Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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*<a href="Nerve entrapment">Radial Nerve entrapment</a> | *<a href="Nerve entrapment">Radial Nerve entrapment</a> | ||
Median and Radial Nerve mobilization (Patients - Treatments - Video - References) | Median and Radial Nerve mobilization (Patients - Treatments - Video - References) | ||
== Outcomes<ref>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 &amp;amp;amp;amp;amp;amp;amp; Physiological Therapeutics. November 2008;31(9):675-681.</ref><ref>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 &amp;amp;amp;amp;amp;amp; Manipulative Therapy (Journal Of Manual &amp;amp;amp;amp;amp;amp; Manipulative Therapy). September 2005;13(3):143-151.</ref><ref>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</ref><ref>Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual &amp;amp;amp;amp; Manipulative Therapy (Maney Publishing). December 2010;18(4):228.</ref><ref>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 &amp;amp;amp;amp;amp;amp;amp;amp; Physiological Therapeutics [serial online]. September 2011;34(7):432-440. fckLR</ref><br> == | == Outcomes | ||
<ref name="6">Ekstrom R, Holden K. Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment. Physical Therapy [serial online]. November 2002;82(11):1077-1086.</ref><ref>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 &amp;amp;amp;amp;amp;amp;amp;amp; Physiological Therapeutics. November 2008;31(9):675-681.</ref><ref>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 &amp;amp;amp;amp;amp;amp;amp; Manipulative Therapy (Journal Of Manual &amp;amp;amp;amp;amp;amp;amp; Manipulative Therapy). September 2005;13(3):143-151.</ref><ref>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</ref><ref>Kearns G. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals. Journal Of Manual &amp;amp;amp;amp;amp; Manipulative Therapy (Maney Publishing). December 2010;18(4):228.</ref><ref>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 &amp;amp;amp;amp;amp;amp;amp;amp;amp; Physiological Therapeutics [serial online]. September 2011;34(7):432-440. fckLR</ref><br> == | |||
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== Cervical Thrust Manipulation for Lateral Epicondylagia == | == Cervical Thrust Manipulation for Lateral Epicondylagia == | ||
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Cervical Thrust Manip Video | Cervical Thrust Manip Video | ||
{{#ev:youtube|SpMhG63CXFQ}} | {{#ev:youtube|SpMhG63CXFQ}} | ||
== Cervico-Thoracic Mobilization for Lateral Epicondylagia == | == Cervico-Thoracic Mobilization for Lateral Epicondylagia == | ||
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*Non-thrust grade III and IV PPIVM and PAIVM directed at impaired segment | *Non-thrust grade III and IV PPIVM and PAIVM directed at impaired segment | ||
<br> | |||
Done in combination with the following: | Done in combination with the following: | ||
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*Stretching of wrist extensors, strengthening of wrist and forearm, and mobilizations of elbow/wrist | *Stretching of wrist extensors, strengthening of wrist and forearm, and mobilizations of elbow/wrist | ||
CT Manip Video | CT Manip Video | ||
{{#ev:youtube|xEd6VdQMKjM}} | {{#ev:youtube|xEd6VdQMKjM}} | ||
== Thoracic Manipulation for Lateral Epicondylagia<br> == | == Thoracic Manipulation for Lateral Epicondylagia<br> == | ||
*Patient supine with arms crossed over chest | *Patient supine with arms crossed over chest | ||
*Physical therapist localizes thoracic segment using “pistol grip” | *Physical therapist localizes thoracic segment using “pistol grip” | ||
*Physical therapist flexes thoracic spine and stabilizes neck and head | *Physical therapist flexes thoracic spine and stabilizes neck and head | ||
*Physical therapist performs high-velocity, low amplitude manipulation in a cephalad direction. | *Physical therapist performs high-velocity, low amplitude manipulation in a cephalad direction. | ||
{{#ev:youtube|9mVKxjN49uM}} | {{#ev:youtube|9mVKxjN49uM}} | ||
== Wrist Manipulation for Lateral Epicondylagia<br> == | == Wrist Manipulation for Lateral Epicondylagia<br> == | ||
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*Wrist flexion maintained and HVLA thrust to triquetral palmarly | *Wrist flexion maintained and HVLA thrust to triquetral palmarly | ||
{{#ev:youtube|PiLvSmVBHeE}} | {{#ev:youtube|PiLvSmVBHeE}} | ||
== Nerve Mobilization for Radial or Medial Nerve Entrapment == | == Nerve Mobilization for Radial or Medial Nerve Entrapment == | ||
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== References == | == References == | ||
<references /> | <references /> | ||
== <br>Search terms == | == <br>Search terms == | ||
*:LE and Radial tunnel syndrome<br> | *:LE and Radial tunnel syndrome<br> | ||
*: | *: | ||
*: | *: | ||
*:MT and radial nerve<br> | *:MT and radial nerve<br> | ||
*: | *: | ||
*: | *: | ||
*:Manipulation and radial nerve<br> | *:Manipulation and radial nerve<br> | ||
*: | *: | ||
*: | *: | ||
*:Posterior interoussens nerve syndrome | *:Posterior interoussens nerve syndrome | ||
*: | *: | ||
Revision as of 20:37, 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]
- <a href="Lateral Epicondylitis">Lateral epicondylitis</a>
Cervical Manipulation (link to spot within this page) (Patients - Treatments - Video - References)
CT Mobilization (Patients - Treaments - Video - References)
Thoracic Manipulation(Patients - Treatments - Video - References)
Wrist Manipulation (Patients - Treatments - Video - References)
- <a href="Cubital Tunnel Syndrome">Cubital tunnel</a>
Carpal Manipulation (Patients - Treatments - Video - References)
- <a href="Nerve entrapment">Radial Nerve entrapment</a>
Median and Radial Nerve mobilization (Patients - Treatments - Video - References)
== Outcomes
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[1][2][3][4][5]
==
| 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, 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 &amp;amp;amp;amp;amp;amp;amp; 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 &amp;amp;amp;amp;amp;amp; Manipulative Therapy (Journal Of Manual &amp;amp;amp;amp;amp;amp; 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 &amp;amp;amp;amp; Manipulative Therapy (Maney Publishing). December 2010;18(4):228.
- ↑ 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 &amp;amp;amp;amp;amp;amp;amp;amp; Physiological Therapeutics [serial online]. September 2011;34(7):432-440. fckLR
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
