Regional Interdependence In Treatment Of The Elbow

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]
[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
[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]

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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
  4. ↑ 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.
  5. ↑ 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
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