Regional Interdependence In Treatment Of The Elbow
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
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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
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- 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
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- 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)
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• 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.