, and outward, contracts and thickens, and is attached to the internal edge of the inferior face of the sciatic tuberosity, where it again enlarges, and gives off a loose, falciform, and thin slip, which goes from the internal face of the ascending branch of the ischium to the descending branch of the same bone.

Beside (§ 940) the uses pointed out, it enlarges the surfaces of attachment of the glutæus maximus muscle and closes the ischiatic notch, which changes into an oval foramen.

B. SMALL SACEO-SCIATIC LIGAMENT.

§942. The small sacro-sciatic , or the’ sacro-spinal ligament ( Lig. pelvis posticum parvinn , s. spinoso-sacrum ) arises before the preceding, from the outer edge of the inferior portion of the sacrum and of the pieces of the coccyx. Its fibres go forward, outward, and upward ; the upper fibres descend, the central are straight, and the inferior ascend. It crosses the preceding, and is attached to the sciatic spine. Its form is an equilateral triangle, and its internal face is usually muscular.

This ligament divides the great fissure or the sciatic foramen into two parts, an upper and a lower ; the first is much larger, and is separated from the other by the parts which pass through it.

C. OBTURATOR MEMBRANE.

§ 943. The obturator membrane {Lig. s. membrana obturatoria , s. foraminis thyroidei ossium pubis) is thin, and formed of irregular fibres, which are mostly transverse and a little oblique, and which intercross variously. It arises from the sharp edges of the obturator foramen, further forward at its upper than at its lower portion, and it closes this opening almost entirely. We see at its upper and external part only a constant rounded and oblong hollow, through which the obturator vessels and nerves pass out from the cavity of the pelvis. But this hollow is partly though imperfectly filled, for one or more bands of very strong transverse fibres go from the anterior edge of the ascending branch of the ischium to the beginning of the external edge of the descending branch of the pubis, several lines behind the membrane ; so that it would seem as if the upper fibres had been separated from each other in this place by the vessels and nerves which pass out from the pelvis.

This space deserves notice ; since in thyroidal hernia, which is very rare, the abdominal viscera protrude from it and follow the course of the vessels.

We also find other openings in the obturator membrane, particularly at its lower part ; but these are less constant.

III. CHANGES OF THE PELVIC LIGAMENTS DURING PREGNANCY. (1 )

§ 944. Most usually, the bones of the pelvis have but a slight degree of motion on each other. Hence arises a question, whether this mobility is not increased under certain circumstances, and particularly if this change does not supervene during pregnancy.

Opinions differ in this respect. Some admit that the change occurs normally in every state of pregnancy. Others think it supervenes only under certain circumstances, as when the bones are diseased, or after very difficult labors ; and ethers, that it never takes place.

The first of these opinions, already advanced by Pineau, is undoubtedly the most correct ; since, according to the testimony of the best observers as Sandifort and Hunter, about the period of parturition, the symphyses, especially that of the pubis, always become looser, broader, and yield more easily. Beside, the latter symphysis is always broader in those females who are mothers of several children, than in virgins. This phenomenon deserves to be pointed out, as it demonstrates that all the parts interested in the act of parturition are analogously changed and become looser and more spungy.

Finally, this change does not necessarily imply a real separation of the pubic cartilages, but only the softening of the fibro-cartilage, — a state in which the articular cartilages do not seem to participate. Tenon has maintained the contrary, but he is wrong: if the cartilages have sometimes been found really separated, this state must be considered as congenital or morbid ; since this arrangement has been observed even in very young girls, or the loose surfaces of the cartilages were likewise rough, or pus has been found in the cavity.(2)

This softening begins to take place in the eighth month of pregnancy, that is to say, precisely at that time when the lower region of the genital organs begins to enlarge and to secrete a great quantity of mucus.

(1) S. Pineau, De distractione ossiumpubis inpartu naturali, deque rationibus quibus ea probatur ; in libris de virginitatis notis, graviditate etpartu, book ii. — Sandifort, Depelvi e jusque inpartu dilatatione, Leyden, 1763. — Hunter, loc. cit. — Louis, Sur V écartement des os du bassin, in the Mém de l'ac. de chir., vol. iv. Paris, 1769. Hist, p. 63-102.— Tenon, loc. cit.

(2) A singular case of the separation of the ossa pubis, in the Med. obs. and inq., vol. ii. no. 28.

