Treatment.
—In most of these instances patience may be easily overtaxed while waiting the tardy results of massage and such correction as apparatus may afford. Very frequently the additional help of an anesthetic, with forced movements, often with tenotomies and sometimes with tendon grafting, will be required. When contractures can be foreseen, as they may be in connection with many lesions which produce them, such as burns and others not specifically mentioned, they should be guarded against by splints, apparatus, or whatever may best serve the purpose.
PARASITIC AFFECTIONS OF THE MUSCLES.
The parasitic affections of muscles are rare. Trichinosis rarely produces tumors which come under the surgeon’s hands. Still there may result from it a form of myositis with formation of cysts which may so far interfere with muscle function as to demand removal. Hydatid cysts and cysticercus are extremely rare, especially in this country.
DISEASES OF THE BURSÆ.
There are two types of bursæ in the body: first, the subcutaneous, or mucous, which are loose sacs containing a clear mucoid fluid. They develop regularly when bony prominences are exposed to friction and develop adventitiously wherever undue irritation is produced. Thus beneath every bunion there will be found a good-sized and thickened bursa.
Synovial bursæ, the second type, are met with in close proximity to joints, and between tendons which play upon each other. They frequently communicate with the joint which they overlie, and infection may easily spread from one to the other. They are liable to traumatism, either extrinsic or intrinsic, the former from chafing or more direct injury, the latter by excessive muscle exertion. When infected they suppurate, forming abscesses of conventional type. As the result of contusions they are frequently filled with blood, in which case there is a bursal hematoma. Acute bursitis usually merges into localized abscess.
PLATE XXX
Foreign Body (Broken Needle) in Foot. Buffalo Clinic. (Skiagram by Dr. Plummer.) Illustrating the Value of this Method of Exactly Locating a Foreign Body and involving the Tissues Considered in Chapter XXVIII.