e to get into a comfortable position. Tenderness may be elicited
over the anatomical limits of the bursa, and is usually most marked over
the great tuberosity, just external to the inter-tubercular (bicipital)
groove. When adhesions are present, abduction beyond 10 degrees is
impossible. 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. In the treatment of this affection the arm
should be maintained at a right angle to the body, the arm being rotated
medially (Codman). When pain does not prevent it, movements of the arm
and massage are persevered with. In neglected cases, when adhesions have
formed and the shoulder is fixed, it may be necessary to break down the
adhesions under an anaesthetic.

The bursa is also liable to infective conditions, such as acute
rheumatism, gonorrhoea, suppuration, or tubercle. In tuberculous disease
a large fluctuating swelling may form and acquire the characters of a
cold abscess (Fig. 115).

The bursa underneath the tendon of the _subscapularis_ muscle when
inflamed causes alteration in the attitude of the shoulder and
impairment of its movements.

An adventitious bursa forms over the _acromion_ process in porters and
others who carry weights on the shoulder, and may be the seat of
traumatic bursitis.

The bursa under the _tendon of insertion of the biceps_, when the seat
of disease, is attended with pain and swelling about a finger's breadth
below the bend of the elbow; there is pain and difficulty in effecting
the combined movement of flexion and supination, slight limitation of
extension, and restriction of pronation.

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.

There are two bursae over the _great trochanter_, one superficial to, the
other beneath the aponeurosis of the gluteus maximus; the latter is not
infrequently infected by tuberculous disease that has spread from the
trochanter.

The bursa _b