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Diseases of Tendons and Bursae

swelling, sac, sheath, finger and hand

DISEASES OF TENDONS AND BURSAE.

Simple Inflammation is liable to attack tendons as the result of a sprain, or owing to gout or rheumatism, their synovial sheaths being also attacked.

The disease may be manifested only by wearing rheumatic pains, accompanied, in some cases, by a creaking feeling when the tendons are moved, and a sound like the rust ling of silk. In more acute forms, and specially as the result of injury, considerable swelling may occur, and the overlying skin is hot and reddened.

Rest to the part and painting with tincture of iodine will do much to relieve the patient. In the acute cases warm fomeutations should be employed.

Whitlow is a severe form of inflammation which attacks the tendons of the fingers. It begins near the point of the finger in front, which is exquisitely tender, red, swollen, and hard. The pain, which is severe and throbbing, spreads often up the arm to the shoulder. The inflammation may run rapidly along the finger in the tendinous sheath, specially if matter forms in the sheath and cannot get a way of escape externally. If it is allowed to progress, the whole band, and even the forearm, may become affected, the joints and bones also being seriously imperilled.

Treatment.—Brisk purgatives of salts or seidlitz should be given to the patient, and leeches followed by hot fomentations applied to the part, the hand being kept at rest in an elevated position.t..But it is usually necessary to make a free incision along the centre of the finger down to the bone, to let matter escape. It sometimes requires most energetic steps on the part of a skilled surgeon to save the finger, and sometimes to save life, which an aggravated case will occasionally threaten. Disfigurement

often results. The patient's strength requires to be properly supported by foods and tonics of bark, iron, &c.

Ganglion (Scotch, lippen sinen) is a swelling at some place in the course of a ten don, due to irritation of the sheath of the tendon, and the consequent outpouring into the sheath of more than the usual amount of lubricating fluid and inflammatory material. As a result there is formed a small, firm, and movable swelling, which grows slowly, and is found to contain a firm, clear, jelly-like sub stance, originally fluid. The swelling is most common on the back of the wrist, and less fre quently on the back of the foot. Occasionally bodies like melon or rice seeds are formed in the sac from the inflammatory deposit.

The proper treatment is either to burst the tumour by pressure and squeeze out the gela tinous substance or to open the sac with a knife. A rough but efficacious method of treating ganglion of the wrist is to cause the patient to lay his hand on the knee of the per son who is going to burst the ganglion. Cover the hand with a towel. Then let the operator take a heavy book and bring it down heavily upon the hand. This will burst the sac. After removal of its contents pressure should be exerted on the sac to prevent the return of the swelling. The hard top from the cork of a lemonade bottle rolled in a small piece of lint and bandaged firmly over the part is a simple way of effecting this. Painting with iodine is used for the same purpose, or a small blister may be applied.