This phenomenon is important, as by it the pelvis is enlarged and the act of parturition is facilitated. We must not confound it with the separation and the rupture of the cartilages, which may result from disease, either by destroying the fibro-cartilage between the two cartilages or by detaching the latter from the surfaces of bone, where the fibro-cartilage separates from the two lateral cartilages ; so that then three cartilages are formed, two of which adhere, while the central one is loose.(l)

Article Second. Of the Ilio-Femoral Articulation

§ 945. The ilio-femoral joint is formed by the fibro-cartilaginous prolongation of the cotyloid cavity, a synovial capsule, a fibrous capsule, and an internal fibrous ligament.

I. FIBRO-CARTILAGINOUS LIGAMENT.

§ 946. The fibro-cartilaginous ligament of the cotyloid cavity, or the cartilaginous lip ( Lig . cotyloideum fibro-carlilagineum , acetabuli labrum cartilagineum ), is a complete triangular ring, formed of fibrocartilage, which is several lines high and thick. It is thickest above and outward, and passes above the cotyloid fissure, so as to complete the edge of this cavity. Its loose edge is sharp and looks a little inward ; hence this ligament serves also to enlarge the cotyloid cavity, but contracts its circumference, although but slightly.

This ligament is formed entirely of cartilaginous substance only where it passes over the cotyloid fissure.

The space below is filled by some bands, situated, one within, the other without, — the external and internal ligaments of the cartilaginous lip {Lig. labri cartilaginei externum et internum ), which are continuous, the first with the obturator membrane and both with the fibro-cartilage.

II. SYNOVIAL CAPSULE.

§ 947. The synovial capsule ( capsularis sijnovialis membrana ) passes from the bottom of the cotyloid cavity on the cartilaginous lip (§ 945). It is intimately connected with both, completely covers the external face of the lip, then is reflected on itself at an acute angle, and finally descends loosely to go to the femur. There it is attached to the lower extremity of the neck, goes to the anterior oblique line, descending lower forward than backward, reflects at an acute angle from below upward, and blends with the cartilage which covers the head.

(1) Tenon, loc. cit., Onsiemc obs., p. 174.

The posterior, superior, inferior, and external parts of the cotyloid cavity are covered by a semicircular cartilage, which extends, on all sides except the cotyloid notch, even to the loose edge of the cavity and to the cartilaginous lip, from which it is evidently separated. This cartilage is intimately connected with the synovial capsule.

The anterior and middle part of the cotyloid cavity is the deepest, and has an irregular quadrilateral form : it is rough, but is not covered with cartilage. It contains much articular fat. The synovial capsule adheres but slightly in this place, and is separated from the bone by layers of fat.

III. ROUND LIGAMENT.

§ 948. Directly before the portion of the synovial membrane which passes on the space below the bridge formed by the cartilaginous lip, arises a quadrangular ligament about an inch long, called the round ligament of the femur ( Lig . ossis femoris teres s. roiundum). The extremities of this ligament enlarge a little, and its outer end is attached to the bottom of the cavity in the head of the femur. It retains this bone more firmly in its situation.

It is formed of longitudinal fibres, which are attached to the upper and lower horns of the cotyloid fissure and unite with the ligaments of the cartilaginous lip and also with the lip itself ; but they are covered in all their circumference by a sheath of synovial membrane, which is reflected on itself.

This ligament prevents the luxation of the femur upward, outward, and downward, as it prevents the femur from escaping in that direction : it is at least necessarily broken when this dislocation takes place, although the femur can quit the cotyloid cavity forward without its being ruptured.

§ 949. The round ligament is sometimes deficient, either primitively or from a violent and often repeated compression of the ilio-femoral joint.

IV. FIBROUS CAPSULE.

§ 950. The fibrous capsule ( capsula fibrosa ossis femoris) is the strongest and most perfect of all in the body. It arises above from the circumference of the inferior edge of the outer face of the cartilaginous lip, unites very narrowly in its whole extent with the external face of the synovial capsule, and is attached to the lower extremity of the head of the femur exactly in that part where the outer part of the capsule is reflected to cover the neck of the bone. It is very strong at its upper external and anterior portion, is two or three lines thick, and is formed of several superimposed layers of longitudinal fibres.

This capsule is protected by the adjacent muscles of the thigh ; although the tendons of the muscles are not connected with it.

From its upper, anterior and internal part arise several bands, which ascend obliquely toward the internal part of the anterior face of the horizontal branch of the pubis and the anterior face of the obturator membrane, with the fibres of which they are blended.

Article Third. Of the Articulation of the Knee

§ 951. The knee-joint is the most complex articulation in the body; for the synovial capsule is not only strengthened externally by three fibrous ligaments, but the corresponding surfaces of the femur and tibia are attached within this capsule by strong fibrous ligaments, which are even their principal mode of union. From this arrangement, the kneejoint is also the strongest of all. What renders the joint more complex is, that the two bones are separated from each other by an interarticular cartilage.

