Many feel that pain in the elbow is not such a serious problem, which is why it is often neglected. Unfortunately, the method of treatment "bother and pass by itself" sometimes leads to undesirable consequences. It's one thing if the elbow is sick as a result of a bruise, and quite another - when the pain appeared suddenly and for unknown reasons. And if in the first case, in principle, you can do without serious treatment, for pain of unknown origin, you need to consult with a specialist.
Causes of pain in the elbows
In fact, causing a pain in the elbows can be a huge number of reasons. And some of them may not even be associated with problems in the musculoskeletal system. That's why letting go of the disease, especially without knowing its true causes, is undesirable.
So, the most common reasons that elbows can hurt are:
- Most elbows begin to ache due to overload. When the same type of movement is performed for a long time, the elbow syndrome of the tennis player develops. Epicondylitis( this is the name of the inflammatory process that develops during congestion) does not bind the movements of the elbow joint. But with loads and feelings, the pain manifests itself quite sharply. With different forms of epicondylitis, the elbow can get sore from the outside or inside.
- Pain occurs when squeezing the ulnar nerve. The nerve is pinched by trauma or frequent flexion-extension of the joint. The pain in this case is sharp and very sharp, can give in a brush or shoulder. In some cases, with tunnel ulnar syndrome, elbows hurt and fingers numb.
- Pain in the elbows is caused by rheumatoid arthritis. This disease appears spontaneously. The strongest thing in this case is that the hands hurt in the morning, and during the day the pain either decreases or disappears altogether. With neglected forms of arthritis, elbows may swell a little.
- Another cause of pain is synovial chondromatosis. This is a problem with the cartilaginous tissue. Due to disturbances in the process of cartilage formation, free cartilaginous bodies may appear. The latter and cause pain. With chondromatosis, the elbow hurts when it is unbent and unbent, the joint may start to crunch and swell.
- Aching pains occur with osteochondrosis. Because of illness, the arm weakens, and the skin in the elbow area becomes less sensitive.
- Knees and elbows can be sore due to hemophilia. With this diagnosis, even the most insignificant trauma causes a hemorrhage. When the blood enters the joint, it grows in size and falls ill. Painful sensations at the same time bursting.
- Gout contributes to the deposition of salt in the joints, which can disrupt their normal functioning. With gout, the elbow can get sick both under load and in a calm state. Usually the patient suffers from night pain. Among the symptoms of gout - redness of the skin in the joint area, the appearance of swelling and swelling.
What if I have an ulcer?
If you have pain in your elbows, do not hesitate. In order to prevent the disease from becoming chronic, it is advisable to consult a specialist immediately. Professionals usually prescribe a comprehensive treatment that relieves pain and eliminates the cause of its appearance.
For the anesthetization of the arm at the elbow use a special ointment. In some severe cases, anesthetics and anti-inflammatory injections are prescribed. Physiotherapy is very effective. The complex of procedures allows faster than many medications to remove inflammation and restore the aching joint. To physiotherapy was the most effective, you need to complete a full course of procedures - at least ten sessions.
How to treat pain in the elbow joint
Our life is a constant movement. The ability to move freely to us primarily provides joints. In the human body, there are about 360 joints of various types and structures. Some of them are very mobile, while others do not move at all. Elbow joints refer to very mobile connections of the musculoskeletal system and provide a wide range of movements of the forearm. They are superficially located, which contributes to frequent injuries and increased stress. Treatment of pain in the elbow joint is a very urgent problem, because it can happen to everyone, whether it be a professional athlete or an ordinary person.
About the elbow of
To better understand why the elbow joint hurts, it is necessary to understand how it is arranged. The joint refers to complex anatomical structures, because three bones - shoulder, elbow and ray - take part in its construction. In fact, these are 3 separate small joints that are enclosed in a single capsule. The heads of these bones are covered with hyaline cartilage. The joint capsule has many twists and pockets, inside the joint are ligaments that provide anatomical integrity and a certain amplitude of movements in the elbow.
In the pit of the elbow there is a very important vascular-neural bundle, which consists of the median, radial and ulnar nerves, as well as the radial and ulnar arteries. In case of traumatic injuries, often these nerves and vessels are injured simultaneously with the elbow joint, which leads to serious complications. Therefore, any elbow injury should be examined not only by a traumatologist, but also by a neurologist for damage to nerve fibers.
