Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

Manual of Surgery eBook

This eBook from the Gutenberg Project consists of approximately 697 pages of information about Manual of Surgery.

In primary sarcoma the treatment consists in removing the muscle.  In the limbs, the function of the muscle that is removed may be retained by transplanting an adjacent muscle in its place.

Hydatid cysts of muscle resemble those developing in other tissues.

DISEASES OF TENDON SHEATHS

Tendon sheaths have the same structure and function as the synovial membranes of joints, and are liable to the same diseases.  Apart from the tendon sheaths displayed in anatomical dissections, there is a loose peritendinous and perimuscular cellular tissue which is subject to the same pathological conditions as the tendon sheaths proper.

#Teno-synovitis.#—­The toxic or infective agent is conveyed to the tendon sheaths through the blood-stream, as in the gouty, gonorrhoeal, and tuberculous varieties, or is introduced directly through a wound, as in the common pyogenic form of teno-synovitis.

Teno-synovitis Crepitans.—­In the simple or traumatic form of teno-synovitis, although the most prominent etiological factor is a strain or over-use of the tendon, there would appear to be some other, probably a toxic, factor in its production, otherwise the affection would be much more common than it is:  only a small proportion of those who strain or over-use their tendons become the subjects of teno-synovitis.  The opposed surfaces of the tendon and its sheath are covered with fibrinous lymph, so that there is friction when they move on one another.

The clinical features are pain on movement, tenderness on pressure over the affected tendon, and a sensation of crepitation or friction when the tendon is moved in its sheath.  The crepitation may be soft like the friction of snow, or may resemble the creaking of new leather—­“saddle-back creaking.”  There may be swelling in the long axis of the tendon, and redness and oedema of the skin.  If there is an effusion of fluid into the sheath, the swelling is more marked and crepitation is absent.  There is little tendency to the formation of adhesions.

In the upper extremity, the sheath of the long tendon of the biceps may be affected, but the condition is most common in the tendons about the wrist, particularly in the extensors of the thumb, and it is most frequently met with in those who follow occupations which involve prolonged use or excessive straining of these tendons—­for example, washerwomen or riveters.  It also occurs as a result of excessive piano-playing, fencing, or rowing.

At the ankle it affects the peronei, the extensor digitorum longus, or the tibialis anterior.  It is most often met with in relation to the tendo-calcaneus—­Achillo-dynia—­and results from the pressure of ill-fitting boots or from the excessive use and strain of the tendon in cycling, walking, or dancing.  There is pain in raising the heel from the ground, and creaking can be felt on palpation.

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Manual of Surgery from Project Gutenberg. Public domain.