I. SYNOVIAL MEMBRANE.

§ 952. The synovial membrane ( membrana synovialis articuli genu) arises some lines before the cartilage of the articular surface of the femur, and backward from directly above this same cartilage. It is attached below to all the circumference of the rough edge of the upper articular cartilaginous surface of the tibia.

Its upper and lower faces unite with the cartilages which cover the articular surfaces of the two bones. A part of its anterior face covers also the posterior face and the lateral edges of the patella ; so that the patella slightly projects within the cavity.

Beside, its upper and anterior portion covers rather closely the lower part of the extensor muscle of the leg, from which however it may be separated more easily than from the bone. The rest is united to the adjacent parts only by a very loose mucous tissue.

The lower part of the cavity which it thus forms is divided into a right and a left portion ; because a perpendicular fold is formed, which is loose upward and extends from the posterior intercondyloid fossa of the femur to the anterior part of its circumference behind the ligament of the patella, and which is attached in this place below the patella itself.

We find considerable accumulations of articular fat in many parts, especially on the anterior wall, around the patella, in the fold we have mentioned, and behind the condyles of the femur.

The whole capsule is very broad and loose, especially at its anterior part; less so however on the sides, which must be ascribed to the nature of the motions of the leg, which are only flexion and extension.

The outer face of the synovial membrane is strengthened behind by oblique fibres, which descend from the external condyle of the femur to the internal condyle of the tibia.

IX. EXTERNAL FIBROUS LIGAMENTS.

§ 953. On the circumference of the synovial membrane we find an internal and two external lateral fibrous ligaments.

I. INTERNAL LATERAL LIGAMENT.

§ 954. The internal lateral ligament ( Lig . laterale internum ) is the strongest, and is formed of perpendicular fibres. It descends from the anterior part of the internal face of the inner condyle to the upper part of the internal face of the tibia, where it is attached. It is broader above than below and is triangular, the base of the triangle being turned forward. It prevents the articular surfaces from being dislocated inward.

II. LONG EXTERNAL LATERAL LIGAMENT.

§ 955. The long, anterior, or external lateral ligament (Lig. genu laterale externum, s. longum, s.anterius) forms an oblong, rounded, firm band. It is situated before the short ligament, between the lower extremity of the external condyle, from the external face of which it arises below, and the anterior part of the external face of the head of the fibula, to which it is attached.

III. SHORT EXTERNAL LATERAL LIGAMENT.

§ 956. The short external or posterior lateral ligament (Lig. genu laterale externum breve s. posterius) is still feebler than the preceding. It arises a little above, and half an inch behind it, from the inferior part of the posterior face of the external condyle of the femur, goes a little obliquely from above downward and from within outward, and is attached to the summit of the head of the tibia, higher than the preceding.

The two external lateral ligaments prevent the luxation of the kneejoint outward. The terms anterior and postenor are more convenient than those generally used, as the length of both is the same or nearly the same.

III. INTERNAL FIBROUS OR CRUCIAL LIGAMENTS.

§ 957. The crucial ligaments (Lig. cruciata genu) are the strongest of all the connections between the femur and the tibia. We find two, an anterior and a posterior.

The posterior is longer, broader, and stronger than the other, and its lower part is thicker but narrower than the upper part. It extends from the posterior extremity of the depression between the two condyles of the tibia, toward the anterior extremity of the posterior intercondyloid fossa, at the internal face of the external condyle of the femur, where it is attached by a semicircular edge. Its direction is from below upward, from behind forward, and from within outward.

The anterior arises from the anterior extremity of the internal point on the upper articular face of the tibia, goes outward, upward, and backward, crosses the preceding but does not touch it, and is attached a little behind it to the internal face of the outer condyle of the femur.

These ligaments unite the tibia to the femur firmly, and also limit the turning of these bones on their axes. The posterior opposes the rotation of the thigh outward and that of the leg inward, while the anterior prevents the rotation of the thigh inward and that of the leg outward.

IV. SEMILUNAR CARTILAGES.

§ 958. The semilunar or falciform cartilages ( cartilagines interarliculares genu semilunares , s .falcatÅ“) derive their name from their form. Both are broader behind than before : the external edge which is convex, is much thicker than the internal which is concave and terminates obliquely in a point. The first adheres intimately to the synovial capsule, while the second is entirely loose ; but their two extremities are attached by a strong fibrous ligament to the posterior part of the intercondyloid fossa of the tibia. Another strong transverse ligament unites them at their anterior extremities. Their inferior faces are plain, but their superior are concave to a greater or less extent, and pointed near the two extremities. Each rests on one of the portions of the cartilaginous face of the tibia, and corresponds to one of the condyles of the femur. They are separated by the eminence on the upper articular face of the tibia, and their concave edges are turned toward each other.

