Massage is always indicated in cases of synovitis, so long as there is no purulent inflammation. The introductory massage, in the form of centripetal stroking, is to be used with great care. When the pain is diminished some passive movements may be applied, as flexion and extension. If the joint be very sore, as is usually the case, work in its neighborhood with kneading and stroking.

In chronic inflammation of the joints it is always necessary to pay special attention to atrophied muscles above and below the joint. Friction (with strokings followed) is the most effective manipulation around joints. (See Fig. 113.)

Fig. 113. - Friction with the Thumb in Cases of Synovitis of the Knee-joint.

In ankylosis always apply very hot water before every seance.

Evald Johnsen, a Scandinavian masseur, out of 137 cases of synovitis, cured 94 perfectly, improved 39 and treated only 4 without any result.

The patient must not be kept in bed, but must use his limbs as much as possible.

Massage not only relieves stiffness of the joint, but also prevents total ankylosis. The treatment must continue not for weeks, but for months.