Regional Interdependence In Treatment Of The Elbow: Difference between revisions

No edit summary
No edit summary
Line 42: Line 42:
| Improved Elbow Flexion Test
| Improved Elbow Flexion Test
|-
|-
| Cervical <ref name="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 &amp;amp;amp;amp;amp; Physiological Therapeutics. November 2008;31(9):675-681.</ref>&nbsp;<ref name="2">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 &amp;amp;amp;amp;amp; Physiological Therapeutics [serial online]. September 2011;34(7):432-440.</ref>  
| Cervical <ref name="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.</ref>&nbsp;<ref name="2">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 53:
|  
|  
|-
|-
| CT <ref name="3">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 &amp;amp;amp;amp; Manipulative Therapy (Journal Of Manual &amp;amp;amp;amp; Manipulative Therapy). September 2005;13(3):143-151.</ref>  
| CT <ref name="3">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 88: Line 88:
|  
|  
|-
|-
| Carpal mobilization <ref name="5">Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual &amp;amp;amp; Manipulative Therapy (Maney Publishing). December 2010;18(4):228</ref>  
| Carpal mobilization <ref name="5">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 99:
| X
| X
|-
|-
| Median/Radial Nerve Mob&nbsp;<ref name="6">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. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 24, 2012.</ref>&nbsp;  
| Median/Radial Nerve Mob&nbsp;<ref name="6">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. Available from: MEDLINE with Full Text, Ipswich, MA.</ref>&nbsp;  
| X  
| X  
| X  
| X  

Revision as of 01:35, 6 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 X X
CT Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X X X
Thoracic Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X

Wrist 
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

X X X X X
Carpal mobilization Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X X X
Median/Radial Nerve Mob Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  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> tag; name cannot be a simple integer. Use a descriptive title
[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 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  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]


Retrieved from "https://www.physio-pedia.com/index.php?title=Regional_Interdependence_In_Treatment_Of_The_Elbow&oldid=62573"