The external falciform cartilage is uniformly broader than the internal in its whole extent, and also a little larger ; hence it covers more of the upper face of the external condyle of the tibia. Its posterior extremity is very firmly attached to the fossa placed behind the spine of the tibia. It is also attached to the femur by a very strong ligament, which arises more posteriorly, ascends obliquely from without inward between the two crucial ligaments, and is inserted directly behind the posterior, on the internal face of the internal condyle of the femur. Its anterior extremity, which is reflected from before backward behind the anterior articular ligament of the two cartilages, is attached to the anterior part of the depression before the spine of the tibia, directly behind the lower extremity of the anterior crucial ligament.

The internal falciform cartilage is attached by its posterior extremity farther inward and backward than the external, directly before the posterior crucial ligament, at the posterior extremity of the depression placed behind the spine of the tibia, much farther forward and outward than the external.

These two cartilages elevate the edge of the upper articular surface of the tibia, and thus impede the gliding of the condyles of the femur ; but they prevent particularly the compression of the femur and the tibia in the motions of the leg.

§ 959. Of all the joints, the articulation of the knee is the most subject to morbid alterations of texture, although it is not often dislocated, since the arrangement and firmness of its fibrous ligaments admit of but slight motions.

In this particularly, above all other articulations, abnormal bones and cartilages are developed, which are at first attached to the synovial membrane by thin peduncles, but which in time are detached and isolated.

This articulation is also almost the only one exposed to fungus of the joints ( fungus articulormn).

These conditions depend, partly on its great size, or partly on its position, as it is exposed to mechanical injury and compression more than any other joint.

Article Fourth. Of the Articulations of the Bones of the Leg

§ 960. The bones of the leg are attached to each other at their upper, middle, and lower portions.

I. UPPER ARTICULATION.

§ 961. The upper articulation of the two bones of the leg is formed by a short synovial membrane, the capsule of the head of the fibula (Lig. capituli fibulae), which arises some lines above the head of the cartilaginous lateral articular facet of the tibia, and below the upper articular facet of the fibula, and the anterior face of which especially is strengthened by very strong transverse fibres, which extend from the internal edge of the head of the fibula to the external face of the upper extremity of the tibia.

II. MIDDLE ARTICULATION.

§ 962. The middle articulation is formed by the interosseous ligament (Lig. interosseum , s. membrana interossea). This ligament is thin and smooth ; it gradually contracts from above downward, and is formed of oblique fibres, which descend from the external edge of the tibia to the crest of the fibula.

At its upper part we see a foramen, through which the anterior tibial vessels and nerves pass, and another below for the peroneal artery. We also occasionally see in all its extent similar but smaller openings.

It is situated between the flexor and the extensor muscles of the leg ; the fibres of which arise in part from its two faces.

III. INFERIOR ARTICULATION.

§ 963. Between the inferior extremities of the tibia and fibula a very narrow slip of the synovial membrane of the articulation of the foot extends in the form of a cul-de-sac, but there is no special articular capsule. This slip is attached by three broad fibrous bands.

I. ANTERIOR TIBIO- PERONEAL LIGAMENT.

§ 964. The anterior tibio-peroneal ligament ( Lig. tibio-fibulare anterim) arises from the external part of the anterior face of the lower extremity of the tibia, and is attached to the inner part of the anterior face of the external malleolus. It is formed of fibres which descend obliquely from within outward.

II. POSTERIOR TIBIO- PERONEAL LIGAMENT.

§ 965. The posterior tibio-peroneal ligament (Lig. tibio-fibulare posterius) is formed of fibres which follow the same direction as those of the preceding ; they extend 1'rom the external part of the posterior face of the inferior extremity of the tibia to the internal part of the posterior face of the external malleolus.

III. SUPERIOR TIBIO-PERONEAL LIGAMENT.

§966. The superior tibio-peroneal ligament (Lig. tibio-fibulare sup erius) is formed of fibres similar to, but much shorter than the two preceding, and extends from the external face of the tibia to the internal face of the fibula, directly above the inferior processes of these two bones.

§ 967. A division of the anterior (§ 963) and of the posterior (§ 664) ligament into two portions, an upper and a lower, is useless, and does not naturally exist.

