Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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Wrist <br><ref name="4">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> | Wrist <br><ref name="4">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> | ||
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| Carpal | | 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> | ||
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Revision as of 22:25, 10 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 |
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]
• Incorporating manual therapy directed at the cervical, thoracic, cervico-thoracic spine, wrist, and carpals may provide additional benefits for those with lateral epicondyalgia, cubital tunnel syndrome, and nerve entrapment over treatment directed only at the elbow.
References[edit | edit source]