CONTRACTION OF THE FINGERS DEPENDENT UPON A TENDO-VAGINITIS OF THE BURSAL SHEATH OF THE FLEXOR TENDONS. The following notes of an example of this somewhat rare condition under my observation may be of interest: The patient, a girl, aged twenty, attended St. Thomas’s Hospital for a swelling of the front of the right wrist, with contraction of the fingers and complete loss of use of the hand. She stated that the contraction appeared six days before without apparent cause. On examination a large swelling was found, extending upwards for about an inch and a half above the anterior annular ligament, and distally along the ulnar side of the palm as far as the root of the little finger. The phalangeal joints of all the fingers were flexed, and any attempt to straighten them caused considerable pain, while the movements of the little finger were accompanied by a peculiar coarse grating, that could be felt along the whole length of the theca and in the palm, ceasing, however, at the level of the carpus. The thumb was flexed and adducted, and the movements of flexion and extension were painful, apparently because they led to disturbance of the enlarged bursal sheath of the finger flexors. The affection was evidently a tendo-vaginitis involving the carpal bursal sheath of the finger flexors and the palmar extension which brings this into communication with the digital bursal sheath of the little finger. The crepitation indicated that the intra-vaginal portion of the tendon was roughened by inflammatory deposits, and it is possible that these irregularities may lay the foundation for a subsequent trigger finger. The case was successfully treated by immobilisation of all the joints of the wrists and fingers in plaster of Paris, followed by passive movement as soon as the acute stage was passed. A tendo-vaginitis of the extensors over the back of the hand may induce considerable functional impairment of the fingers, with more or less contraction at the metacarpo-phalangeal joints. Such a condition has been described by Vogt as an occasional result of gonorrhœa, and Verneuil has met it as a manifestation of syphilis. The majority of examples, however, occur without any ascertainable constitutional cause. CONTRACTIONS DEPENDENT UPON INFLAMMATORY AND DEGENERATIVE CHANGES IN THE ARTICULAR STRUCTURES.