Article Fifth. Of The Articulation of the Foot

I. SYNOVIAL CAPSULE.

§ 968. The synovial capsule of the joint of the foot ( membrana arliculi pedis synovialis) arises from the edge of the articular and cartilaginous face of the articulation of the tibia and fibula, and from the corresponding face of the astragalus. It blends with all these surfaces, and sends a slip between the tibia and the fibula (§ 963). It is every where very loose, but loosest at its external part.

II. FIBROUS LIGAMENTS.

§ 969. The synovial capsule is covered forward, backward, and on the sides, by several bands, which do not unite in a fibrous capsule, and which extend from the tibia and fibula to the astragalus and calcanéum.

I. ANTERIOR LIGAMENTS.

§ 970. We may admit two anterior ligaments, an internal and an external. The central part of the anterior wall of the synovial capsule being loose, its two ligaments are much thinner than the others.

The internal anterior ligament {Lig. anterius internum) is composed of perpendicular fibres, some of which ascend a little obliquely outward. It is larger than the external, and goes from one part of the anterior edge of the lower articular face o? the tibia to the back of the scaphoid bone.

The external anterior ligament ( Lig. anterius externum) arises from the anterior part of the outer face of the external malleolus, and being formed of oblique fibres, proceeds from without inward and from behind forward, and is attached to ' the outer part of the anterior face of the body of the astragalus. It is usually formed of two bands, situated one at the side of the other, and separated by an interval. The upper band is much larger than the lower. The whole ligament has an irregular quadrilateral form.

II. POSTERIOR LIGAMENTS.

§ 971. Usually there are two posterior ligaments, one superficial and the other deep. The superficial posterior ligament {Lig. posterius superficiale) has an elongated cylindrical form, and extends from the internal edge of the external malleolus, below the insertion of the posterior tibio-peroneal ligament, to the centre of the posterior edge of the body of the astragalus, where it is attached to an eminence of this bone. Usually, a special and smaller band is detached from this point, which unites to the preceding, but goes in a contrary direction downward and outward, to be inserted in the upper part of the internal face of the tuberosity of the calcanéum.

The deep posterior ligament {Lig. posterius profundum) is much stronger than the preceding, and is separated from it by fat and cellular tissue. It rests directly on the posterior wall of the synovial capsule, and is formed of longitudinal and oblique fibres, which arise from the posterior edge of the lower articular face of the tibia, and from the under part of the inner face of the external malleolus. These fibres converge and go downward, and are inserted above the preceding ligament in the posterior face of the bodj? of the astragalus.

Sometimes the two ligaments are blended together.

The fibres which come from the fibula are always the strongest.

III. LATERAL LIGAMENTS.

§ 972. The lateral ligaments are much stronger than all the other fibrous ligaments.

A. EXTERNAL LATERAL LIGAMENT.

§ 973. The external lateral ligament ( Lig. laterale externum fibulae, rectum , s. perpendiculare , s. medium, s. triquetrum) is much longer from above downward than from before backward, and gradually enlarges in the first direction. It extends from the summit of the internal malleolus to the external face of the calcanéum, to which it is attached, after dividing into an anterior and a posterior fasciculus.

B. INTERNAL LATERAL LIGAMENT.

§ 974. The internal lateral ligament, called generally the triangular ligament, and which might be called the trapezoid {Lig. laterale internum deltoides, trapezium ), goes from the inferior edge of the internal malleolus to the internal faces of the astragalus and calcanéum. It is more broad than high, is lower than the external, but is broader and as strong. It blends with the inner anterior ligament forward, and with the internal portion of the deep posterior ligament backward.

6. Of the Ligaments of the Tarsus

§ 975. All the bones of the tarsus are confined by short and thick synovial capsules, over which in many parts fibrous ligaments are extended. The latter are divided into those of the back, of the sole, of the tibial and fibular edges of the foot.

I. LIGAMENTS OF THE POSTERIOR RANGE.

I. SYNOVIAL CAPSULE.

§ 976. The two bones of the posterior range are united by two synovial membranes, a proper and a common.

The proper synovial capside {capsula propria astragalo-calcanea ) arises below from the edges of the upper and cartilaginous face of the body of the calcanéum, extends a little backward, over the portion of this same face, which is not cartilaginous, and is attached above to the corresponding circumference of the cartilage on the cartilaginous inferior face of the body of the astragalus.

The common synovial capsule ( capsula communis , s. asiragalo-calcaneo-scaphoidea ) will be described hereafter. It is situated between the upper cartilaginous face of the anterior process of the calcanéum and the lower face of the head of the astragalus.

II. FIBROUS LIGAMENTS.

§ 977. The two synovial capsules are strengthened in several parts by fibrous ligaments, and the proper capsules particularly by the lateral and the posterior ligaments of the articulation of the foot (§ 971).

