Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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== Cervical Thrust Manipulation <ref name="1" /><ref name="2" /> == | == Cervical Thrust Manipulation <ref name="1" /><ref name="2" /> == | ||
*One randomized pilot study and one randomized clinical trial have shown that the following cervical manipulation is beneficial in those with lateral | *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 | *Patient supine with neck in nuetral | ||
*Physical therapist positions neck into rotation and contralateral flexion | *Physical therapist positions neck into rotation and contralateral flexion | ||
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Cervical Thrust Manip Video | Cervical Thrust Manip Video | ||
{{#ev:youtube|LADO0Rj8KGw}} | {{#ev:youtube|LADO0Rj8KGw}} | ||
== Cervico-Thoracic Mobilization <ref name="3" /> == | == Cervico-Thoracic Mobilization <ref name="3" /> == |
Revision as of 18:37, 11 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 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 Cite error: Invalid <ref>
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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 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 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 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
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
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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
|
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 |
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 epicondyalgia, 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]