Manual of Surgery Volume First: General Surgery. Sixth Edition.

by Alexis Thomson; Alexander Miles

Fig. 116.—Great Enlargement of the Ischial Bursa.

(Mr. Scot-Skirving's case.)

The bursa between the ligamentum patellæ and the tibia is rarely the seat of disease. When it is, there is pain and tenderness referred to the ligament, the patient is unable to extend the limb completely, the tuberosity of the tibia is apparently enlarged, and there is a fluctuating swelling on either side of the ligament, most marked in the extended position of the limb.

Of the numerous bursæ in the popliteal space, that between the semi-membranosus and the medial head of the gastrocnemius is most frequently the seat of disease, which is usually of the nature of a simple hydrops, forming a fluctuating egg-or sausage-shaped swelling at the medial side of the popliteal space. It is flaccid in the flexed, and tense in the extended position. As a rule it causes little inconvenience, and may be left alone. Otherwise it should be dissected out, and if, as is frequently the case, there is a communication with the knee-joint, this should be closed with sutures.

Fig. 117.—Gouty Disease of Bursæ in a tailor. The bursal tumours were almost entirely composed of urate of soda. (Cf. [Fig. 114].)

An adventitious bursa may form over the lateral malleolus, especially in tailors, giving rise to the condition known as “tailor's ankle” ([Fig. 117]).

The bursa between the tendo-calcaneus (Achillis) and the upper part of the calcaneus may become inflamed—especially as a result of post-scarlatinal rheumatism or gonorrhœa. The affection is known as Achillo-bursitis. There is severe pain in the region of the insertion of the tendo-calcaneus, the movements at the ankle-joint are restricted, and the patient may be unable to walk. There is a tender swelling on either side of the tendon. When, in spite of palliative treatment, the affection persists or relapses, it is best to excise the bursa. The tendo-calcaneus is detached from the calcaneus, the bursa dissected out, and the tendon replaced. If there is a bony projection from the calcaneus, it should be shaved off with the chisel.