The elbow joint is rather complex in structure and consists of 3 bones - the shoulder, radial, ulnar
. The main causes of pain.
. The reasons for which the elbow may hurt are different: inflammatory lesions, traumatic injuries, degenerative-dystrophic processes, occupational diseasesetc. Find out why it hurts the elbow, it is very important, because this directly depends on the treatment.
Most often you have to deal with such pathologies:
- arthrosis is a degenerative-dystrophic lesion of articular cartilage with subsequent damage to all anatomical structures of the joint;
- arthritis - an inflammatory lesion of the elbow of various etiologies - infectious, allergic, autoimmune;
- epicondylitis is a degenerative process at the site of attachment of muscle ligaments to the medial or lateral epicondyle of the humerus, respectively, the epicondylitis can be medial and lateral;
- bursitis of the elbow joint - inflammation of the bags of the joint capsule and the accumulation of inflammatory or aseptic exudates in them;
- various traumatic elbow injuries.
Lateral epicondylitis is a professional disease of tennis players, it is also called the "elbow of tennis player"
How to get rid of pain?
Treatment of pain in the elbow should begin immediately after its appearance, otherwise you risk the function of your hand. How and what to treat, we'll talk below. First of all you need to understand the etiology of the disease, which caused pain. To do this, describe in detail the physician all the symptoms, tell us how the disease started, what was accompanied, what at your discretion it provoked, what medications help with pain, etc.
It is practically impossible to treat pains in the elbow joints without medication. There are several groups of drugs that are used for this purpose.
To begin with, let us recall non-steroidal anti-inflammatory drugs. It is this group of drugs that is most often used to eliminate pain, of any kind. This is not surprising. These drugs act quickly and effectively, relieve inflammation and tenderness, but treatment with only one NSAID result in the future will not bring. After all, these drugs eliminate only the symptoms of the disease, and not its cause. But, when a person has an unbearably painful elbow, only anesthetic therapy can alleviate his suffering.
The modern pharmaceutical market has about 40 active ingredients from this group, and hundreds of drugs and dosage forms based on them. Most commonly used drugs based on: diclofenac, nimesulide, indomethacin, celecoxib, meloxicam, ketorolac, ibuprofen, naproxen, piroxicam. Such "first aid" products are released in the form of tablets, gels, ointments, solutions for intravenous, intramuscular, intraarticular injections, suppositories, patches, etc. A combination of them( inside and locally) will help to get rid of pain much more quickly.
It should be remembered that although it is OTC drugs, it is not worth taking in their reception - they have many contraindications and side effects. Of course, if the pain is severe, you can drink an anesthetic pill, but swallowing them in packs is strictly prohibited( they are not intended for long-term use).
In order to prevent exacerbation of the pain syndrome and to treat not only the symptoms but also the causes of the disease, prescribe means that are capable of restoring the damaged cartilage of the joint and slowing the progression of the dystrophic process - the chondroprotectors. All such drugs basically have 2 substances - chondroitin and glucosamine( natural components of human cartilage).To mark a positive result, the course of treatment should be long - at least 3-4 months, and it is necessary to start with 15-20 intramuscular or intraarticular injections and continue taking the drug inside for 2-3 months. Every year, the course of treatment should be repeated in order to consolidate the results achieved.More to read:
Lateral epicondylitis of the elbow joint
Most often used such drugs:
If the pain is very severe, the doctor may prescribe an injection in the joint cavity. Such treatment is very effective, but it is used only in acute situations. To be carried away by such methods it is not necessary, after all each prick is a risk of introduction of an infection in an elbow joint that will only aggravate a situation.
Three groups of medicines can be inserted into the joint:
- glucocorticoid hormones;
- chondroprotective agents;
- preparations of hyaluronic acid.
Glucocorticoid hormones are powerful anti-inflammatory drugs, but they also have many contraindications and side effects. Relief from such a prick comes immediately, which makes this procedure very popular among patients with joint pain. Most often, drugs such as:
The course of treatment consists of 3-5 injections at intervals of about 2 weeks. Despite the rapid elimination of symptoms, it is impossible to treat joint disease with corticosteroids alone, since they do not affect the cause of the pathology and do not contribute to stopping the progress of the disease.
