Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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'''Original Editor '''- [[User:Bryndee Boheman|Bryndee Boheman]], [[User:Jubil Young|Jubil Young]], [[User:Molly Haberichter|Molly Haberichter]], [[User:Meghan Barclayas|Meghan Barclayas]] and [http://www.physio-pedia.com/User:Shannon_Petersen Shannon Petersen] part of the [[Des Moines University Student Project]] | |||
'''Lead Editors''' | |||
</div> | |||
== [[Regional Interdependence|Regional Interdependence]] == | == [[Regional Interdependence|Regional Interdependence]] == | ||
*Treatment directed at one area of the body to elicit changes in another | *Treatment directed at one area of the body to elicit changes in another | ||
*In addition to treatment directed at the elbow, patients with elbow pain may benefit from treatment directed at the cervical or thoracic | *In addition to treatment directed at the elbow, patients with elbow pain may benefit from treatment directed at the cervical or thoracic spines, and/or wrist. | ||
== Examination == | |||
*Differential diagnosis for [[Lateral Epicondylitis|Lateral Epicondylalgia]] can be done through [[Elbow Examination|Elbow Examination]] | |||
*Prior to performing interventions directed at the spine, appropriate examination and safety screens should be performed. | |||
-[[Cervical Examination|Cervical Examination and screen for Red Flags]] | |||
-[[Vertebral Artery Test|Vertebral Artery Test]] | |||
-[[Transverse Ligament Stress Test|Transverse Ligament Stress Test]] | |||
-[[Cervical Instability|Tests for Cervical Instability]] | |||
-[[Thoracic Examination|Thoracic Examination]] <br> | |||
== Interventions for the Following Diagnoses == | == Interventions for the Following Diagnoses == | ||
*[[Lateral Epicondylitis|Lateral | *[[Lateral Epicondylitis|Lateral Epicondylalgia]] | ||
-Cervical Manipulation | -Cervical Manipulation | ||
- | -[[Manual Techniques for the Cervicothoracic Spine|Cervico-Thoracic Mobilization]] | ||
-Thoracic Manipulation | -Thoracic Manipulation | ||
| Line 17: | Line 37: | ||
-Wrist Manipulation | -Wrist Manipulation | ||
*[[Cubital Tunnel Syndrome | *[[Cubital Tunnel Syndrome |Cubital Tunnel Syndrome]] | ||
-Carpal Manipulation | -Carpal Manipulation | ||
*[[Nerve entrapment|Nerve entrapment]] | *[[Nerve entrapment|Nerve Entrapment]] | ||
<span id="1355197573060S" style="display: none"> </span> -[[Neurodynamics|Neurodynamics]] | |||
-Median and Radial Nerve mobilization | |||
<br> | |||
== Cervical Thrust Manipulation <ref name="p1" /><ref name="p2" /> == | |||
*One randomized pilot study and one randomized clinical trial have shown that the following cervical manipulation is beneficial in those with lateral epicondylalgia | |||
*Patient supine with neck in nuetral | |||
*Physical therapist positions neck into rotation and contralateral flexion | |||
*High velocity low amplitude (HVLA) thrust manipulation directed superior and medial towards contralateral eye | |||
Cervical Thrust Manip Video | |||
{{#ev:youtube|LADO0Rj8KGw}} | |||
== Cervico-Thoracic Mobilization <ref name="p3" /> == | |||
*One pilot clinical trial has shown that the following cervico-thoracic mobilization is beneficial in those with lateral epicondylalgia | |||
*Non-thrust grade III and IV PPIVM and PAIVM directed at impaired segment | |||
<br> | |||
Done in combination with the following: | |||
*Stretching of wrist extensors, strengthening of wrist and forearm, and mobilizations of elbow/wrist | |||
CT Manip Video | |||
{{#ev:youtube|VEpiGhkgUuU}} | |||
== Thoracic Manipulation <ref name="p2" /><br> == | |||
*One randomized clinical trial has shown the following thoracic manipulation is beneficial in those with lateral epicondylalgia | |||
*Patient supine with arms crossed over chest | |||
