. La pratique américaine de la chirurgie ; un système complet de la science et de l'art de la chirurgie . sa sous le tendon du popliteus est d'une importance particulière, en général une extension de la membrane synoviale de l'articulation. La bursa sous le tendo Achilis peut être le siège de toute forme de bursite, mais la maladie habituellement observée est soit la variété aiguë ou chronique de bursite asipple, qui est assez souvent associée à une maladie similaire de MALADIES CHIRURGICALES DE BURSiE. 443 la gaine du tendon sus-jacent, car les deux processus proviennent des mêmes causes, c'est-à-dire, le traumatisme des mauvaises chaussures et

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. American practice of surgery ; a complete system of the science and art of surgery . sa beneath the tendon of the popliteus is of special importance, beingusually an extension of the synovial membrane of the joint. The bursa under the tendo Achillis may be the seat of any form of bursitis, but the disease usually observed is either the acute or the chronic variety of asimple bursitis, which is quite commonly associated with a similar disease of SURGICAL DISEASES OF BURSiE. 443 the sheath of the overlying tendon, as both processes arise from the same causes, viz., traumatism from bad shoes and exposure to cold. Other small bursse inthis region may also become inflamed, but this occurs only rarely. The sjmip-toms are: pain on dorsal flexion of the foot or when the patient is standing flaton the foot, and the presence of a fluctuating tumor under the tendon. Thetreatment is the same as that noted above for other bursse. Distention of the bursa under the psoas tendon causes a fluctuating tumor inScarpas triangle, with flexion of the thigh and pain when the limb is extended.. Fig. 121.—Simple Chronic Prepatellar Bursitis. (Original) This bursa lies in unmediate contact with the capsule of the hip joint, a fact thatmust be remembered in operating in this situation. The distended bursa maypress on the anterior crural nerve and so cause pain in the area of its distribution. The gluteal bursa, which is located between the gluteus maximus and thegreat trochanter, is not a rare seat of bursitis, and this is often tuberculous inits nature. This gives rise to a doughy tumor behind the trochanter, witheversion and abduction of the thigh, but without flexion and without anylimitation of the movements of the hip—characteristics which distinguish itfrom hip-joint disease. If relief is not afforded, the bursa ruptures and thetuberculous process burrows widely among the muscles of the hip. The propertreatment comprises early incision, curettage and packing, or excision of thebursa

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