. A manual of therapeutic exercise and massage, designed for the use of physicians, students and masseurs. of the otherfingers, always working toward each other with small rotarymovements. In that way perfect control can be exerted overthe fragments without causing any pain (Fig. 48). We begin with massage of very short duration, three orfour minutes being sufficient on the first days of treatment,increasing the time gradually up to about ten minutes. We be-lieve that in a fresh case this is all that is needed to produce thedesired effect on the absorption of the hematoma. We wantto emphasize
. A manual of therapeutic exercise and massage, designed for the use of physicians, students and masseurs. of the otherfingers, always working toward each other with small rotarymovements. In that way perfect control can be exerted overthe fragments without causing any pain (Fig. 48). We begin with massage of very short duration, three orfour minutes being sufficient on the first days of treatment,increasing the time gradually up to about ten minutes. We be-lieve that in a fresh case this is all that is needed to produce thedesired effect on the absorption of the hematoma. We wantto emphasize that the operator need not look for a distinctly FRACTURES 171 visible effect of an actual reduction of the swelling while heapplies the treatment. An effect as strong as that is likely toproduce irritation of the tissues. All that we need is a stimu-lation of the blood and lymph capillaries to do their workproperly, and we have often been impressed by the speedyreduction of swelling in a few days of treatment. A shorttreatment once or twice a day is preferable to long treatmentsat greater Fig. 48.—Manipulation suitable for kneading and friction of the shoulderin a case of fracture. The hands steady the upper end of the humeruswhile the deltoid is kneaded and frictioned between the thumbs. Also for the exercise we follow the same principle of slowgradual approach from the periphery toward the chieflyaffected joints. We start with of the fingers. Itmay be objected that the patient can do such exercisesalone, and, of course, if he is able to move his fingers hecertainly should do so at reasonable intervals; but we haveseen enough patients of that and similar types who hold 172 INJURIES the wliolo oxtr(Mnit\ in a somewhat spastic, rigid contraction,not (larin<]: to move one single joint. These i)atients needlielp and sni)p()rt in the beginning. \\e do the exercises of the fingers, wrist and forearm withthe apj)aratns for fixation of the shoulder in plac
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