Injections in the elbow joint are a very effective and quick way to get rid of the pain, but only an experienced specialist in the stationary conditions should do this manipulation.
Recently, hyaluronic acid preparations have been very popular for insertion into the joint cavity affected by the degenerative process. Such injections are called a liquid prosthesis. On the modern pharmaceutical market, preparations Ostenil, Fermatron, Sinocrom are presented. They replace the missing intraarticular fluid and restore the natural lubrication of the joint, and also improve the nutrition of the cartilaginous tissue, which positively affects its condition.
Orthopedic methods of treating pain in the elbow come to the fore in case of traumatic injury. Depending on the type of injury and its severity, an orthopedic trauma specialist may assign you to wearing gypsum, longi, taut bandages, a special orthosis that will help immobilize and rest the affected joint, which is the main component of the successful treatment of injuries.
Modern orthoses make it possible to achieve maximum peace of mind for the elbow joint, while you can monitor the condition of the elbow and perform all the medical manipulations on it.
Folk recipes for pain in the elbow
Folk remedies for joint pain have been known for a long time. Sometimes choose the right one for you, it becomes very difficult, because the abundance of national recipes is confusing. Below we give a few recipes that will prove effective just with pain in the elbow:
- Take a pre-cleaned and dried egg shell, shatter it into powder, mix it with sour milk to a consistency of gruel, apply the mixture to a sick elbow, and wrap it with a warm cloth. Keep such a compress you need at least 1 hour. The course of treatment is 5 days.
- Treatment with a buttercup. To do this, fill the flowers with a glass of boiling water, let it brew for 5-6 hours. Then bring the volume of broth to 5 liters of hot water and take "elbow baths."The water should be hot, keep the elbow in it for 1 hour. At night, you can make lotions from the same broth. The course of treatment is 10 days.
- Therapeutic home ointment. To do this, take camphor 50 grams, 50 ml 70% alcohol, 3 tablespoons dry mustard, protein 2 eggs. The resulting ointment is treated with an elbow and wrapped with a cloth overnight. The course of treatment - 5 wraps.
Also it is impossible to forget about physiotherapeutic procedures, which sometimes prove to be even more effective than medicines. If all of the above methods do not help you get rid of the pain, then the pathological process may have gone far and you need surgery. Modern equipment and methods of surgical interventions allow to return the function of the hand and get rid of the pain even in the most severe cases. But, in order to prevent this, apply for specialized medical help in a timely manner.
Various pathological conditions can lead to pain in the elbow joints of the hands: inflammatory, tumor, degenerative-dystrophic processes, the consequences of injuries and even reflection of pain in the elbow from a pathogenic process located in a very different organ.
The most common cause of pain in the elbow are the following diseases:
This is a very common disease among the adult population.
In epicondylitis, one of the epicondylitis of the humerus is affected, less often both( epicondyles are two tubercles along the sides of the elbow).
The appearance of epicondylitis is facilitated by:
- permanent repetitive monotonous movements in the elbow joint;
- physical load on the hands with a certain fixed position of the body, which is typical of some professions( typists, musicians, dentists, turners, locksmiths, carpenters).
In addition, epicondylitis very often hits athletes, especially players in tennis and golf, hence the other names - "tennis elbow" and "elbow of the golfer."
Of course, a dislocation or fracture of bones in the elbow joint area will be accompanied by severe pain and restriction of movements in the elbow, and patients clearly associate the appearance of pain with trauma.
However, subluxation, cracks and other minor injuries after a "minor" injury often go unnoticed, leading after a while to swelling, pain, impaired function.
In this case, patients sometimes have time to forget about the injury.
Reflex pain in osteochondrosis of the cervical, thoracic spine
Osteochondrosis is another common condition that can cause pain in the hands, and in particular in the elbow joints.
Reflected pains are explained by a peculiar perception, when the elbow is falsely felt as a source of pain, but in fact there are no damages there.
Irradiating pain develops when the roots of the spinal nerves are jammed, the branches of which pass to the arm and elbow joint.
Although the elbow joint is not the most typical localization of osteoarthritis, degeneration of cartilage in it is still possible, more often as a secondary phenomenon, caused by general exchange hormonal disorders or consequences of inflammatory processes.
The destruction of cartilage tissue over time can cause the formation of bone growths on the joint surfaces, leading to pain and limited mobility due to them.