*Physical therapist localizes thoracic segment using “pistol grip” | |||
*Physical therapist flexes thoracic spine and stabilizes neck and head | |||
*Physical therapist performs high-velocity, low amplitude manipulation in a cephalad direction. | |||
{{#ev:youtube|HeOt9bsSSdo}} | |||
== Wrist Manipulation <ref name="p4" /> == | |||
*One randomized pilot study has shown the following wrist manipulation is beneficial in those with lateral epicondylalgia | |||
*Therapist grips patient's scaphoid between thumb and index finger | |||
*Place other hand over same landmarks for stabilization | |||
*Extend patient's wrist while manipulating scaphoid ventrally | |||
{{#ev:youtube|D5JBE7kBso4}} | |||
== Carpal Mobilization <ref name="p5" /> == | |||
*One case study has shown the following carpal mobilization is beneficial in those with cubital tunnel syndrome | |||
*Patient seated | |||
*Physical therapist stabilizes patient's hamate palmarly | |||
*Dorsally, physical therapist palpates triquetrum with thumbs stacked on one another | |||
*Patient instructed to lean back to provide traction on carpals | |||
*Wrist flexion maintained and HVLA thrust to triquetrum palmarly | |||
{{#ev:youtube|PIQYlJCPBxs}} | |||
== Nerve Mobilization <ref name="p6" /> == | |||
*One case report has shown the following nerve mobilizations are beneficial in those with radial or median nerve entrapment | |||
*Patient supine, placed in [[Neurodynamic Assessment|ULTT positions]] for radial or median nerve | |||
*Flex/Extend patients elbow while in test positions | |||
*Extend elbow about 2 seconds into range | |||
*Tension felt/ no pain | |||
*Flex elbow to point of no tension | |||
*Repeat 6-7 times | |||
| {{#ev:youtube|qEcyLJzfOFg}} | ||
<br> | |||
<br> | |||
{{#ev:youtube|plljy8vUN7g}} | |||
== Outcomes <br> == | == Outcomes <br> == | ||
{| | {| cellspacing="1" cellpadding="1" border="1" width="700" align="center" | ||
|- | |- | ||
| <br> | | <br> | ||
| Line 42: | Line 140: | ||
| Improved Elbow Flexion Test | | Improved Elbow Flexion Test | ||
|- | |- | ||
| Cervical <ref name=" | | Cervical <ref name="p1">Fernández-Carnero J, Fernández-de-las-Peñas C, Cleland J. Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal Of Manipulative and Physiological Therapeutics. November 2008;31(9):675-681.</ref> <ref name="p2">Fernández-Carnero J, Cleland J, Touche. Examination of Motor and Hypoalgesic Effects of Cervical vs Thoracic Spine Manipulation in Patients With Lateral Epicondylalgia: A Clinical Trial. Journal Of Manipulative and Physiological Therapeutics. September 2011;34(7):432-440.</ref> | ||
| | | | ||
| X | | X | ||
| Line 53: | Line 151: | ||
| | | | ||
|- | |- | ||
| CT <ref name=" | | CT <ref name="p3">Cleland J, Flynn T, Palmer J. Incorporation of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia: a pilot clinical trial. Journal Of Manual and Manipulative Therapy (Journal Of Manual and Manipulative Therapy). September 2005;13(3):143-151.</ref> | ||
| X | | X | ||
| X | | X | ||
| Line 64: | Line 162: | ||
| | | | ||
|- | |- | ||
| Thoracic <ref name=" | | Thoracic <ref name="p2" /> | ||
| | | | ||
| | | | ||
| Line 76: | Line 174: | ||
|- | |- | ||
| | | | ||
Wrist <br><ref name=" | Wrist <br><ref name="p4">Struijs P, Damen P, Bakker E, Blankevoort L, Assendelft W, van Dijk C. Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Physical Therapy. July 2003;83(7):608-616.</ref> | ||
| X | | X | ||
| Line 88: | Line 186: | ||
| | | | ||
|- | |- | ||
| Carpal Mobilization <ref name=" | | Carpal Mobilization <ref name="p5">Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual and Manipulative Therapy (Maney Publishing). December 2010;18(4):228.</ref> | ||
| X | | X | ||
| | | | ||
| Line 99: | Line 197: | ||
| X | | X | ||
