The treatment consists in putting the affected tendon at rest, and with this object a splint may be helpful; the usual remedies for inflammation are indicated:  Bier’s hyperaemia, lead and opium fomentations, and ichthyol and glycerine.  The affection readily subsides under treatment, but is liable to relapse on a repetition of the exciting cause.

Gouty Teno-synovitis.—­A deposit of urate of soda beneath the endothelial covering of tendons or of that lining their sheaths is commonly met with in gouty subjects.  The accumulation of urates may result in the formation of visible nodular swellings, varying in size from a pea to a cherry, attached to the tendon and moving with it.  They may be merely unsightly, or they may interfere with the use of the tendon.  Recurrent attacks of inflammation are prone to occur.  We have removed such gouty masses with satisfactory results.

Suppurative Teno-synovitis.—­This form usually follows upon infected wounds of the fingers—­especially of the thumb or little finger—­and is a frequent sequel to whitlow; it may also follow amputation of a finger.  Once the infection has gained access to the sheath, it tends to spread, and may reach the palm or even the forearm, being then associated with cellulitis.  In moderately acute cases the tendon and its sheath become covered with granulations, which subsequently lead to the formation of adhesions; while in more acute cases the tendon sloughs.  The pus may burst into the cellular tissue outside the sheath, and the suppuration is liable to spread to neighbouring sheaths or to adjacent bones or joints—­for example, those of the wrist.

The treatment consists in inducing hyperaemia and making small incisions for the escape of pus.  The site of incision is determined by the point of greatest tenderness on pressure.  After the inflammation has subsided, active and passive movements are employed to prevent the formation of adhesions between the tendon and its sheath.  If the tendon sloughs, the dead portion should be cut away, as its separation is extremely slow and is attended with prolonged suppuration.

Gonorrhoeal Teno-synovitis.—­This is met with especially in the tendon sheaths about the wrist and ankle.  It may occur in a mild form, with pain, impairment of movement, and oedema, and sometimes an elongated, fluctuating swelling, the result of serous effusion into the sheath.  This condition may alternate with a gonorrhoeal affection of one of the larger joints.  It may subside under rest and soothing applications, but is liable to relapse.  In the more severe variety the skin is red, and the swelling partakes of the characters of a phlegmon with threatening suppuration; it may result in crippling from adhesions.  Even if pus forms in the sheath, the tendon rarely sloughs.  The treatment consists in inducing hyperaemia by Bier’s method; and a vaccine may be employed with satisfactory results.