A characteristic symptom of deforming arthrosis is a crunch during movements.
This is an inflammatory lesion of the elbow joint, which can be:
- reactive - develops against a background of severe ARI, measles, rubella, bacterial infections, including specific arthritis( tuberculosis, gonorrhea, syphilitic, brucellosis);
- is post traumatic;
- occurred in systemic connective tissue diseases( rheumatic fever, systemic lupus erythematosus), with metabolic disorders( gout).
It is an inflammation of the periarticular bag, it develops for the same reasons as arthritis.
The main signs - pronounced puffiness around the joint, pain, with acute bursitis - a rise in temperature.
Irradiation of pain in the elbow from the internal organs
These can be pains reflected from the heart, pancreas, stomach, liver.
So, the pain and burning sensation in the left elbow is one of the symptoms of an attack of angina pectoris, with a heart attack, an exacerbation of the stomach ulcer.
Irradiation of pain in the elbow joint of the right hand can occur with biliary colic, cholecystitis.
is a compression of the ulnar nerve, caused by:
- repeated microtrauma;
- overvoltage( in athletes);
- prolonged squeezing( the habit of long leaning on elbows when talking on the phone, the drivers pushing their hands out the window).
Appears with pain and a feeling of stiffness in the elbow joint, numbness and tingling in the fingers of the hand, mainly in the little finger and the finger of the finger near the little finger.
Neuritis( inflammation) of the ulnar nerve
It is accompanied by pains in the elbow, forearm, numbness of the hand and fingers.
Malignant neoplasm of the elbow joint
This tumor can develop from cartilage or bone tissue.
are rare, and are diagnosed usually in later stages, when the tumor grows and disrupts the function of the joints.
Among the initial symptoms - unexplained temperature rises, weight loss, lack of appetite, later pain, swelling around the joint.
Among the rare causes of pain in the elbow joint can be noted:
- diffuse fasciitis;
- synovial chondromatosis;
Each pathology is characterized by a peculiar symptomatology, painful feelings behave differently, appearing in certain movements, after some actions or constantly.Why does it hurt under the left shoulder blade? Find out the causes of pain under the left scapula from our article.
Joints on the fingers are aching - what should I do? Read in this article.
Pain in the elbow during flexion is noted with:
- deforming arthrosis( usually accompanied by a crunch, painful and unbending);
- arthritis, bursitis - any movements in the elbow joint are painful, the acute phase is characterized by edema, fever, redness of the skin over the affected joint;
- after injury.
Painful sensations in the elbow when flexing the hand and rotating( turning the brush) occur against the background of the medial epicondylitis( "golf elbow").
Reduction of flexion force, tenderness, swelling are observed when the forearm tendon ruptures.
Pain during extension is also accompanied by osteoarthritis, arthritis, bursitis, tumors and various injuries.
Intensive pains when trying to unbend an arm are characteristic for the "elbow player of tennis", or acute lateral epicondylitis.
Patients with lateral epicondylitis are unable to hold the weight on the elongated arm( a symptom of fatigue), experience severe pain when the hand is compressed into a fist and are unable to hold the elongated arm( Thompson's symptom) with a compressed hand.
Sharp pain and an obstruction to full extension in the elbow joint, along with a shortening of the forearm, is characteristic of posterior dislocation.
The deformity of the joint, the protruding elbow process, is visually determined.
On the inside of the
Pain on the inside occurs with medial epicondylitis, with bruises and other traumatic injuries from the inside of the elbow.
Pain sensations when pressing and probing the elbow joint are characteristic for inflammatory lesions( arthritis, bursitis), while swelling is determined, skin over the joint hot to the touch.
bursitis of the elbow joint
Tumor in the elbow joint in the later stages of development can also be palpated.
The appearance of pain when pressing on the epicondyle of the elbow is a sign of epicondylitis.
Pressing on the elbow itself and epicondyles is painful for fractures and dislocations, bruises, sprains.
The onset of pain immediately after training may be due to an injury:
- stretching ligaments due to overexertion, sudden movement, improper exercise.
If the pain after training is a constant concern, epicondylitis or the syndrome of the cubital canal is very possible.
The pain that appears when you shake hands is one of the symptoms of epicondylitis.
In addition, handshake can be painful for cracks and other injuries of the elbow joint.
