Elbow interventions - Lecture 2 Flashcards
What 4 motions can be acomplished at the elbow joint?
Pronation
Supination
Flexion
Extension
What would we use an elbow medial glide for?
pt w/ reduced flexion
What would we use an elbow lateral glide for?
pt w/ reduced elbow extension
Which kind of mobilization is best for having pain free grip strength?
Latearl mobilization of the elbow
What kind of glide is best for lateral epicondylagia?
Lateral glide
An anterior glide of the radius on the humerus helps w/ what?
Flexion (concave on convex)
When would we use an anterior radiohumeral glide? (2)
To help w/ elbow flexion and pronation
When would you do a posterior radiohumeral glide?
To help w/ reduced elbow extension and supination
What would an anterior glide of the ulna do?
help pt w/ reduced flexion and supination
What would an antrior glide of the radus do?
help w/ flexion and pronation
What would a posterior glide of radius do?
help w/ extension and supination
What would a posterior glide of the ulna do?
help w/ extension and pronation
When would you do a radioulnar inferior glide (distraction)
restricted elbow extension
When would you do a radioulnar superior glide (approximation)
used for pts w/ reduced elbow flexion
KNOW: PTs used to use cross friction massage w/ lateral / medial epicondyalgia - but it would actually be more beenficial to do a latearl and medial glide
What is iontophoresis used for?
Its a patch (negatively and positively charged) that treats inflammation
What does stretching address?
restores mobility (reduces protective tone)
What are the stretching principles (3)
20-30 seconds in duration
5 repetitions
Non-painful range
Does stretching increase sarcomere length?
No
Does serial casting increase sacromere length?
Yes
What does a dynosplint do? When is it used
Holds them in some ROM at the elbow (can change the degrees its held at)
*its a prolonged stretch
* this actually lengthens sacromere and m tissue
used w/ muscle contractures to try and legthen it back out
pt has elbow flxn 2/5 will they get full range in the impage below?
Partial ROM (cant go against gravity in a 2/5)
at what MMT should you add resistive movements?
4/5
Isometrics –> eccentric / concentric –> plyometrics = tendon loading principles
Whats good for isolating 1 muscle at a time –> open kinetic chain activities vs closed kindetic chain activities?
Open
When going up in this image what motion is it?
Resisted supination?
KNOW: If someone is having a hard time pouring something work on reissted supination / pronation
Whats best for recruitment and utilization of multiple groups of muscles - OKC or CKC?
Closed kinetich chain
What reduces protective tone / spasticity OKC or CKC?
CKC
KNOW: Common causes of elbow pain:
* Medial epicondylalgia
* Ulnar collateral ligament injury
* Lateral epicondylalgia
* Elbow fracture/dislocatoin
* Olecranon bursitits
* Bicipital tendinopathy
* Triceps tendinopathy
Nerve entrapment:
* Ulnar nerve entrapment: (cubital tunnel syndrome)
* Radial n entrapment
* Median n entrapment
What two muscles are primarily involved in medial epicondylalgia?
* NOTE: this affects the tendon bundle so what kind of progression of EX should we have them doing?
Flexor carpi radialis
Pronator teres
Lesser extent: PL, FCU, FDS
We need our tendon loading principles!
* Isometrics –> heavy slow eccentric / concentric –> low load fast concentric / eccentric –> high load fast concentric / eccentric
Tendon loading principles (correct)
Isometric –> heavy but slow eccentric / concentric –> low load fast concentric / eccentric (looks more like plyometrics) –> high load fast concentric / eccentric (looks a lot like plyometrics)
This is resisted pronation or supination?
What condition would we use this for?
resisted pronation
is this resisted flexion or extension
resisted flexion
used for medial epicondyalagia
What 5 exercises / interventions should we do for someone w/ acute medial epicondyalagia?
Mobility work (AAROM / PROM / AROM)
Joint mobilization
Distal/proximal joint EX (work in areas other than just elbow)
Isometrics (it is a tendon)
Ice massage / e stem
NOTE: Never to early to do resisted activity
w/ moderate irritability medial epicondylagia = improve tolerance to load (utlize a variety of grips)
Low irritability goals =
* regular strengthening / power development
* specific to patient functional requirements
What two things cause UCL injury (elbow)
valgus w/ shoulder ER
* NOTE: if I have limited ER i increase my valgus at the elbow
What kind of traumatic injurys often cause UCL issues?
FOOSH (go into valgus when you fall)
What stress test do we do to find UCL issues?
Moving valgus stress test
If we have UCL issues what nervy condition can develop?
Cubital tunnel syndrome (Ulnar n)
What motion would we want to avoid w/ acute UCL injuryies? why?
full extension because were going into valgus (further putting stress on that ligament)
what is the carrying angle?
Angle between the humerus and ground and humerus and forearm when in full extension
* indicates the amount of valgus
* bigger angle = more valgus
throwing injuries are normally where?
UCL (go into valgus when throwing)
NOTE: treat UCL/MCL like any other tendinopathy (work on ROM/pain modualtion/isometrics acute then progress to more loading)
What percent of UCL repairs have ulnar nerve issues?
12%
What is the typical immobilization position (holding it in one spot) of UCL repair? WHy?
around 90 degrees of flexion for 7 days and working on ROM
because we dont want them to fall into extension and have valgus
KNOW: crossover affects from strengthening = strengthen contralateral side and get cross over effects to the ipsialteral side (ipsilatearl side will get stronger [i think this is mind muscle related / nerve related])
Good thing to do if someone is immobilized on ipsilateral side
ballistic = concentric and high velocity eccentric
What % of global upper extremity limb semmetry index do we want them to have before going to return to sport?
70%
what text measures side to side UE stregnth?
seated shock put
