WEEKEND 2 Elbow. Elbow Range of Motion Assessment

Transcription

1 Virginia Orthopedic Manual Physical Therapy Institute Technique Manual WEEKEND 2 Elbow Elbow Range of Motion Assessment - Patient Positioning: Sitting or supine towards the edge of the bed - Indications: Completed as part of the elbow exam. o Assess quality and quantity of motion and look for asymmetries o AROM assesses willingness to move and may determine whether overpressure is appropriate o Utilize overpressure when appropriate to get a sense of end feel and to provoke symptoms o Due to joint surface anatomy, conjunct motion of the elbow is extension -forearm pronation and flexion forearm supination o With all joints involved and muscles that cross the elbow and wrist, assess combined motions in all combinations that involve elbow flexion/extension, forearm supination/pronation and wrist flexion/extension

2 Radio-Humeral Joint Motion Assessment - Patient Positioning: Sitting or standing - Test Performance: Standing facing the patient with both the patient s hands resting on therapists proximal forearms. Therapist palpates the radiohumeral joint space with their index fingers. Therapist passively flexes and extends the patient s elbows while assessing motion at the joint - Indications: Completed as part of elbow exam particularly when there is active or passive motion loss into elbow flexion/extension - Contraindications: Red flag concerns, fracture o Joint is concave (radial head) on convex (capitulum) Anterior glide of the radius with extension and posterior glide of the radius with extension Radius moves distally upon elbow extension (you will feel increased space at the radio-humeral joint) and proximally upon elbow flexion (you will feel decreased space at the radio-humeral joint) o Slow assessment observing amount of motion, neutral zone (movement prior to resistance), end feel, tissue response, pain provocation.

3 HumeroUlnar Joint Distraction Assessment - Patient Positioning: Supine towards the edge of the bed - Test Performance: Standing facing the head of the bed. Therapist places the patient s elbow in 70 deg of flexion and slight supination and allows the wrist to rest on the insde shoulder. Therapist grasps around the proximal radius and ulna as close to the joint line as possible. The joint is distracted by leaning back and pulling the radius and ulna towards you. Provide a counterforce with the inside shoulder to minimize forearm motion. For a more effective assessment, stabilize the humerus with assistance from a strap or aid - Indications: Competed as part of the elbow exam particularly when there is loss of elbow flexion or extension motion - Contraindications: Red Flag concerns, fracture, o Slow assessment observing amount of motion, neutral zone (movement prior to resistance), end feel, tissue response, pain provocation. o Assessment position can turn into powerful treatment position to improve flexion or extension ROM loss

4 RadioHumeral Long Axis Distraction Assessment - Patient Positioning: Supine, arm at the edge of the bed - Test Performance: Standing on the side of the bed, facing the head of the bed. Therapist places the patient s elbow in 45 deg of flexion and forearm neutral. Therapist stabilizes the humerus against the bed with the outside hand and grasps the distal radius with a golfer s grip using the inside hand. Therapist distracts the joint by rotating their body away rather than pulling on the radius. - Indications: To assess non-directional specific mobility at the radiohumeral joint - Contraindications: Red Flag concerns, fracture o Slow assessment observing amount of motion, neutral zone (movement prior to resistance), end feel, tissue response, pain provocation. o Utilize theraband on mobilizing hand to prevent slippage o Assessment technique turns into treatment technique o Technique is gentle and can improve general RH joint mobility contributing to improvements in end ROM elbow flexion and extension o Technique is also helpful to improve supination and pronation when there is joint mobility loss

