Elbow Forearm Rx Flashcards
What are the 3 most important drivers of intervention strategy in the elbow?
conservative vs surgical
Desired function (What kind of athlete)
Underlying pathology/trauma
Acute phase interventions with elbow:
EARLY AROM/AAROM avoid elbow contractures!!!! (get out of brace ASAP)
Submax isometrics
Let pain be your guide
move the shoulder too
In the elbow, should we do eccentric or concentric exercises first
start with CONCENTRIC!
To move from the acute to the subacute phase in the elbow, what are the 2 conditions?
Full pain free ROM acheived
Muscle strength is 70% of more of contralateral limb
Subacute goals in elbow
Restore normal joint kinematics
Improve muscle strength to WNL
Improve NM control
Restore normal strength/muscle force relationship
At what phase should we introduce CKC activities in the elbow?
Subacute
To return to sport activities, what are the norms we must achieve when comparing sides
Nondominant: 10-15% weaker than dominant
dominant arm: needs to be 10-15% stronger than nondominant
How should we educate our patients about surgeries for lateral elbow tendinopathy
positive outcome not guaranteed with surgery
what is the consensus for optimal tx of lateral elbow tendinopathy
no consensus
Lateral elbow CPG evidence levels
B level evidence: use isometric, concentric, eccentric exercises for wrist extensors
B level evidence: elbow mobs to reduce pain and increase pain free grip strength
C level: Cerivcal/thoracic mob/manips if those regions are involved
C level evidence: soft tissue massage
D level evidence: Cross friction massage (conflicting evidence, cannot be recommended)
F level evidence: can use phased approach to reintroduce stress
What is the best modality for lateral elbow tendinopathy/pain
Dry needling! B level evidence
Also: Rigid taping (B level evidence)
Lateral elbow tendinopathy: Pain w/ active wrist ext and __________
Medial elbow tendinopathy: pain with active wrist flex and _________
supination
pronation
What are the best treatments for elbow stiffness
Low load long duration stretch
Joint mobs
Dynamic splints as needed
What is the prognosis for returning to activity after a UCL sprain?
3-5 months
Throwers may need surgical intervention
UCL sprains need to avoid what motions initially
Avoid ER stretching and IR strengthening of shoulder
Optional bracing for UCL injury:
Brace between 10-100 for a variable period of around 3 weeks
Dull ache -> sharp pain at Humero-radial joint line
feeling of joint slipping/unstable, clicking
pain and symptoms w/ CKC UE tasks
Dc grip strength w or w/o pain
RCL sprain, (PLR elbow instability)
Doesnt do well w/ conservative tx!
What are the 5 classification elements of elbow instability
Timing (acute, chronic, recurrent)
Articulation involved (1-3 joints)
Direction of displacement (varus, valgus, PLR, anterior)
Degree of displacement
Presence of absence of fx
The ________ nerve is the most commonly affected nerve at the elbow
ulnar
Progress to surgical managment of cubital tunnel if it doesn’t resolve in ________
3-4 months of PT
Conservative recommendations for cubital tunnel:
Avoid prolonged movements or static positioning
pad and protect the medial elbow
avoid end-ROMs
How long does it take to heal a ORIF at the elbow
4-5 months
how long does it take to heal a UCLR
9-12 months
How long does it take to heal an arthoscopic debridement/ loose body removal
2-3 months
How long to heal a distal bicep tendon repair
6+ months
How long to heal a total elbow arthroplasty?
3 months
Phase 1 and 2 of ORIF at elbow:
Phase 1: (week 1-week 2):
Early ROM of shoulder wrist and hand
AROM of Elbow
Minimize edema
Phase 2 (wk 2-6)
Increase elbow ROM
progress to light functional activities
Phase 3 and 4 of ORIF at elbow:
Phase 3 (wk 6-12)
Regain full elbow ROM
Regain functional strength
Return to PLOF
Phase 4(12-20)
Advanced strengthening
Return to sport
how long until an ORIF can return to sport
12 weeks minimum
What are the phase 1 goals of an UCLR
Protect healing site
Reduce pain/inflammation
Decrease muscle atrophy
Regain full wrist/shoulder motion
how long must a UCLR wear a brace
6 weeks
How long until a UCLR can initiate plyometrics
what is the criteria
No earlier than 8 weeks
Pain free ADLs and strengthening
4/5 or more MMTs or 80% on HHD
Scap control
No neural tension or shoulder impingement
90% compared to other side on prone single arm ball drop test
Single limb squats 5 times
Y balance testing 94% or better on both legs
*Note how it includes leg stuff even tho its for the elbow)
How long until a UCLR can return to sport?
5 months minimum (and 4 months to start return to activity phase)
typically 8
for a UCLR , what position do we immobilize the arm in the first phase?
at 90 degrees of flexion
When can a UCLR continue training their trunk and legs
wait until 7 days post-op
At phase 2 of the UCLR, what happens to the brace
unlocks to 30-110 at week 2
10-125 at week 3
week 4-5, 0-145
How long until a UCLR can run?
6 weeks
When can a UCLR return to activity?
4 months minimum
At what time will we initiate the throwing program for UCLR
Hitting program?
12-14 weeks
10 weeks (preform atleast 2 weeks of hitting before throwing)
