Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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== Nerve Mobilization <ref name="6" /> == | == Nerve Mobilization <ref name="6" /> == | ||
*One case report has shown the following nerve mobilizations are beneficial in those with radial or median nerve entrapment | *One case report has shown the following nerve mobilizations are beneficial in those with radial or median nerve entrapment | ||
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== Clinical Bottom Line <br> == | == Clinical Bottom Line <br> == |
Revision as of 06:02, 3 December 2012
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 spine, elbow, and/or wrist.
Interventions for the Following Diagnoses [edit | edit source]
Cervical Manipulation
CT Mobilization
Thoracic Manipulation
Wrist Manipulation
Carpal Manipulation
Median and Radial Nerve mobilization
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 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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X | X | |||||||
CT Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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X | X | X | X | |||||
Thoracic Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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X | ||||||||
Wrist |
X | X | X | X | X | ||||
Carpal mobilization Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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X | X | X | ||||||
Medain/Radial Nerve Mob Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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X | X |
Cervical Thrust Manipulation Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title[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 epicondyalgia
- 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 Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]
- One pilot clinical trial has shown that the following cervico-thoracic mobilization is beneficial in those with lateral epicondyalgia
- 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 Cite error: Invalid <ref>
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[edit | edit source]
- One randomized clinical trial has shown the following thoracic manipulation is beneficial in those with lateral epicondyalgia
- 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 Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]
- One randomized pilot study has shown the following wrist manipulation is beneficial in those with lateral epicondyalgia
- 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 Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title[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 triquetral bone with thumbs stacked on one another
- Patient instructed to lean back to provide traction on carpals
- Wrist flexion maintained and HVLA thrust to triquetral palmarly
Nerve Mobilization Cite error: Invalid <ref>
tag; name cannot be a simple integer. Use a descriptive title[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
Clinical Bottom Line
[edit | edit source]
• Manipulation of the wrist in those with lateral epicondylitis might have additional treatment effects short term compared with ultrasound, friction massage, and muscle strengthening and stretching
• Incorporating manual therapy directed at the cervicothoracic spine may provide additional benefits over treatment directed only at the elbow.
References[edit | edit source]