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.

Interventions for the Following Diagnoses  [edit | edit source]

        Cervical Manipulation

        CT Mobilization

        Thoracic Manipulation

        Wrist Manipulation

        Carpal Manipulation

        Median and Radial Nerve mobilization

Outcomes
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 Decreased Pain

Increased Pain Free Grip Strength

Increased Pressure Pain Threshold Decreased Disability (DASH) Perception of Change Global Improvement Increased Max Grip Force Improved Carpal Mobility Improved Elbow Flexion Test
Cervical Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X
CT Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X X X
Thoracic Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X

Wrist 
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

X X X X X
Carpal mobilization Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title X X X
Medain/Radial Nerve Mob Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  X X


 

Cervical Thrust Manipulation Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]

  • One randomized pilot study and one randomized clinical trial have shown that the following cervical manipulation is beneficial in those with lateral epicondyalgia
  • 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 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]

  • One pilot clinical trial has shown that the following cervico-thoracic mobilization is beneficial in those with lateral epicondyalgia
  • 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 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
[edit | edit source]

  • One randomized clinical trial has shown the following thoracic manipulation is beneficial in those with lateral epicondyalgia
  • 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 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]

  • One randomized pilot study has shown the following wrist manipulation is beneficial in those with lateral epicondyalgia
  • 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 Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]

  • One case study has shown the following carpal mobilization is beneficial in those with cubital tunnel syndrome
  • 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  Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[edit | edit source]

  • One case report has shown the following nerve mobilizations are beneficial in those with radial or median nerve entrapment
  • 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
[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]


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