WOUNDS OF TENDONS.—Tendons are susceptible to traumatisms of any kind, but their density causes them to resist penetration. Puncture-wounds, there fore, are seldom met with, the point of the instrument being diverged in the majority of instances. The sheath, how ever, is usually torn, but it quickly re covers, if pyogenic organisms have not been introduced. Incised wounds are of little moment unless the entire tendon is cut, when, with a snap, it assumes the relations outlined under RUPTURE. In the latter, however, the solution of con tinuity being subcutaneous, pyogenic elements are not introduced; in rupture due to the thrust of a knife, sword, chisel, etc., the contrary is likely, and the surgeon should always assume that he is dealing with an infected wound. He will thus insure an early recovery in all cases.
Treatment.—Whatever be the cause of the laceration, the ends should be stitched with buried catgut sutures, care being taken that the ends be carefully placed in apposition, or, better still, over lapped. It is sometimes necessary, in order to recover the proximal end, to slit the sheath, or to free it some distance from its surroundings to do this. The suture holds best when passed through transversely about one-third inch above each free end. In: some cases, as in bul let wounds, much of the tendinous sub stance has been carried away, while the softer and more elastic sheath remains, at least to a greater extent. If the ends of this are united, so as to form a con tinuous canal, a new section of tendon will be formed if the vitality of the sheath was sufficient from the start.
Lengthening of the tendon may also be resorted to. Either Poncet's or Czerny's method may be resorted to. Poncet's is described above. Czerny's consists in cutting the tendon half through some distance above the end, then longitudinally toward the latter until near it. The portion thus partly detached is then turned down toward the other free end of tendon and sutured to it. If too great an extent of tendon has been lost, an animal tendon may be transplanted and sutured to both free ends. This forms the basis of a new tendon, the animal tendon being usually absorbed.
Bursitis. — Bursa;, protective cushions developed in the cellular tissue, may be normally provided, or mired, when certain parts, superficial or deep, are ex posed to unusual friction or pressure. These may become inflamed through in jury or overuse, constituting acute bur sills, or through continued irritation, constituting chronic bursitis. The burs often become involved in diathetie proc esses, rheumatism, gout, and syphilis especially.
ACUTE BURSITIS.—An acute inflam mation of a bursa may be serous or puru lent, and, as stated, is usually due to injury. When located superficially there is marked swelling, redness, and local heat. When an inflamed bursa is situ ated in the deeper tissues, the swelling can only be detected with difficulty, if at all, and the pain, especially on motion, is severe. General febrile symptoms often appear when a deep bursa is in volved, especially when there is a tend ency to suppuration, this being likely to extend. The inflammatory process some times extends to a neighboring joint, in cluding the synovial sac, which is easily penetrated. The diagnosis can usually be established by judging the effects of motion. Extreme abduction or adduc tion of the humerus, for instance, causes severe pain, if the inflamed bursa is under the deltoid; when the bursa be tween the quadriceps extensor and the femur, or that under the ligamentum patella:, is the seat of the inflammatory process, flexion of the leg upon the thigh becomes painful, through the pressure thus exerted upon the bursa.
Treatment.—Absolute rest in bed and immobilization, by placing the extremity in a splint and pressure, elevation of the part, and cold or hot antiseptic applica tions are indicated. If the active symp toms persist notwithstanding these meas ures, the sac should be aspirated if the fluid is serous, followed by pressure or free if pus he present, and the purulent discharge completely evacu ated, and a saturated solution of iodo form in ether injected. Lugol's solution mixed with an equal quantity of glycerin is also useful.