The Elbow Joint is very often the seat of trauma, especially in the icy land of Sweden (in which, moreover, at least half the working population are every now and then unsteady on their legs through drink).

Severe contusions of this joint are common, and in such cases it is not unusual to find it distended with blood, which shows itself later on as large haemoglobin-coloured patches in the subcutaneous tissues of the upper arm. Even if a fracture cannot be diagnosed in a case of this sort there is very often a partial fracture.

The only common dislocation, of both ulna and radius backward, requires massage immediately after reduction if the coronoid process is not broken off.

The transverse fracture of the lower part of the humerus, with displacement backward of the lower fragment, the T-shaped partially intra-articular fracture, and other fractures in or near the joint, are all easy to detect. This is especially true in cases of fracture of the olecranon, by no means an uncommon fracture, if only one remembers to search for it by careful palpation of the usual place, about an inch below the upper edge of the olecranon.

Fracture of the Olecranon is the only major fracture for which treatment by massage and gymnastics alone can, under certain conditions, i.e., with minimum effusion, be defended. In such cases one gives effleurage and frictions preferably twice a day, and soon begins with quite small movements of flexion, which are by degrees cautiously enlarged, always provided that the effusion between the fragments is not increased. If the fracture is not compound and the effusion is slight, a bony union may often be produced, which is greatly assisted by effleurage. Healing then begins in the outer parts of the fracture and proceeds slowly inward.

Surgeons are, however, fairly unanimous in the opinion that under all conditions the best and surest way of dealing with fracture of the olecranon (as with fracture of the patella) is by suture. Eight, or at most fourteen, days after this operation massage and careful flexion may be given. During the period of fixation some doctors use different splints one after the other, which fix in different positions, from almost complete extension to many different degrees of flexion.

Effusion in this joint shows best from behind by a bulging on either side of the tendon of Triceps.

Tuberculosis in this joint is not uncommon, nor is arthritis deformans; but, on the other hand, gonorrhceal synovitis rarely affects the elbow joint.

In giving frictions it is easiest to get at the joint on the outer and inner sides of the extensor and flexor tendons and through Anconeus. When necessary the accessible part of the annular ligament and the joint between the head of the radius and ulna are worked upon. In treating this complex joint by gymnastics one must not omit pronation and supination as well as flexion and extension, and in fracture of the olecranon one must not begin too early with free flexions.

A convenient arrangement is for the masseur and patient to sit opposite each other during treatment, one on each side of the plinth.

It should be borne in mind that the anatomy of this joint is very favourable for treatment by stasis or by heat.