The most general, and from our point of view the most important, are the first three in the following list: -

1. Chronic serous synovitis, hydrops articuli, hydrarthron, "Water in the joint."

2. Chronic progressive polyarthritis.

3. Chronic rheumatism in the joints following rheumatic fever. Other secondary affections of the joints following other infectious diseases.

4. Arthritis deformans.

5. Tuberculosis of joints.

6. Syphilis of joints.

7. Neuralgia of joints.

8. Joint affections in diseases of the central nervous system (tabes).

9. Gout.

All these are concerned to a certain extent with massage and gymnastics. Haemorrhage, tumours, and ganglion affecting joints may here be omitted. I shall refer later on, if necessary, to such pathological conditions of joints as anchylosis, loose joints, and non-traumatic dislocations.

The Traumatic Joint Affections are extremely common, and form the majority of the cases at clinics where the patients are for the most part manual workers.

Before I speak further on the treatment of traumatic joint affections by massage and gymnastics, I must point out that this treatment is contra-indicated in recent fracture, and in such cases is only indicated when the first stages of healing and the formation of callus are assured. In all cases of trauma it is therefore important to diagnose the absence of a fracture before beginning treatment. This can be done by noting the absence of deformity, of abnormal mobility at the seat of fracture, of abnormal position, of altered measurements and of crepitus, usually accompanying fracture, and the examination of difficult cases has been much simplified by means of X-rays.

Contusions (= crushing blows) of joints may vary to almost any extent in their effects. In most cases they give nature such a short and trifling work of repair, and give the patient so little trouble, that they are not often treated. In other cases contusions may cause infiltration in the capsule without effusion in the joint cavity, a so-called circumscribed capsulitis, a very important joint affection from the point of view of the masseur. Even if the infiltration in the capsule is quite slight, so that it hardly affects the shape of the joint, or can only just be detected by palpation, with many people who otherwise have never seemed to be at all "neurotic" it may cause such trouble that a patient cannot use the joint. Inactivity leads to atrophy and contraction of the limb, and the patient, if, for example, the knee is affected, may never be able to do without crutches.

In some extreme cases an acute serous synovitis results, which may become chronic.

A contusion may also cause the development of gout, arthritis deformans, or tuberculosis in a joint.

Contusion of a joint is therefore something which ought always to be taken seriously, and which the masseur, whose treatment in such cases is the most important of all, ought to see completely cured before he leaves off treatment.

Muscles, nerves, and bones may also be more or less injured by contusion of a joint (see Chapter XIII (Muscles, Tendons, Tendon Sheaths, Fascia And Bursae)., dealing with Traumatic Myositis and Neuritis).

In the case of a simple contusion the treatment consists of a raised position, with or without an icebag, rest and massage. The compression bandage and the more or less firm bandages which were sometimes used formerly have been abandoned wherever massage is in general use, and are superfluous in dealing with simple contusions. A sling is generally used for the arm. Massage should begin immediately after the trauma, and at first, while the part is much inflamed, should consist exclusively of effleurage, given twice a day if possible. If the absorption of the infiltration is slow, harder and harder frictions may be given as time goes on.