|- | |- | ||
| Median/Radial Nerve Mob <ref name=" | | Median/Radial Nerve Mob <ref name="p6">Ekstrom R, Holden K. Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment. Physical Therapy [serial online]. November 2002;82(11):1077-1086.</ref> | ||
| X | | X | ||
| X | | X | ||
| Line 113: | Line 211: | ||
<br> | <br> | ||
<br> | |||
<br> | |||
== Clinical Bottom Line <br> == | == Clinical Bottom Line <br> == | ||
• Incorporating manual therapy directed at the cervical spine, thoracic spine, cervico-thoracic junction, wrist, and carpals appear to provide benefits for patients with lateral | • Incorporating manual therapy directed at the cervical spine, thoracic spine, cervico-thoracic junction, wrist, and carpals appear to provide benefits for patients with lateral epicondylalgia, cubital tunnel syndrome, and nerve entrapment. Clinicians may consider these interventions in addition to treatment directed only at the elbow. More specific information can be found in the references below. | ||
== References == | == References == | ||
<references /> | <references /> | ||
: | : | ||
[[Category:Assessment]] [[Category:Elbow]] | |||
[[Category:Elbow - Assessment and Examination]] | |||
[[Category:Interventions]] [[Category:Elbow - Interventions]] [[Category:Elbow - Interventions]] | |||
[[Category:Des Moines University Student Project]] | |||
Latest revision as of 12:02, 2 August 2021
Original Editor - Bryndee Boheman, Jubil Young, Molly Haberichter, Meghan Barclayas and Shannon Petersen part of the Des Moines University Student Project
Lead Editors
Regional Interdependence[edit | edit source]
- Treatment directed at one area of the body to elicit changes in another
- In addition to treatment directed at the elbow, patients with elbow pain may benefit from treatment directed at the cervical or thoracic spines, and/or wrist.
Examination [edit | edit source]
- Differential diagnosis for Lateral Epicondylalgia can be done through Elbow Examination
- Prior to performing interventions directed at the spine, appropriate examination and safety screens should be performed.
-Cervical Examination and screen for Red Flags
-Transverse Ligament Stress Test
-Tests for Cervical Instability
Interventions for the Following Diagnoses [edit | edit source]
-Cervical Manipulation
-Cervico-Thoracic Mobilization
-Thoracic Manipulation
-Wrist Manipulation
-Carpal Manipulation
-Median and Radial Nerve mobilization
Cervical Thrust Manipulation [1][2][edit | edit source]
- One randomized pilot study and one randomized clinical trial have shown that the following cervical manipulation is beneficial in those with lateral epicondylalgia
- Patient supine with neck in nuetral
- Physical therapist positions neck into rotation and contralateral flexion
- High velocity low amplitude (HVLA) thrust manipulation directed superior and medial towards contralateral eye
Cervical Thrust Manip Video
Cervico-Thoracic Mobilization [3][edit | edit source]
- One pilot clinical trial has shown that the following cervico-thoracic mobilization is beneficial in those with lateral epicondylalgia
- Non-thrust grade III and IV PPIVM and PAIVM directed at impaired segment
Done in combination with the following:
- Stretching of wrist extensors, strengthening of wrist and forearm, and mobilizations of elbow/wrist
CT Manip Video
Thoracic Manipulation [2]
[edit | edit source]
- One randomized clinical trial has shown the following thoracic manipulation is beneficial in those with lateral epicondylalgia
- Patient supine with arms crossed over chest
- Physical therapist localizes thoracic segment using “pistol grip”
- Physical therapist flexes thoracic spine and stabilizes neck and head
- Physical therapist performs high-velocity, low amplitude manipulation in a cephalad direction.
