Case of painful crepitation in the course of the radial extensor muscles of the carpus / [Robert Knox].

  • Knox, Robert, 1791-1862.
Date:
[©1837?]
Catalogue details

Licence: Public Domain Mark

Credit: Case of painful crepitation in the course of the radial extensor muscles of the carpus / [Robert Knox]. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    pathology of the disease. Lobstein thinks that a little air may always be found in the meshes of every synovial tissue. Mr Boyex-, with whom originated the discovery of this disease, seems to me, properly enough perhaps in a surgical point of view, to deem its consideration unimportant, mention- ing it only while describing fractures of the radius, with which he observes it might be confounded by inexperienced surgeons. Yet he properly enough, as a pathologist, calls it a singular affection, describing it as a collection of air in the cellular tissue, surrounding the long abductor muscle and short exten- sor of the thumb. To this opinion of Mr Boyer, in respect to the actual situation of the air so formed, it seems to me impossible to subscribe; it is neither in itself probable, nor founded on any pathological views. But there does seem to me an anatomical peculiarity in respect to the parts of the body, most liable to the accident, which, so far as I know, has escaped the notice of anatomists. With whatever care the filamentous tissue surrounding the radial extensors and extensors of the thumb, where they cross and play over each other in pronation and supination, be examined, no distinct vagineform synovial bursae can be made out; the structure, it is true, is unlike common cellular tissue, but still is not a bursa mucosa, nor a synovial capsule strictly; neither, excepting by a very strained analogy, can it be compared to a multilocular synovial capsule. The same remark applies, I venture to think, to the sheath of the plan- taris longus, as it lies betwixt the soleus and gastro-cnemius, and, though perhaps not always, to the central tendon of the omohyoideus muscle. It is difficult to arrange the kind of texture I speak of, since it seems to hold an intermediate place between multi- locular synovial bursae, and common cellular tissue. It is in this texture that, in by far the greater number of cases, air has been generated pathologically; and in this opinion I venture, with great deference, to differ from Boyer and Poulain; the former assigning as a locality to the air so collected the common cellular sheaths of the muscles generally; the latter, with Dr Velpeau, believing its seat to be exclusively in the interior of real synovial bursas or capsules, whenever they exist, whether investing tendons and their fibrous retinacula, or forming an essential part of moveable articulations.* f * On one occasion, some years ago, a case occurred, in which 1 did think that air had collected in the knee joint.