Elbow Mobilizations

Original Editor - David Drinkard

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Elbow Complex

The elbow complex consists of humeroulnar and humeroradial joints. For the complete range of motion for elbow flexion and extension, accessory motions of valgus and varus are essential. The technique for each of the joints is described.

Elbow mobilization is proved to be effective in post-traumatic or post-operative elbow injury cases.For improved results, it is usually combined with pain-relieving modalities, active exercises, stretching, and functional activities.

Humeroulnar Articulation

The trochlea is convex and it articulates with the olecranon fossa which is concave.

Loose pack position

Elbow flexion of 70 degrees and forearm supination of 10 degrees.

Humeroulnar Distraction and Progression

Indications

For the purpose of testing, pain control(grade 1/2), to increase ROM (flexion and extension movement) of the elbow (grade 3/4).

Patient Position-

• Supine lying with the elbow placed at the edge of the treatment table. The joint will be kept in resting position during the initial treatment and the patients hand will rest on the therapist's shoulder.

• To stretch into flexion or extension, the therapist has to position the elbow at the end of the available range.

Hand Placement -

• The elbow of the client is kept either in resting position or at the end available range of flexion.

• The therapist places the hand over the proximal part of ulna on the volar surface and reinforces it with other hand.

Mobilizing Force-

• Force is applied at the proximal ulna at 45 degree angle to the shaft of the bone.

Humeroulnar Distal Glide

Indication

To increase flexion

Patient Position and Hand placement

Supine lying with elbow over the edge of the treatment table. Initially the elbow is in resting position. Progression is done by positioning the elbow at the end range of flexion. The therapist places the fingers on the proximal ulna over the volar surface and reinforces with another hand.

Mobilizing Force

The therapist at first applies the distraction force to the joint at a 45-degree angle to the ulna, after that while maintaining the force of distraction, the force is directed in the distal direction along the long axis of the ulna. This is called a scooping motion.

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Humeroulnar Radial Glide

Indication

To increase the accessory motion of varus which happens along with elbow flexion and hence used to progress flexion.

Patient Position

Sidelying on the arm to be mobilised , with the shoulder in lateral rotation. The humerus is supported on the table. Commence in resting position and then progress to end range elbow flexion.

Hand Placement

The base of the proximal hand of the therapist is kept just distal to the elbow joint and the distal forearm is supported with another hand.

Mobilizing Force

Force is applied against the ulna in the radial direction.

Humeroulnar Ulnar Glide

Indication

To increase valgus which is an accessory motion of elbow joint and is accompanied with extension of elbow and hence it is used to improve the ROM of the same.

Patient Position

Its the same as for the radial glide and the wedge is kept under proximal part of forearm for stabilization. During the initial treatment sessions, the elbow is kept in the resting position and slowly progressed to extension till end range.

Mobilizing Force

The direction of force is towards radial direction against the distal humerus causing the ulna to glide in the anterior direction.

Humeroradial Articulation

The capitulum is convex and it articulates with the concave radial head.

Resting Position

Elbow extension and forearm supination to the end available range.

Treatment Plane

It is in concave radial head which is perpendicular to the long axis of the radius.

Humero-radial Distraction

Indications

To increase the ROM of humeroradial joint.

Patient Position

Supine lying or sitting position and the arm resting on the treatment table.

Therapist Position and Hand Placement

The therapist is on the ulnar side of the patient's forearm between the client's hip and upper extremity.

Stabilize the humerus of the client with your superior hand.

Hold the distal radius with fingers and thenar eminence of the hand which is inferior.

Grasping /holding of only radius should be done ,not of the ulna.

Mobilizing Force

Long axis traction is given to the radius in the distal direction.

Humeroradial Dorsal /Volar glides

Indication

Dorsal glide is to increase the extension of the elbow joint and volar glide is to increase flexion.

Patient position

Supine/sitting, keeping the elbow extended and supinated till the available range.

Hand placement

The humerus is stabilized by the therapist on the medial side of the patient's arm. The radial head is grabbed by the palmar surface of the lateral hand.

Mobilizing force

The head of the radius is moved in the volar or dorsal direction by the palm of the therapist.

Humeroradial compression

Indication

For the treatment of pulled elbow

Position of the patient

Sitting/Supine(90 degrees elbow flexion)

Hand placement

The right hand of the patient is approached with the right hand of the therapist and vice versa. The posterior part of the elbow is stabilized with another hand.

The thenar eminence of the client is against the thenar eminence of the therapist and the thumbs are locked.

Mobilizing force

The therapist give compression force along the long axis of the radius while supinating the forearm and extension of the wrist.

Elbow Distraction

For this technique, the patient is positioned supine on a mat with the elbow flexed to 90 degrees and by the patient's side. The upper arm is stabilized with the non-mobilizing hand. The mobilizing hand grabs the patient's wrist and provides a superior-directed force toward the ceiling, creating distraction at the elbow joint that promotes joint play necessary for elbow flexion. This technique can also be performed with the elbow in more extension as a mobilization to promote elbow extension or an anterior capsular stretch.

Anterior Glide

With the patient positioned in prone and the shoulder abducted to 90 degrees, the operator stabilizes the distal humerus with the stabilizing hand. The mobilizing hand is placed over the olecranon process. The mobilization involves a force directly through the line of the ulna toward the floor, moving the ulna in an anterior direction. This technique is often used for increasing elbow flexion.

Distal Radial Glide (on Ulna bone)

Patient positioned supine with the arm at the side, forearm in neutral. The distal humerus is stabilized by one hand. The mobilizing hand is placed along the distal radius just proximal to the thumb. The mobilization occurs as the therapist pulls on the distal radius. This technique is often used to promote elbow extension by distracting the radiohumeral joint.

Humeroradial Approximation

With the patient lying supine on a mat and the elbow flexed perpendicular to the mat, the therapist grasps the humerus with the stabilizing hand. The mobilizing hand is placed around the patient's hand at the thumb. The mobilization is a downward-directed force through the radius and then pronated or supinated. This technique is useful for regaining pronation and supination range of motion.