Alexis Thomson

“ When shut off from the joint it may suffer independently, and when distended with fluid forms a horse-shoe swelling above the patella.
In front of the patella and its ligament is the _prepatellar bursa_, which may have one, two, or three compartments, usually communicating with one another. It is the seat of the affection known as "housemaid's knee," which is very common and is sometimes bilateral, and, less frequently, of tuberculous disease which usually originates in the patella. ”

“ Demonstrable effusion is not uncommon, but is disguised by the overlying tissues. If left to himself, the patient tends to maintain the limb in the "sling position," and resists movements in the direction of abduction and rotation. ”

“ Infective bursitis; Traumatic or trade bursitis; Bursal hydrops; Solid bursal tumour; Gonorrhoeal and suppurative forms of bursitis; Tuberculous and syphilitic disease--Tumours--_Diseases of individual bursae in the upper and lower extremities_. A bursa is a closed sac lined by endothelium and containing synovia. Some are normally present--for instance, that between the skin and the patella, and that between the aponeurosis of the gluteus maximus and the great trochanter. ”

“ In the lower extremity, a large number of normal and adventitious bursae are met with and may be the seat of bursitis. That over the _tuberosity of the ischium_, when enlarged as a trade disease, is known as "weaver's" or "tailor's bottom." It may form a fluctuating swelling of great size, projecting on the buttock and extending down the thigh, and causing great inconvenience in sitting (Fig. 116) . It sometimes contains a number of loose bodies. ”

“ These affections are characterised by an effusion of fluid into the sac of the bursa with thickening of its lining membrane. While friction and pressure are the most evident factors in their production, it is probable that there is also some toxic agent concerned, otherwise these affections would be much more common than they are. ”

“ It may occur as an independent affection, or may be associated with disease in an adjacent bone or joint. It is met with chiefly in the prepatellar and subdeltoid bursae, or in one of the bursae over the great trochanter. The clinical features are those of an indolent hydrops, with or without melon-seed bodies, or of uniform thickening of the wall of the bursa; the tuberculous granulation tissue may break down into a cold abscess, and give rise to sinuses. ”

“ It is liable to traumatic affections from a fall on the shoulder, pressure, or over-use of the limb. Pain, located commonly at the insertion of the deltoid, is a constant symptom and is especially annoying at night, the patient being unable to get into a comfortable position. ”