Wrist Manipulation [4][edit | edit source]
- One randomized pilot study has shown the following wrist manipulation is beneficial in those with lateral epicondylalgia
- Therapist grips patient's scaphoid between thumb and index finger
- Place other hand over same landmarks for stabilization
- Extend patient's wrist while manipulating scaphoid ventrally
Carpal Mobilization [5][edit | edit source]
- One case study has shown the following carpal mobilization is beneficial in those with cubital tunnel syndrome
- Patient seated
- Physical therapist stabilizes patient's hamate palmarly
- Dorsally, physical therapist palpates triquetrum with thumbs stacked on one another
- Patient instructed to lean back to provide traction on carpals
- Wrist flexion maintained and HVLA thrust to triquetrum palmarly
Nerve Mobilization [6][edit | edit source]
- One case report has shown the following nerve mobilizations are beneficial in those with radial or median nerve entrapment
- Patient supine, placed in ULTT positions for radial or median nerve
- Flex/Extend patients elbow while in test positions
- Extend elbow about 2 seconds into range
- Tension felt/ no pain
- Flex elbow to point of no tension
- Repeat 6-7 times
Outcomes
[edit | edit source]
| Decreased Pain |
Increased Pain Free Grip Strength |
Increased Pressure Pain Threshold | Decreased Disability (DASH) | Perception of Change | Global Improvement | Increased Max Grip Force | Improved Carpal Mobility | Improved Elbow Flexion Test | |
| Cervical [1] [2] | X | X | |||||||
| CT [3] | X | X | X | X | |||||
| Thoracic [2] | X | ||||||||
|
Wrist |
X | X | X | X | X | ||||
| Carpal Mobilization [5] | X | X | X | X | |||||
| Median/Radial Nerve Mob [6] | X | X |
Clinical Bottom Line
[edit | edit source]
• Incorporating manual therapy directed at the cervical spine, thoracic spine, cervico-thoracic junction, wrist, and carpals appear to provide benefits for patients with lateral epicondylalgia, cubital tunnel syndrome, and nerve entrapment. Clinicians may consider these interventions in addition to treatment directed only at the elbow. More specific information can be found in the references below.
References[edit | edit source]
- ↑ 1.0 1.1 Fernández-Carnero J, Fernández-de-las-Peñas C, Cleland J. Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. Journal Of Manipulative and Physiological Therapeutics. November 2008;31(9):675-681.
- ↑ 2.0 2.1 2.2 2.3 Fernández-Carnero J, Cleland J, Touche. Examination of Motor and Hypoalgesic Effects of Cervical vs Thoracic Spine Manipulation in Patients With Lateral Epicondylalgia: A Clinical Trial. Journal Of Manipulative and Physiological Therapeutics. September 2011;34(7):432-440.
- ↑ 3.0 3.1 Cleland J, Flynn T, Palmer J. Incorporation of manual therapy directed at the cervicothoracic spine in patients with lateral epicondylalgia: a pilot clinical trial. Journal Of Manual and Manipulative Therapy (Journal Of Manual and Manipulative Therapy). September 2005;13(3):143-151.
- ↑ 4.0 4.1 Struijs P, Damen P, Bakker E, Blankevoort L, Assendelft W, van Dijk C. Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Physical Therapy. July 2003;83(7):608-616.
- ↑ 5.0 5.1 Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual and Manipulative Therapy (Maney Publishing). December 2010;18(4):228.
- ↑ 6.0 6.1 Ekstrom R, Holden K. Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment. Physical Therapy [serial online]. November 2002;82(11):1077-1086.