When lifting the severity of
The absence of pain in the performance of normal daily movements and their appearance under load( lifting of the heaviness, increased work by hand) is a typical sign of subacute epicondylitis.
Lifting of gravity can lead to pinching roots of spinal nerves and the occurrence of pain along their course - in the shoulder, elbow.
After an injury
Depending on the strength of the injury, damage of varying degrees is possible: from microcracks to fractures.
Accordingly, the nature of the pain will be different: in case of fracture and dislocation - acute, simultaneous deformation in the joint, at the time of fracture, a characteristic crunch is often heard.
Microcracks and cracks may not give pain immediately after the injury, but manifest after a while, in some cases such subtle traumas cause the syndrome of the cubital canal.
A bruise of only soft tissues is accompanied by rather severe pain immediately at the time of injury, then the pain becomes not too intense, the soreness at the touch is localized, as it were over the joint, in the region of the hematoma, the movements in the elbow are painless and easily accomplished in full.
A fall on the elbow with a blow against a hard surface can result in a fracture.
Fracture in the elbow joint is manifested by sharp pain, deformity of the joint, edema.
Movement is almost impossible because of the extreme pain.
Pulling, like other loads, provokes the occurrence of pain in the elbow in subacute epicondylitis. What to do with pain in elbows?
Section: Author: Роман Помазанов Comments: 3 Ask a question
Мне 44 года.Since January I decided to study in the hall to throw off 10-15 extra fat, and in the amount of hands I need to get a couple of centimes. Everything went well. He started with a small weight, more paid cardio training, he went systematically. In June, decided that it was time to start to work hard and make a jerk of my dreams.
For a month I threw off 6 kg, and in the volume of the biceps I typed 2 cm. And here I went wrong. The elbows started to hurt incredibly. Rubbing, ointments and compresses do not give their effects. At night I wake up in pain and I can not bend my arm.
Stopped doing. The pain subsided a little, but it reminds of itself constantly.
Now questions to the professional.
Should I go back to training?( Because the desire is great because I began to feel much better and more confident)
If so, when?
Are there any tips on how to get rid of elbow pain?
Is there a set of exercises that does not hurt the elbow joints?
Pain in elbows can have different causes. But the most likely are:
1. Osteochondrosis or other diseases of the spine( thoracic department).
This is neurology and should be treated seriously. Problems with the spine are problems with the nerves that control the subtle processes in the limbs. And problems with innervation are problems with capillaries. Because of this, cartilage joints can stop getting enough nutrients. And hence the various problems associated with rapid wear, etc. And the more fanatical a person trains on the background of such problems, the faster he will feel the pain.
2. Excessive triceps overload.
Occurs when the athlete works a lot in bench press, bench press, tilt rod, deadlift, and then separately loads triceps, performing various extension of arms with a barbell, dumbbells, on blocks.
when falling, improperly striking, or because of uncomfortable( hands bent under him) poses in a dream. And it happens. ..
4. Wrong execution of strength exercises,
in which an excessive load falls on the elbow joints.
Mahi dumbbells in the sides( hands should always bend slightly in the elbows)
All kinds of presses in which the hands are excessively unbending( to the point of failure)
Thrusts and any weight holdings in hands with relaxed biceps.
So carefully( and not as usual) read the description of the technique exercises. Pay attention to the nuances.
5. Age changes.
You are 44 years old. Not a boy anymore. Age necessarily makes its own adjustments to the training. This is inevitable, despite the fact that some of my readers clearly object to this( psychologically resist age).Some exercises are better to exclude or simplify technically, so as not to work for wear. After all, the reserves of 20-year-olds are much higher than those of people over 40. I will try to make a separate post about such exercises.
By the way, Jack London has well described this age difference in his story MEAT PIECE.
Usually, if the pain has arisen as a result of training, just a few days of rest and a change in the training program is enough for it to pass.
Regarding non-passing pain, I recommend that you consult a doctor as soon as possible, rather than dealing with the elimination of symptoms with ointments. Establish the reason and undergo a full course of treatment: physiotherapy, medicine, massage. Do not confuse the cause of pain and pain itself.
To full training should be returned when the pain goes away. Remove all exercises that cause even the slightest pain, but I think that, in general, training should not be abandoned altogether( unless the doctor specifically forbade it).
Is there a complex that does not injure elbow joints?
