Elbow Flashcards
Distraction of Humeroulnar joint #1
Purpose: to increase overall range of motion, to decompress the joint, to decrease pain
Precautions: Use a soft hand approach so that the pressure applied does not elicit pain. The median nerve and brachial artery are just medial to the biceps tendon
Stabilize: Distal forearm with one hand and humerus with the other hand. Apply a firm pressure to the humerus towards the treatment table to stabilize the humerus
Mobilize: Place your 2nd MCP joint onto the anterior surface of the proximal end of the ulna. Then direct the mobilization perpendicular (at right angles) to the ulna in order to distract the ulna from the humerus
Distraction of Humeroulnar Joint #2
Purpose: to increase overall range of motion
Precautions: use a soft hand approach so that too much pressure does not elicit pain. The median nerve and brachial artery are just medial to the biceps tendon.
Stabilize: distal forearm & hand with your shoulder as shown as well as stabilizing the humerus by applying pressure towards the table
Mobilize: place index, middle & ring fingers of both hands onto the anterior surface of the proximal end of the ulna; then direct the mobilization perpendicular to the ulna in order to separate the ulna from the humerus
Medial Gap (L->M)
Purpose: to increase elbow flexion & extension; to decompress the medial elbow. Flexion stresses the posterior fibers of the medial collateral ligament (UCL) and extension stresses the anterior fibers of the medial collateral ligament (RCL)
Precautions: do not lever the joint by pulling the forearm laterally
Hand Placement: proximal hand crosses the lateral joint line & distal hand grasps the medial distal forearm
Stabilize: distal forearm on ulnar side
Mobilize: apply gentle force from lateral to medial stressing the medial collateral ligament (UCL)
Lateral Gap (M->L)
Purpose: to increase elbow flexion
Precautions: do not mobilize in full extension & do not lever the joint
Hand Placement: Mobilizing hand crosses the medial joint line
Stabilize: the radial side of the distal forearm
Mobilize: apply gentle force from medial to lateral stressing the lateral collateral ligament (RCL)
Medial Glide
Purpose: to increase ROM into flexion & extension
Precautions: pressure into the cubital tunnel will cause compression onto the ulnar nerve. Do not squeeze with your fingers as this may cause pain and muscle guarding.
Hand Placement: mobilizing hand is just distal to the joint line & stabilizing hand is just proximal to the joint line
Stabilize: the medial surface of the humerus just proximal to the joint line of the elbow
Mobilize: the proximal ulna by applying a medial force on the proximal ulna. Use your index finger to guide the mobilization on the olecranon; this will facilitate an easier and more effective mobilization to the ulna and less pressure on the radius
Lateral Glide
Purpose: to increase ROM into flexion & extension
Precautions: do not squeeze with your fingers as this may cause pain and muscle guarding
Hand Placement: mobilizing hand is just distal to the joint line; the stabilizing hand is just proximal to the joint line
Stabilize: just proximal to the joint line of the elbow on the lateral surface
Mobilize: mobilize the ulna by applying a lateral force on the proximal ulna. Use your index finger to guide the mobilization on the olecranon; this will facilitate an easier and more effective mobilization to the ulna. Direct the mobilization force onto the medial side of the olecranon.
Anterior Glide of Radius on Ulna
Purpose: to increase supination of the forearm
Precautions: use a soft hand as you may compress the deep branch of the radial nerve
Hand Placement: stabilizing hand on the proximal ulna, mobilizing hand on the proximal radius (lateral aspect). If a rolled up towel is placed in the patient’s hand, make sure the wrist flexors and extensors are not contracting since this will reduce the effectiveness of the mobilization
Stabilize: The posterior & medial surfaces of the proximal ulna
Mobilize: the proximal radius towards the cubital fossa (anterior); picture one using thumb and picture 2 using the palm to do the mobilization
Posterior Glide of the Radius on the Ulna
Purpose: to increase pronation of the forearm; to decrease pain
Precautions: do not compress the median nerve and brachial artery just lateral to the biceps tendon; use the soft hand approach
Hand Placement: stabilizing hand on the proximal ulna, mobilizing hand on the proximal radius, anterior aspect
Stabilize: the proximal ulna with your inside hand placed over the olecranon
Mobilize: glide the proximal radius directly posterior. As you are applying the mobilization don’t let the forearm supinate. Adjust your direction of the mobilization so that this does not occur!
: Axial Distraction
Purpose: to increase overall ROM in the humeroradial joint and the proximal radioulnar joint; To decompress the humeroradial joint; To decrease pain .
Precautions: do not pull on the carpal bones in the wrist; grasp proximally to the wrist
Hand Placement: stabilizing hand on distal humerus, mobilizing hand grasps the distal radius by gently squeezing between your index finger, web space & your thumb
Stabilize: apply a firm pressure to the humerus towards the treatment table to stabilize the humerus
Mobilize: apply an axial distraction by gently pulling on the distal radius
: Posterior Glide of the Radius on the Humerus
Purpose: to increase extension of the humeroradial joint; to decrease pain in the elbow
Precautions: use a soft hand approach so that too much pressure doesn’t elicit pain. Make sure the patient is not actively contracting the elbow flexors, as this will make the mobilization ineffective.
Hand Placement: inside hand stabilizes the humerus; outside hand is used to perform the mobilization
Stabilize: the medial surface of the distal humerus
Mobilize: use your thumb and thenar eminence to direct mobilization in the posterior direction
Anterior Glide of the Radius on the Humerus
Purpose: to increase flexion at the humeroradial joint
Precautions: use a soft hand approach so that too much pressure does not elicit pain. Make sure the patient is not actively contracting the elbow flexors/extensors, as this will make the mobilization ineffective
Hand Placement: inside hand stabilizes the humerus; outside hand is used to perform the mobilization
Stabilize: the medial surface of the distal humerus
Mobilize: use your thenar eminence to direct the mobilization in the anterior direction
Helpful Suggestions:
Do not grasp too tightly with either hand, as this is a very pain sensitive area
The humerus is somewhat supported by the pillow under the elbow
