Syphilitic Affections of Tendon Sheaths.—These closely resemble the syphilitic affections of the synovial membrane of joints. During the secondary period the lesion usually consists in effusion into the sheath; gummata are met with during the tertiary period.
Arborescent lipoma has been found in the sheaths of tendons about the wrist and ankle, sometimes in a multiple and symmetrical form, unattended by symptoms and disappearing under anti-syphilitic treatment.
Tumours of Tendon Sheaths.—Innocent tumours, such as lipoma, fibroma, and myxoma, are rare. Special mention should be made of the myeloma which is met with at the wrist or ankle as an elongated swelling of slow development, or over the phalanx of a finger as a small rounded swelling. The tumour tissue, when exposed by dissection, is of a chocolate or chamois-yellow colour, and consists almost entirely of giant cells. The treatment consists in dissecting the tumour tissue off the tendons, and this is usually successful in bringing about a permanent cure.
All varieties of sarcoma are met with, but their origin from tendon sheaths is not associated with special features.
CHAPTER XIX
THE BURSÆ
- [Anatomy—Normal and adventitious bursæ]
- —[Injuries: Bursal hæmatoma]
- —[Diseases]:
- [Infective bursitis];
- [Traumatic or trade bursitis];
- [Bursal hydrops];
- [Solid bursal tumour];
- [Gonorrhœal and suppurative forms of bursitis];
- [Tuberculous and syphilitic disease]
- —[Tumours]
- —[Diseases of individual bursæ in the upper and lower extremities].
A bursa is a closed sac lined by endothelium and containing synovia. Some are normally present—for instance, that between the skin and the patella, and that between the aponeurosis of the gluteus maximus and the great trochanter. Adventitious bursæ are developed as a result of abnormal pressure—for example, over the tarsal bones in cases of club-foot.
Injuries of Bursæ.—As a result of contusion, especially in bleeders, hæmorrhage may occur into the cavity of a bursa and give rise to a bursal hæmatoma. Such a hæmatoma may mask a fracture of the bone beneath—for example, fracture of the olecranon.
Diseases of Bursæ.—The lining membrane of bursæ resembles that of joints and tendon sheaths, and is liable to the same forms of disease.
Infective bursitis frequently follows abrasions, scratches, and wounds of the skin over the prepatellar or olecranon bursa, and in neglected cases the infection transgresses the wall of the bursa and gives rise to a spreading cellulitis.