aking slight traction on the forearm, and
alternately pronating and supinating it. After reduction, a few days'
massage is all that is necessary, the joint in the intervals being
kept at rest in a sling.

#Sprain# of the elbow is comparatively common as a result of a fall on
the hand or a twist of the forearm. The point of maximum tenderness is
usually over the radio-humeral joint, the radial collateral and
annular ligaments being those most frequently damaged. Effusion takes
place into the synovial cavity, and a soft, puffy swelling fills up
the natural hollows about the joint. The bony points about the elbow
retain their normal relationship to one another--a feature which aids
in determining the diagnosis between a sprain and a dislocation or
fracture. In children it is often difficult to distinguish between a
sprain and the partial separation of an epiphysis. Sprains of the
elbow are treated on the same lines as similar lesions elsewhere--by
massage and movement.

The condition known as _tennis elbow_ is characterised by severe pain
over the attachment of one or other of the muscles about the elbow,
particularly the insertion of the pronator teres during the act of
pronation, and is due to stretching or tearing of the fibres of that
muscle, and of the adjacent intermuscular septa. A similar
injury--_sculler's sprain_--occurs in rowing-men from feathering the
oar. The treatment consists in massage and movement, care being taken
to avoid the movement which produced the sprain.

FRACTURE OF THE FOREARM

The _shafts_ of the bones of the forearm may be broken separately, but
it is much more common to find both broken together.

#Fracture of both bones# may result from a direct blow, from a fall on
the hand, or from their being bent over a fixed object. The line of
fracture is usually transverse, both bones giving way about the same
level. The common situation is near the middle of the shafts. In
children, greenstick fracture of both bones is a frequent result of a
fall on the hand--this indeed being one of the commonest examples of
greenstick fracture met with (Fig. 41).

[Illustration: FIG. 41.--Greenstick Fracture of both Bones of the
Forearm, in a boy.]

The _displacement_ varies widely, depending partly upon the force
causing the fracture, partly on the level at which the bones break,
and on the muscles which act on the respective fragments. It is common
to find an angular displacement of both bones to the