TENDON OF THE MIDDLE GLUTEUS MUSCLE 133 



there is a tendency during progression to move obliquely from the 

 lame side." 



Locally there is heat and tenderness over the region of the 

 convexity and later there appears a swelling, which is also hot and 

 painful to the touch. Careful observation will reveal a depression 

 in the middle of the swelling due to the pressure of the tendon on 

 the underlying enlarged bursa. Two bulgings appear, one on either 

 side the tendon. These are diverticula of the bursa itself. 



This form of lameness is very amenable to treatment particularly if 

 attention be directed to it in its earlier stages. Complete rest should 

 be prescribed and cold applications utilised. The acute inflammatory 

 symptoms will frequently subside rapidly, when a mild counter-irritant 

 should be applied and a period of rest allowed during convalesence. 

 If quick recovery does not occur, the muscles of the quarter become 

 atrophied. This is treated by the application of a blister or the insertion 

 of seton tapes. It occasionally happens that we have septic infection 

 of the bursa with the formation of an abscess. The ordinary treatment 

 of an abscess elsewhere should be adopted, i.e., the abscess should be 

 opened surgically, its contents evacuated, and the abscess cavity injected 

 with antiseptic solutions. 



In cases where lameness persists, further structural changes occur. 

 The walls of the bursa become very much thickened and hardened. 

 The surface of the convexity becomes eroded, and irregular calcareous 

 deposits form on the great trochanter, extending upwards to its summit 

 and downwards even as far as the external or small trochanter, and filling 

 up the trochanteric fossa. The tendency is lor the disease to extend 

 in this direction rather than inv/ardly to the articular cavity of the 

 joint itself From what we have said regarding the numerous tendons 

 inserted into this area, it will be gathered that interference with 

 the action of the quarter in such cases will be most pronounced, 

 and it will be also quite obvious that treatment of such cases will be 

 of no avail. 



