Chronic inflammation of the bicipital bursa is occasionally met with wherein both members are affected. Because of the nature of the structures involved, when inflamed, chronic inflammation is a more frequent termination than is complete recovery. Bilateral affections are seen in horses that are driven for years, regularly at a fast pace on paved streets. In such cases, the gait is stilted, that is, there is incomplete advancement of both members and, of course, the period of weight bearing is correspondingly shortened; hence the short strides.
In chronic cases, little if any evidence of inflammation is to be detected by digital manipulation of the parts. If flinching occurs, one is often unable to interpret the manifestation as to whether it is due to inflammation or not.
There is no marked “warming out” in this condition, and animals are nearly as lame after having been driven a considerable distance as when started, although the lameness is not as a rule very great.
Treatment.—In very painful cases acute inflammation is treated by employing cold applications during the initial stage. Cracked ice when contained in a suitable sack may be held in contact with the affected part and the pack is supported by means of cords or tapes as suggested in the discussion on treatment of scapulohumeral arthritis on page 66. Later, hot applications may be employed to good advantage.
In the course of ten days or two weeks, if the acute painful condition has entirely subsided, vesication is indicated. The ordinary mercury and cantharides combination does very well. Depending upon the course taken in any given case, one is guided in the treatment employed. If prompt resolution comes to pass, the subject may be given free run at pasture after three or four weeks confinement in a box stall. If, however, the case does not progress in a prompt and satisfactory manner, absolute quiet must be enforced for six weeks or more. Repeated blistering is beneficial, although it is doubtful if firing is of sufficient benefit in the average chronic case of intertubercular bursitis to justify the punishment which this form of treatment inflicts, unless infliction of pain is the thing sought, to enforce repose in restless subjects. Patients are best given a long rest at pasture and returned to work for two or three months after an acute attack of inflammation of the bursa, lest the condition become chronic. When due consideration is given the pathology of such cases, the frequent unsatisfactory termination under the most careful treatment, is readily understood.
Anatomy.—The triceps brachii is the principal structure which fills the space between the posterior border of the scapula and the humerus. The several heads originate for the most part on the border of the scapula, the deltoid tuberosity of the humerus and the shaft of the humerus. Insertion of this large muscular mass is effected by means of several tendons to the olecranon. A synovial bursa is situated underneath the tendinous attachment of the posterior portion of the triceps brachii—the long head or caput magnum.