Elbow Diagnosis and Treat Flashcards
Myositis Ossificans can be sub acute or chronic but when inflammatory: (direct blow to soft tissue, soccer initially develop a hematoma. What are some symptoms and what is the treatment approach?
- swelling in the area of trauma
- typically develops in the acute phase of healing
- high pain levels; more painful with active contraction due to presence of osteophytes
- redness in area
- significant pain during palpation
Hands off approach. No vigorous stretching, only low load, long duration techniques.
STM contraindicated, heat discouraged
What are the physiological outcomes of using eccentric exercise when treating tendonitis?
- help to lengthen tissue
- help with muscle unit nutrition
- facilitate more normal appearance or healing of tissue
List the general principles for therex with eccentric exercise (7).
1) Stretches: slow, longer hold times, non-ballistic
2) Eccentric contraction beginning with slow contractions
3) For the elbow, begin in flexed position and progress to extended elbow as tolerated
4) Slow static stretch post Rx
5) Ice in lengthened position of muscle-tendon unit
6) Increase speed every few days as tolerated (slow medium fast according to functional target)
- slower speed allows patient more time to develop force
7) Begin with AAROM, AROM then may add external load or body weight for closed chain, redo speed progression as you advance weights
What kind of patient education would you conduct for someone in the return to function phase after lateral epicondylitis when they return to tennis?
Patient education (ex: tennis):
1) Assess/ change grip on tennis racket, hammer etc.
2) Have racquet restrung to vibration
3) Task analysis: observe pt’s performance of the task and provide cueing to improve posture and appropriate motor recruitment patterns that will prevent re-development/aggravation of the overuse problem
4) Instruct in self care re: stretch pre/post activity, self icing, pacing activities
List, in broad categories, the types of interventions available to a PT in the subacute and chronic phases of healing, especially s/p tendonosis.
-Deep Friction Mobilization/Massage (DFM)
-Joint mobilization
-Mobilization with Movement (MWM)
-Bracing/Sling
-Therapeutic Exercise
~Protective equipment (distribute pressure that would otherwise be concentrated to the tendon and tendinous attachment)
ACUTE
- stretching
- Isometric stabilization
How long do you treat with DFM and what can a patient expect during and after?
-treat for up to 5 mins
- starting at a relatively superficial depth, gradually going deeper
- dependent on phase of tissue healing
- pain tolerance
- not always pain free, but discomfort should lessen as technique continues
- if increase, something is incorrect or person not appropriate
- need to traverse the entire width of the tissue
- want joint to be relatively slack when you start
- analgesic effect should start about 1min into treatment
For medial and lateral joint play at the ulnar-humeral joint, what is the procedure?
Lateral: wedge under distal humerus, arm in ER, press through proximal ulna
Medial: wedge under proximal ulna, arm in ER, glide humerus down (lateral)
At the distal radio-ulnar joint, what do anterior and posterior glides aid?
Pronation and supination respectively.
At the proximal radio-ulnar joint, what are anterior and posterior glides for?
Supination and pronation respectively.
At the radio-humeral joint, flexion and extension are what glides?
flexion = anterior extension = posterior
MWM is used in literature with lateral epicondylitis. How does it help?
Lateral glide of the radio-ulnar joint on the humerus (done grossly with proximal forearm) is used while pt grasps object. Aids in tracking problem or positional fault with wrist extensors
Does plyometric training increase power output over a 6 week training program in the shoulder and elbow?
Yes.
In a study comparing mobilzation with movement, wait and see and injection, the results where clear. What were they?
6 weeks: PT better than nothing, injection superior to both
52 weeks: PT better than both; injection saw relapse of injury
