Regional Interdependence In Treatment Of The Elbow: Difference between revisions
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*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. | *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. | ||
== Diagnosis == | == Diagnosis == | ||
*[[Lateral Epicondylitis|Lateral Epicondylitis]] | *[[Lateral Epicondylitis|Lateral Epicondylitis]] | ||
| Line 21: | Line 21: | ||
Carpal Manipulation | Carpal Manipulation | ||
*[[ | *[[Nerve entrapment|Nerve entrapment]] | ||
Median and Radial Nerve mobilization | Median and Radial Nerve mobilization | ||
== 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 and 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 and Manipulative Therapy (Journal Of Manual and 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 and 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 and 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 and 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 and Manipulative Therapy (Journal Of Manual and 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 and 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 and Physiological Therapeutics [serial online]. September 2011;34(7):432-440. fckLR</ref><br> == | ||
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<br> | <br> | ||
| | ||
== Cervical Thrust Manipulation for Lateral Epicondylagia [2] == | == Cervical Thrust Manipulation for Lateral Epicondylagia [2] == | ||
*Patient supine with neck in nuetral | *Patient supine with neck in nuetral | ||
| Line 123: | Line 123: | ||
Cervical Thrust Manip Video | Cervical Thrust Manip Video | ||
{{#ev:youtube|SpMhG63CXFQ}} | {{#ev:youtube|SpMhG63CXFQ}} | ||
== Cervico-Thoracic Mobilization for Lateral Epicondylagia [3] == | == Cervico-Thoracic Mobilization for Lateral Epicondylagia [3] == | ||
*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 | ||
| Line 137: | Line 137: | ||
CT Manip Video | CT Manip Video | ||
{{#ev:youtube|xEd6VdQMKjM}} | {{#ev:youtube|xEd6VdQMKjM}} | ||
== Thoracic Manipulation for Lateral Epicondylagia [6]<br> == | == Thoracic Manipulation for Lateral Epicondylagia [6]<br> == | ||
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*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[4]<br> == | == Wrist Manipulation for Lateral Epicondylagia[4]<br> == | ||
| Line 154: | Line 154: | ||
*Extend patient's wrist while manipulating scaphoid ventrally | *Extend patient's wrist while manipulating scaphoid ventrally | ||
{{#ev:youtube|NkbiiE5IHTo}} | {{#ev:youtube|NkbiiE5IHTo}} | ||
== Carpal Mobilization for Cubital Tunnel Syndrome [5] == | == Carpal Mobilization for Cubital Tunnel Syndrome [5] == | ||
*Patient seated | *Patient seated | ||
| Line 164: | Line 164: | ||
*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 [1] == | == Nerve Mobilization for Radial or Medial Nerve Entrapment [1] == | ||
*Patient supine, placed in [[ | *Patient supine, placed in [[Neurodynamic Assessment|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 | ||
| Line 181: | Line 181: | ||
<br> | <br> | ||
{{#ev:youtube|ScuBg9Y22lY}} | {{#ev:youtube|ScuBg9Y22lY}} | ||
== Clinical Bottom Line (conclusion)<br> == | |||
== Clinical Bottom Line (conclusion)<br> == | |||
• 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 <br>• Incorporating manual therapy directed at the cervicothoracic spine may provide additional benefits over treatment directed only at the elbow. | • 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 <br>• Incorporating manual therapy directed at the cervicothoracic spine may provide additional benefits over treatment directed only at the elbow. | ||
| Line 191: | Line 189: | ||
== 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 19:36, 26 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.
Diagnosis[edit | edit source]
Cervical Manipulation
CT Mobilization
Thoracic Manipulation
Wrist Manipulation
Carpal Manipulation
Median and Radial Nerve mobilization
Outcomes Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[1][2][3][4][5]
[edit | edit source]
| Decreased Pain |
Increased Pain Free Grip Strength |
Increased Pressure Pain Threshold | Decreased Disability | Perception of Change | Global Improvement | Increased Max Grip Force | Improved Carpal Mobility | Improved 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 [2][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 [3][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 [6]
[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[4]
[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 [5][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 [1][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
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 and 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 and Manipulative Therapy (Journal Of Manual and 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 and 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 and 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
- MT and radial nerve
- LE and Radial tunnel syndrome