Besides, a broad internal ligament extends from the internal part of the posterior face of the body of the astragalus, to the posterior part of the internal face of the calcanéum, and is called the internal and posterior aslragalo-calcanean ligament ( Lig. astragalo-calcaneum internum, , s. posterius.

The anterior face is confined by an internal and an external ligament.

The internal anterior aslragalo-calcanean ligament (Lig. astragalocalcaneum internum anterius ) extends from the internal extremity of the cartilaginous surface of the anterior process of the calcanéum to the internal face of the astragalus.

The external astragalo-calcanean , or interosseous ligament (Lig. astragalo-calcaneum externum , s. interosseum ) is composed of five or six very strong fasciculi, which are situated behind one another, and which diminish in length very much from behind forward and also from without inward. These fasciculi go from the external rough part of the upper face of the anterior process of the calcanéum to the external face of the neck and head of the astragalus, and to the channeled and acartilaginous part of the inferior face which separates the upper faces of the body and the anterior process. They fill the large space between these two bones.

II. OF THE LIGAMENTS BETWEEN THE ANTERIOR AND THE POSTERIOR RANGE.

I. SYNOVIAL CAPSULES.

§ 978. There are two synovial capsules, one for the astragalus, ihe calcanéum, and the scaphoid bone ; the other for the calcanéum and the cuboid bone.

The first, or the astragalo-calcaneo-scaphoid capsule, has already been mentioned (§ 976). It arises from the margin of the anterior articular face of the astragalus, forms a cul-de-sac backward, which is reflected on the upper articular face of the anterior process of the calcanéum, and goes to the circumference of the posterior articular face of the scaphoid bone, and is blended with its posterior cartilaginous face.

The proper, or the calcanco -cuboid capsule ( capsula synovialis calcaneo-cuboidea), extends between the corresponding articular faces of these two bones.

II. FIBROUS LIGAMENTS.

§ 979. The astragalus and the calcanéum are united to the scaphoid bone, and this latter to the cuboid bone by external fibrous ligaments.

A. CALCANEO-SCAPHOID LIGAMENTS.

§ 980. There are two calcaneo-scaphoid ligaments ( Lig . calcaneoscaphoidea ), a superior and an inferior.

The superior is much weaker than the other, and arises from the anterior edge of the rough portion of the tuberosity of the calcanéum, and ascends obliquely from behind forward, and from without inward, where it is attached to the external extremity of the back of the scaphoid bone.

The inferior , much stronger than the superior, being formed of several distinct bands, is more broad than long. It extends from the anterior edge of the tuberosity of the calcanéum to the external part of the inferior face of the scaphoid bone. It forms, conjointly with the calcanéum and scaphoid bones, a cavity for the head of the astragalus.

B. ASTRAGALO-SCAPHOID LIGAMENT.

§ 981. The astragalo-scaphoid ligament (Lig. astragalo-scaphoidcum) covers all the upper surface of the synovial capsule of the two bones. It is formed of thin fibres, the direction of which is from before backward. Some of these fibres proceed even to the cuneiform bones.

C. OALCANEO-CUBOID LIGAMENTS.

§ 982. The calcanéum is united to the cuboid bone by superior, external, and inferior ligaments.

The superior ligaments (Lig. calcaneo-cuboidea superior a s. dorsalia) are usually three in number, placed successively from without inward. They form thin and flat bands, which increase progressively in length, from within outward, and are situated between the upper edge of the articular face of the calcanéum and the same edge of the corresponding face of the cuboid bone.

The external ligament (Lig. calcuneo-cuboideum externum s.fibulare) extends as high as the cartilaginous faces of the two bones, on the outsides of which they are attached. It is also thin, but stronger than the superior.

The inferior ligament (Lig. calcaneo-cuboideum inferius s. plantare) may be considered as formed by three superimposed layers, each of which is stronger than the other ligaments of these bones, and which unite to form one of the strongest fibrous ligaments of the tarsus, perhaps the strongest even in the whole body.

The superficial layer, the longest and strongest, arises directly from the lower face of the tuberosity of the calcanéum, and is attached to all the tuberosity of the cuboid bone.

The central layer is much shorter and narrower, and is not entirely covered on the inside by the preceding. We ought, properly speaking, to consider it as a continuation of the inferior calcaneo-scaphoid ligament (§ 980). It arises from the inner part of the anterior edge of the articular face of the calcanéum, and is attached behind to the internal part of the rough inferior face of the cuboid bone.

The deep layer is entirely covered by the superficial ; but by the central layer, only at its internal part. It is formed of fibres which go more obliquely from without inward and forward. It arises from the same parts of the two bones, but a little more externally.