Almost any literate complex takes into account the anatomical feature of the triceps and does not overload it. After all, he is involved not only in extending his hands during pressures. Triceps is actively involved in traction, pull-ups and even in shags.
In addition, do not forget that before the start of strength training for the result you must undergo a medical examination. For some reason, most beginners do not pay any attention to this requirement. Therefore, if you neglected this requirement, do not complain and do not say that you were not warned.
If the elbow hurts - treatment of epicondylitis |NATIONAL MEDICINE
Among the many types of pain, unpleasant pulling sensations on the elbow are well known to many people.
Epicondylitis or second name - "elbow tennis player" - a disease that occurs with prolonged rotation of the forearm at the same time with flexion and extension of the arm at the elbow. It is these movements that tennis players make.
But in the risk group there are also people of such professions as blacksmiths, painters, bricklayers, plasterers, fitters, masseurs, machine operators and even inveterate truck farmers who operate a hoe or housewives who carry heavy buckets and bags.
Sometimes it is enough just one sharp rise in gravity, a spurt on yourself, throwing any object - and as a result of a traumatic movement there is pain in the elbow. And, once appeared, it can last for weeks and months, because a person is not being treated. After all, he feels pain in the elbow only with a lot of stress or strain.
Why does the elbow hurt
If the elbow hurts for a long time, then gradually in the place of damage, a degeneration of the tendon can occur due to the proliferation of connective tissue. Subconsciously, guarding the injured hand, the patient begins to redistribute the load, which leads to disruption of biomechanics and, subsequently, can provoke other diseases of the musculoskeletal system.
The main symptoms of epicondylitis are pain near the elbow joint, which is strengthened when the hand is extended backward, while turning the forearm with the palm of the hand, while holding heavy objects. Although outwardly the elbow joint does not differ in any way from a healthy one - there is no pain at rest, there is no tumor, the shape of the joint has not changed.
What to do if the elbow joint
hurts Neither analyzes, nor X-rays of deviations will not fix. But if a sensible doctor tries to maximally unfold the patient's wrist clockwise or counter-clockwise, fixing the elbow beforehand, and then suggest that the patient return his hand to the starting position, overcoming the physician's resistance, then a sharp pain will not keep you waiting. After such a test, it remains only to proceed to the treatment of a patient elbow.
The doctor will prescribe various medications, but sometimes it is sufficient to provide the patient with an elbow joint rest for 1 to 2 months and a gentle regimen under the load. But folk medicine has prepared several very effective prescriptions for the treatment of this disease.
Treatment of pain in the elbow with folk remedies
If the elbow joint and muscles are hurting around, then compresses from medicinal plants work well on it.
• Mashed and steamed birch leaves are applied to the diseased joint, covered with a cotton cloth, then with polyethylene and a scarf. Hold a compress for 2 - 4 hours a day, every day, a course of treatment 15 - 20 procedures.
• Mix the flowers of chamomile and elderberry black 1: 1, turn over with boiling water and apply a warm mixture to the elbow, as in the previous recipe. Keep 1 to 2 hours.
• 2 tablespoons of herbs of geranium meadow filled with 2 glasses of cold water, insist 8 hours. Wet the napkin in the infusion, apply to the sick elbow, top cover with polyethylene and wrap up the scarf for 1 - 2 hours.
• Fresh buds of poplar black( osokorya) put in a glass at 1/3 and pour boiling water to a glass. After cooling the resulting pulp 15-20 minutes, apply to the joint for 3 to 4 hours. The course of treatment 10 - 20 procedures.
• You can also make ointment from kidney buds. To do this, mix 3 tablespoons of kidneys and unsalted butter, stand for 1 hour in a water bath and 5 days in a refrigerator. The obtained ointment is rubbed into the diseased joint daily for 4 days. After a short break, this treatment can be repeated 5 to 6 times.
• For the treatment of pain in the elbows make a tincture of violet fragrant. To do this, 20 g of leaves are poured 200 grams of vodka and aged for 10 days. Wet the napkin in this tincture, apply to the diseased joint, then polyethylene and a warm scarf. Hold a compress for 2 to 4 hours a day, the treatment lasts a course of 15 - 20 procedures.
For prevention, doctors are advised to observe the correct position of the hands, landing and posture and perform several simple exercises: shaking hands, squeezing the hands into a fist, rotating the fingers, blading the blades, massage.