Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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== Nerve Mobilization for Radial or Medial Nerve Entrapment == | == Nerve Mobilization for Radial or Medial Nerve Entrapment == | ||
*Patient supine, placed in [[ | *Patient supine, placed in [[Upper limb tension test A|ULTT positions]] for radial or median nerve | ||
*Flex/Extend patients elbow while in test positions | *Flex/Extend patients elbow while in test positions | ||
*Extend elbow about 2 seconds into range | *Extend elbow about 2 seconds into range | ||
*Tension felt/ no pain | *Tension felt/ no pain | ||
*Flex elbow to point of no tension | *Flex elbow to point of no tension | ||
*Repeat 6-7 times | *Repeat 6-7 times | ||
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== • 4. Treating Cubital Tunnel Syndrome 5<br>• Carpal manipulation<br>• Presentation<br> Insidious medial elbow pain, 2-6 out of 10 on VAS scale<br> Parathesia in ulnar distribution<br> Aggravating movements: pushing and pulling with R arm, lifting her children, holding phone to her ear, using a computer<br> Denied neck, shoulder, or radicular pain<br>• Examination<br> Cervical stability tests<br> Selective tissue tension test (STTT) for the upper extremity<br> AROM, PROM w/ OP and strength assessment at wrist and elbow<br> Cervical compression and distraction<br> Sensory testing: deep tendon reflexes C5-C8, sensory testing dermatones C5-T1, strength testing of muscle in C5-C8 myotomes<br> Elbow and wrist ligamentous testing<br> Elbow flexion test for Cubital Tunnel Syndrome<br> Upper Limb Tension Test (ULTT)<br> Joint passive mobility<br>• Intervention Strategy<br> With the patient seated comfortably, the therapist grasps the patient’s wrist with both hands. On the palmar side, the therapist stabilizes the patient’s hamate with both index fingers, one on top of the other. On the dorsal side, the therapist palpates the triquetral with both thumbs. To assess the patient’s tolerance to the mobilization a pre manipulation hold was implemented by pushing down palmarly through the triquetral while stabilizing the hamate. If tolerated, the therapist proceded to have the patient lean back to provide a little traction on the carpals and then while maintaining some wrist flexion, the therapist performed a downward HVLA thrust to the triquetral in a palmar direction. Immediately following manipulation the patient was asked to move the elbow, without pain, in the new unrestricted ROM: Elbow flexion, elbow supination, wrist extension, and ulnar deviation.<br> <br> <br>• Follow up<br> Patient returned 3 more times to the clinic at 2 days, 1 week, 2 week, and 4 weeks after the initial visit.<br> Negative ULTT with ulnar nerve bias 2 days later and normal carpal mobility both maintained until discharge. <br> Less provocative elbow flexion test at 2 days which resolved at 1 week, returned at 2 weeks, and had resolved by discharge.<br> At 2 weeks patient was manipulated with same procedure<br> At 4 weeks all positive tests were now negative and pain was 0/10<br>SOURCEMEDICAL DIAGNOSIS OF CUBITAL TUNNEL SYNDROME AMELIORATED WITH THRUST MANIPULATION OF THE ELBOW AND CARPALS- KEARNS, WANG == | == • 4. Treating Cubital Tunnel Syndrome 5<br>• Carpal manipulation<br>• Presentation<br> Insidious medial elbow pain, 2-6 out of 10 on VAS scale<br> Parathesia in ulnar distribution<br> Aggravating movements: pushing and pulling with R arm, lifting her children, holding phone to her ear, using a computer<br> Denied neck, shoulder, or radicular pain<br>• Examination<br> Cervical stability tests<br> Selective tissue tension test (STTT) for the upper extremity<br> AROM, PROM w/ OP and strength assessment at wrist and elbow<br> Cervical compression and distraction<br> Sensory testing: deep tendon reflexes C5-C8, sensory testing dermatones C5-T1, strength testing of muscle in C5-C8 myotomes<br> Elbow and wrist ligamentous testing<br> Elbow flexion test for Cubital Tunnel Syndrome<br> Upper Limb Tension Test (ULTT)<br> Joint passive mobility<br>• Intervention Strategy<br> With the patient seated comfortably, the therapist grasps the patient’s wrist with both hands. On the palmar side, the therapist stabilizes the patient’s hamate with both index fingers, one on top of the other. On the dorsal side, the therapist palpates the triquetral with both thumbs. To assess the patient’s tolerance to the mobilization a pre manipulation hold was implemented by pushing down palmarly through the triquetral while stabilizing the hamate. If tolerated, the therapist proceded to have the patient lean back to provide a little traction on the carpals and then while maintaining some wrist flexion, the therapist performed a downward HVLA thrust to the triquetral in a palmar direction. Immediately following manipulation the patient was asked to move the elbow, without pain, in the new unrestricted ROM: Elbow flexion, elbow supination, wrist extension, and ulnar deviation.<br> <br> <br>• Follow up<br> Patient returned 3 more times to the clinic at 2 days, 1 week, 2 week, and 4 weeks after the initial visit.<br> Negative ULTT with ulnar nerve bias 2 days later and normal carpal mobility both maintained until discharge. <br> Less provocative elbow flexion test at 2 days which resolved at 1 week, returned at 2 weeks, and had resolved by discharge.<br> At 2 weeks patient was manipulated with same procedure<br> At 4 weeks all positive tests were now negative and pain was 0/10<br>SOURCEMEDICAL DIAGNOSIS OF CUBITAL TUNNEL SYNDROME AMELIORATED WITH THRUST MANIPULATION OF THE ELBOW AND CARPALS- KEARNS, WANG == |
Revision as of 16:47, 12 November 2012
Regional Interdependence of manipulation on elbow pain[edit | edit source]
Definition: [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.
Treatment Techniques[edit | edit source]
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)
Carpal Mobilization (Patients - Treatments - Video - References)
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 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 Mobilization for Lateral Epicondylagia[edit | edit source]
- 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 for Lateral Epicondylagia
[edit | edit source]
- Patient is supine with arms across their chest
- PT places stabilizing hand just under restricted segment
- Other hand is used to stabilize neck, head, and upper thoracic spine
- PT performs gentle flexion to targeted segment
- High-velocity, low amplitude thrust in downward, cephalad direction
Wrist Manipulation for Lateral Epicondylagia
[edit | edit source]
- 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 for Cubital Tunnel Syndrome[edit | edit source]
- 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 for Radial or Medial Nerve Entrapment[edit | edit source]
- 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