Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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== | == Wrist Manipulation for lateral epicondylagia<br> == | ||
== Clinical Presentation<br>1. Patients had a diagnosis of lateral epicondylitis as defined as a positive finding in 2 or more of <br>A. Pain with palpation of lateral epicondyle<br>B. Pain with resisted wrist extension<br>C. Pain with resisted middle finger extension <br>2. Patients also had to demonstrate articular impairments of the cervical, cervicothoracic, or upper thoracic spine. <br>3. Patients excluded if bilateral symptoms, multiple diagnoses, signs of radial tunnel syndrome, and if this was not the patient’s first episode of lateral epicondylitis<br> Patient Assessment<br>1. PROM, AROM, palpation of soft tissues, strength of the elbow and forearm, neurodynamic testing, joint assessment of the radiohumeral joint, ulnarhumeral joint, and proximal/distal radio-ulnar joints. <br>2. Cervical/thoracic assessment- AROM, overpressure, passive intervertebral mobility of OA for flexion, extension, and sidebending, AA flexion and rotation test, PPIVM of C2-C7 into flexion, extension, sidebending, rotation, and PA centrally of C2-T6<br> Intervention strategy <br>1. All groups received local treatment to the elbow which included stretching of wrist extensors, strengthening of the wrist and forearm musculature, mobilizations of the elbow/wrist, instructions to avoid activities that would aggravate their condition <br>2. Group received local treatment and manual therapy to the cervicothoracic spine. This group received grade III and IV PPIVM and PAIVM directed at the impaired segments. <br> <br> Outcomes <br>1. Both local treatment and local treatment with manual therapy groups had success in global improvements and decreasing disability<br>2. Local treatment plus manual therapy group showed greater improvements in painfree grip strength, pain, and disability <br>3. Combined treatment group showed overall greater perception of change following treatments <br>4. Most dramatic difference in the combined treatment group was grip strength 3 == | == Clinical Presentation<br>1. Patients had a diagnosis of lateral epicondylitis as defined as a positive finding in 2 or more of <br>A. Pain with palpation of lateral epicondyle<br>B. Pain with resisted wrist extension<br>C. Pain with resisted middle finger extension <br>2. Patients also had to demonstrate articular impairments of the cervical, cervicothoracic, or upper thoracic spine. <br>3. Patients excluded if bilateral symptoms, multiple diagnoses, signs of radial tunnel syndrome, and if this was not the patient’s first episode of lateral epicondylitis<br> Patient Assessment<br>1. PROM, AROM, palpation of soft tissues, strength of the elbow and forearm, neurodynamic testing, joint assessment of the radiohumeral joint, ulnarhumeral joint, and proximal/distal radio-ulnar joints. <br>2. Cervical/thoracic assessment- AROM, overpressure, passive intervertebral mobility of OA for flexion, extension, and sidebending, AA flexion and rotation test, PPIVM of C2-C7 into flexion, extension, sidebending, rotation, and PA centrally of C2-T6<br> Intervention strategy <br>1. All groups received local treatment to the elbow which included stretching of wrist extensors, strengthening of the wrist and forearm musculature, mobilizations of the elbow/wrist, instructions to avoid activities that would aggravate their condition <br>2. Group received local treatment and manual therapy to the cervicothoracic spine. This group received grade III and IV PPIVM and PAIVM directed at the impaired segments. <br> <br> Outcomes <br>1. Both local treatment and local treatment with manual therapy groups had success in global improvements and decreasing disability<br>2. Local treatment plus manual therapy group showed greater improvements in painfree grip strength, pain, and disability <br>3. Combined treatment group showed overall greater perception of change following treatments <br>4. Most dramatic difference in the combined treatment group was grip strength 3 == |
Revision as of 04:39, 12 November 2012
Regional Interdependence of manipulation on elbow pain[edit | edit source]
Definition: Treatment directed at one area of the body to ellicit changes in another[edit | edit source]
-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.[edit | edit source]
I.Treatment techniques[edit | edit source]
- Lateral epicondylitis
Cervical (link to spot within this page) (Patients - Treatments - Video - References)
CT (Patients - Treaments - Video - References)
Thoracic (Patients - Treatments - Video - References)
Wrist (Patients - Treatments - Video - References)
- Cubital tunnel
Carpal Mobilization (Patients - Treatments - Video - References)
- Radial Nerve entrapment
Median and Radial Nerve mobilization (Patients - Treatments - Video - References)
Outcomes
[edit | edit source]
Pain |
Pain free Grip strength |
Pressure pain threshold | Disability | Perception of change | Global improvement | Max grip force | Carpal mobility | Elbow flexion test | |
Cervical | X | X | |||||||
CT | X | X | X | X | |||||
Throacic | X | ||||||||
Wrist |
X | X | X | X | X | ||||
Carpal mobilization | X | X | X | ||||||
Medain/Radial Nerve Mob | X | X |
Cervical Thrust manipulation technique for lateral epicondylagia[edit | edit source]
- 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 Manipulation Technique for lateral epicondylagia[edit | edit source]
- Non-thrust grade III and IV PPIVM and PAVM directed at impaired segment
Done in combination the following:
- Stretching wrist extensors strengthening wrist and forearm and mobilizations of elbow/wrist
CT Manip Video
Thoracic Manipulation for lateral epicondylagia
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