5 Proximal RadioUlnar Joint Motion Assessment - Patient Positioning: Supine, arm at the edge of the bed - Test Performance: o Anterior: Patients elbow placed in 70 deg of flexion with hand resting on stomach. Therapist places both thumbs on the dorsal aspect of the radial head with one hand stabilizing the ulna and the other hand stabilizing the humerus. Therapist applies an anterior (volar) glide to the radial head. o Posterior: Patients elbow placed in extension and pronation. Therapist places both thumbs on the volar aspect of the radial head. Therapist applies a posterior (dorsal) glide to the radial head. - Indications: To determine Proximal radiohumeral joint mobility particularly when there is loss of forearm supination or pronation - Contraindications: Red flag concerns, fracture, o Slow assessment observing amount of motion, neutral zone (movement prior to resistance), end feel, tissue response, pain provocation. o During pronation the radial head glides dorsally and volarlly during supination o Assessment technique turn into treatment technique Anterior (volar) Glide Posterior (dorsal) Glide

6 Elbow Stability Assessment - Patient Positioning: Supine with the arm at the edge of the bed - Test Performance: o Lateral: Therapist stands to the inside of the patients elbow facing away from the bed. Therapist places cephalad hand along the joint line of the medial elbow and the caudal hand on the lateral forearm. In 5 deg of flexion with forearm supinated, therapist directs a varus force to the elbow by pushing laterally at the joint line and medially at the forearm o Medial: Therapist stands to the outside of the patients elbow facing the bed. Therapist places cephalad hand along the joint line of the lateral elbow and the caudal hand on the medial forearm. In 5 deg of flexion with forearm supinated, therapist directs a valgus force to the elbow by pushing medially at the joint line and laterally at the forearm - Indications: To determine the integrity of the medial and lateral ligamentous structures of the elbow - Contraindications: Red flag concerns, fracture o Slow assessment observing amount of motion, end feel, tissue response, pain provocation. o Use opposite side for comparison but could be a significant difference between dominant and non-dominant UE especially due to sport play (i.e. throwing laxity) Lateral Stability Test Medial Stability Test

7 Anterior RadioHumeral Mobilization with Movement Treatment - Patient Positioning: Standing at the edge of the bed with forearm pronated and the palm resting on the table - Treatment Technique : Therapist Standing behind the patient with thumbs on the posterior aspect of the radial head. Therapist applies an anterior directed force to the radial head as the patient moves from and elbow flexed position to an extended position - Indications: To improve extension ROM via radiohumeral joint motion - Contraindications: Red flag concerns, fracture o Used to promote elbow end ROM extension in closed chain positioning o Improves patient tolerance for weight bearing extension

8 Lateral Epicondyalgia Mobilization with Movement Treatment - Patient Positioning: Seated, or supine, arm resting on the table with elbow extended and forearm pronated. Patient grasping a small weight or dynamometer. - Treatment Technique: o Therapist stands facing the patient. Places one hand on the medial aspect of the proximal forearm and one hand on the lateral distal humerus. Therapist asks the patient to grasp as a lateral force is directed at the medial forearm. A counterforce at the humerus is applied simultaneously. - Indications: To decrease pain with grasping in patients who suffer from lateral epicondyalgia - Contraindications: Red flag concerns o Align forearms perpendicular to the UE to properly deliver the mobilization o Perform 6-10 repetitions o If successful treatment, can turn into home exercise using a belt around the waist and around the forearm Mobilization with Movement Self Treatment

9 Mill s Manipulation - Patient Positioning: Seated - Technique Performance: o Therapist stands behind the patient and places the patient s shoulder in 90 deg of abduction and full IR (so olecranon is facing up), the elbow in extension, forearm pronated and wrist extended. The lateral hand maintains the UE position through the wrist. The therapist medial hand is placed over the posterolateral elbow and directs a HVLA into end range elbow extension - Indications: Performed when the patient suffers from chronic non-inflammatory lateral epicondylosis. - Contraindications: Elbow stability problems, anterior shoulder instability or impingement, radial nerve irritability, loss of end ROM elbow extension, fracture o The technique is attempting to break up scar tissue that has formed in the common extensor tendon o May not be tolerated in patients with impingement or anterior shoulder instability due to shoulder position