356 Anatomy Applied to Medicine and Surgery. 



sized orifice, so that, inflammatory actions starting in the 

 former will, in the majority of cases, affect the latter, also 

 a point that should be borne in mind in wounds of the 

 anterior aspect of the lower part of the femur. (2). A 

 second, in front of the lower portion of the patella the 

 prepatellar bursa. This extends over the upper part of 

 the ligamentum patellae as well, and may be acutely or 

 chronically inflamed, in those whose occupations necessi- 

 tate frequent kneeling, as stone-masons, housemaids, etc., 

 hence the term "housemaid's knee." This prepatellar 

 bursa is occasionally traversed by one or more septa, 

 with the result, that, when inflamed, more or less irreg- 

 ularity in shape is produced. Pain is frequently com- 

 plained of, in inflammation of this sac, on account of the 

 distention stretching the patellar plexus of nerves, which 

 is composed of branches from the internal, middle 

 and external cutaneous and from the long saphenous 

 nerves. ( 3 ) A third, beneath the lower third of the liga- 

 mentum patellae and between it and the upper part of the 

 tubercle of the tibia the pretibial bursa. This bursa is 

 occasionally distended in rapidly growing boys, about the 

 age of puberty, and can be diagnosed by the fact, that 

 the swelling bilobed the ligamentum patellae being 

 stretched over it and hence, fluctuation may be elicited 

 from one side of the ligament to the other in this situation. 

 Synovitis. In synovitis, the effusion distends the 

 depression, normally present on either side of the tendon of 

 the quadriceps extensor, patella and the ligamentum patel- 

 lae, so as to obliterate these depressions, and, since the cap- 

 sular ligament between the ligamentum patellae and the la- 

 teral ligaments, is the most lax part of the ligamentous 

 structures of the joint, it follows that the swelling is most 

 marked on either side of the patella and of the upper part of 