III. LIGAMENTS BETWEEN THE BONES OF THE ANTERIOR RANGE.

I. SC APHO IDO-CUBOID LIGAMENTS.

§ 983. The scaphoid and cuboid bones are united, especially posteriorly, in their whole extent by the interosseous ligament ( Lig . interosseum scaplwido-cuboideum ), the fibres of which are oblique, short, and very compact. We usually find a synovial capsule before this ligament.

§ 984. The external fibrous ligaments are two :

1st. The dorsal scaphoido-cuboid ligament (Lig. scaphoideo-cuboideum dorsale ) which is square, and arises from fibres which extend obliquely from behind forward, and from within outward, it goes from the external edge of the scaphoid to the centre of the upper face of the cuboid bone.

2. The plantar , Lig. scaplioideo-cuboideum plantare) has the same form and direction as the preceding, but is composed of fibres which are more detached from each other : it extends from the centre of the inferior face of the scaphoid bone to the centre of the internal edge of the cuboid bone.

II. LIGAMENTS BETWEEN THE SCAPHOID AND CUNEIFORM BONES.

§ 985. The ligaments which unite the scaphoid to the three cuneiform bones, are a synovial capsule and fibrous ligaments.

A. SYNOVIAL CAPSULE.

§ 986. The synovial capsule is situated between the commencement of the anterior face of the scaphoid bone, and the posterior face of the three cuneiform bones. It also penetrates between the latter

B. FIBI10U8 LIGAMENT?.

§ 987. a. The fibrous ligaments are, the dorsal , the internal , and the plantar.

We may admit two dorsal ligaments ( Lig . scaphoideo-cuboidea dorsalia), an internal and an external.

The internal is triangular, and extends from the anterior and external part of the upper face of the scaphoid bone to the upper face of the second cuneiform bone. Its fibres go forward and outward.

The external is smaller than the other, from which it is entirely separated, is square, and formed of fibres which proceed in the same direction. It arises more externally, immediately at the side of the preceding, and is attached to the upper face of the third cuneiform bone. It is blended with the dorsal scaphoido-cuboid ligament (§ 984).

b. A strong internal ligament, (Lig. scaphoideo-cuboideum internum ), the fibres of which are straight and almost horizontal, extends from the anterior edge of the internal face of the scaphoid bone to the posterior part of the inner face of the first cuneiform bone, and unites these two bones in their whole extent.

c. We may admit three plantar ligaments. The internal, the strongest is the continuation of the preceding, but is thicker than it. It is square, and its fibres which are straight, extend from the tuberosity of the scaphoid bone to that on the inferior face and the posterior edge of the first cuneiform bone.

The central is feebler, but longer, and arises at the side of the preceding a little more externally. It goes obliquely from before back ward, and from without inward, to the posterior part of the inferior edge of the second cuneiform bone.

The external , which is feebler and situated more deeply, is composed of detached, oblique, and transverse fasciculi. It extends from the external and anterior part of the inferior face of the scaphoid bone, to the posterior extremity of the inferior edge of the second and third cuneiform bones.

III. LIGAMENTS BETWEEN THE CUBOID AND CUNEIFORM BONES.

§ 988. These ligaments are, a synovial capsule and two fibrous ligaments.

The synovial capsule is situated between the cartilaginous points of the cuboid and of the third cuneiform bones.

There are two fibrous ligaments, a dorsal and a plantar.

a. The dorsal ligament., which is not constant, being often entirely replaced by the dorsal scaphoido-cuboid ligament (§ 984), when it exists, is very feeble, and is situated at the external edge of this last : it is formed of longitudinal fibres, which extend from the back of the cuboid bone to the posterior extremity of the back of the third cuneiform bone.

b. The plantar ligament is much stronger, and is formed of several distinct fasciculi, the anterior of which is the largest, and which all extend transversely from the internal edge of the plantar face, and from the lower part of the inner face of the cuboid bone to the inferior face and to the inferior part of the internal face of the third cuneiform bone.

IV. LIGAMENTS Of THE CUNEIFORM BONES.

§ 989. 1st. The synovial capsules between the three cuneiform bones, arise from the common capsule between the scaphoid and the cuneiform bones (§ 986).

2d. The fibrous ligaments are,

a. The dorsal ligaments which form several feeble layers of oblique and transverse fibres, which extend from the first to the second, and from this to the third cuneiform bone.

b. The interosseous ligaments, which are very firm transverse fibres, extend between the internal faces of the first and second, and of the second and third cuneiform bones, where there is no slip from the synovial capsule.

c. The plantar ligaments are firm but isolated and usually oblique bands, which go from the posterior part of the internal face of the first cuneiform bone to the posterior extremity of the inferior edge of the second, and from this to the posterior extremity of the inferior edge of the third. They unite with the interosseous and plantar scaphoidocuboid ligament.

