Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual & Manipulative Therapy (Maney Publishing). December 2010;18(4):228. | Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual & Manipulative Therapy (Maney Publishing). December 2010;18(4):228. | ||
== <br>Search terms | == <br>Search terms == | ||
*:LE and Radial tunnel syndrome<br> | *:LE and Radial tunnel syndrome<br> | ||
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*:MT and radial nerve<br> | *:MT and radial nerve<br> | ||
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*:Manipulation and radial nerve<br> | *:Manipulation and radial nerve<br> | ||
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*:Posterior interoussens nerve syndrome | *: | ||
*:Posterior interoussens nerve syndrome | |||
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Revision as of 19:24, 12 November 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.
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 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 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
Physical Therapy Management in addition to manipulation….[edit | edit source]
Clinical Bottom Line (conclusion)
[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]
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 & Physiological Therapeutics [serial online]. September 2011;34(7):432-440.
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 & Physiological Therapeutics. November 2008;31(9):675-681.
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 & Manipulative Therapy (Journal Of Manual & Manipulative Therapy). September 2005;13(3):143-151.
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.
Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual & Manipulative Therapy (Maney Publishing). December 2010;18(4):228.
Search terms[edit | edit source]
- LE and Radial tunnel syndrome
- MT and radial nerve
- Manipulation and radial nerve
- Posterior interoussens nerve syndrome
- LE and Radial tunnel syndrome