Article Seventh. Of the Ligaments Between the Tarsus and Metatarsus

I. SYNOVIAL CAPSULE.

§ 990. The synovial membrane between the bones of the metatarsus on one side, the three cuneiform and the cuboid bones on the other, are not arranged in the same manner in all parts nor in all subjects.

We however find a special synovial membrane between the anterior extremity of the first cuneiform bone and the posterior extremity of the first metatarsal bone.

Usually, the second metatarsal bone is united to the three cuneiform bones by a common synovial capsule.

We find a third synovial membrane between the third metatarsal and the third cuneiform bones.

Finally, the fourth and fifth metatarsal bones are united to the cuboid bone b}r a common capsule.

II. FIBROUS LIGAMENTS.

§ 991. The fibrous ligaments which strengthen these synovial membranes are divided into dorsal and plantar.

а. The dorsal form several square and thin bands, which go from the upper face of the bones of the metatarsus corresponding to the tarsal bones, to the posterior extremity of the latter. The fibres of the external are a little oblique from within outward and from behind forward ; those of the internal go directly from before backward.

б. The plantar correspond to the dorsal : they are however, except the first, a little weaker. They are strengthened by the tendons of the tibialis anticus and posticus muscles.

We see also strong fibrous bands, which go from some of the metatarsal to the tarsal bones which do not articulate with them ; for instance, from the base of the second and fourth metatarsal bones to the anterior extremity of the third cuneiform bone going directly from before backward, and from the plantar face of the posterior extremity of the fifth metatarsal bone, transversely, to the extremity of the third cuneiform bone.

The posterior part of the circumference of the articulation of the first cuneiform bone with the metatarsal bone of the first toe is also furnished with strong ligamentous fibres, which go directly from before backward.

ARTICLE EIGHTH.

OF THE LIGAMENTS OF THE METATARSAL RONES AND PHALANGES.

I. METATARSAL LIGAMENTS.

I. POSTERIOR LIGAMENTS.

§ 992. The metatarsal bones, except the first, have the corresponding faces of their posterior extremities covered by slips of the synovial membranes extended between them and the bones of the anterior range of the tarsus (§ 990).

Th e fibrous ligaments resemble those of the metacarpus (§ 919-921). They are divided into dorsal , middle , and plantar.

The upper or dorsal ( Lig . ossium metacarpi dorsalia) are formed of transverse fibres, which arise from the dorsal side of the corresponding faces of the posterior extremity of the adjacent bones. We find only three of them, because the metatarsal bone of the first toe does not articulate in this manner with the second. The upper ligament is however here replaced by an analogous ligament, which extends from the first cuneiform bone to the base of the second metatarsal bone.

The middle or interosseous ligaments ( Li g . ossium metatarsi media s. interossea) are sometimes only three in number, and proceed obliquely from above and inward to go to the next metatarsal bone : more frequently however there are four. Similar fibres exist also between the first and second metatarsal bones.

The inferior or plantar ligaments ( Lig . ossium metatarsi inferiora s. plantaria ) are like the dorsal, only three in number, and are the strongest. The ligament between the first and second metatarsal bone becomes a very strong fibrous layer, which extends from the first cuneiform bone to the second and third metatarsal bones.

The fibres of this very long ligament proceed in a direction opposite to that of those between the fourth and fifth metatarsal bones ; that is, the former go from behind forward and from within outward, the latter from without inward and from behind forward, so that they converge anteriorly.

II. ANTERIOR LIGAMENTS.

§ 993. On the plantar face between the anterior extremities of all the metatarsal bones, are very strong square ligaments, formed of longitudinal fibres, which are attached to the synovial capsules rather than to the bones. These are called the anterior metatarsal ligaments (Lig. metatar-si anteriora ptantaria).

II. LIGAMENTS OF THE TOES.

§ 994. Synovial capsules, with lateral and inferior fibrous ligaments, exist between the posterior phalanx of each toe and the corresponding metatarsal bone, and also between the different phalanges. The final phalanges also have ungual ligaments. These parts being similar to those of the hand (§ 922-927), it is unnecessary to describe them.

Next - Book 3 Myology

Meckel JF. Handbook of Pathological Anatomy (Handbuch der pathologischen Anatomie) Vol. 2. (1812) Leipzig.

I. Ligaments of the Trunk | II. Ligaments of the Head | III. Ligaments of the Extremities

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