Elbow Mobilizations Flashcards
Humero-ulnar Distraction:
if tx best to do a sustained stretch and we can even get close to 90 degrees in treatment, if mobility test palpate with a finger)
- Patient Position: supine, elbow in resting position (70 degrees flexion, 10 degrees supination)
PT stands facing the patient - Stabilize: fixate patient arm on table: can use one of my hands, can do strap
- Mobilize: PT place both hands at ventral proximal forearm with my ulna border close to the joint line
- Force/Direction: get as close to the joint line as possible, PT shifts body weight back to move ulna away from humerus to produce traction
Note: fixation and movement can be done with straps
Humeroulnar Medial Gap: Valgus Strain
- Patient Position: supine, elbow just shy of full extension
ONLY used for testing ligamentous stability, it is not a mobility test and it is not for treatment - Stabilize: distal lateral humerus
- Mobilize: distal medial forearm for long lever (can use a finger to feel the joint line)
- Force/Direction: laterally directed force at distal medial forearm to increase valgus at the elbow
Humeroulnar Lateral Gap: Varus Strain
(be pure to medial and lateral plane, so that not flexing elbow. Do with palm up)
- Patient Position: supine, elbow just shy of full extension
a. Used to test ligamentous stability ONLY
b. Radial collateral ligament - Stabilize: fixate on distal medial aspect of humerus
- Mobilize: hold distal lateral aspect of forearm
- Force/Direction: force directed medially in forearm increase varus angle
Humeroulnar Medial Glide 1:
medial and lateral glide for flexion and extension
- Patient Position: supine or seated, elbow in resting position
a. 70 flexion, 10 supination (don’t let it flex) - Stabilize: medial distal humerus
- Mobilize: lateral proximal forearm
- Force/Direction: force directed in a medial direction
a. (think about the surfaces gliding past each other)
Humeroulnar Medial Glide 2:
medial and lateral glide for flexion and extension
- Patient Position: sidelie (arm testing is the lower arm)
a. Assess the lower arm, position shoulder in ER with elbow in resting position
b. 70 degrees flexion, 10 degrees supination - Stabilize: stabilize proximal forearm on wedge
- Mobilize: distal humerus
- Force/Direction: glide humerus towards the table to create a medial glide of forearm on the humerus
- **strong stabilization and gravity helps, good for treatment too
Humeroulnar Lateral Glide 1:
medial and lateral glide for flexion and extension
- Patient Position: supine, elbow in resting position
70 flexion, 10 supination - Stabilize: distal lateral humerus
- Mobilize: proximal medial forearm
- Force/Direction: lateral direction
Humeroulnar Lateral Glide 2:
medial and lateral glide for flexion and extension
- Patient Position: sidelie
a. Assess the lower arm, position in external rotation with elbow in resting position
b. 70 degrees flexion, 10 degrees supination - Stabilize: stabilize distal lateral humerus on wedge
- Mobilize: mobilize proximal forearm
- Force/Direction: glide ulna towards table laterally
Humero-Radial Distraction:
(it is also an inferior glide at the radial-ulnar joint) general mobility
- Patient Position: supine, resting position of superior radialulnar joint
a. 70 degrees flexion, 35 degrees supination
i. (for a purchase on the bone so we can glide it) - Stabilize: volar aspect of distal humerus
- Mobilize: distal radius (key grip at distal radius: puh away soft tissue and grab a key grip then do a lift up or a lean back, force will pull through the length of the radius)
- Force/Direction: force is directed longitudinally creating ** traction in the humeroradial joint and an **inferior glide in the proximal radial-ulnar joint
a. Separate head of radius from capitulum: palpate it
b. Inferior glide of the radius in the notch of the ulna
Humero-Radial Compression/Approximation:
can use to treat in grade 1 for pain, can use as come closer to full flexion the superior glide
- Patient Position: supine, elbow flexed 90 degrees
a. Elbow flexed to 90 degrees (almost closed packed)
b. Why do this if tight? as the radius head comes into humerus, there may be some compressive force, more of a superior glide than a compression - Stabilize: distal lateral humerus, also palpate the joint space and radial head here
- Mobilize: grasp patients hand so that thenar eminence in contact with thenar eminence
- Force/Direction: move radius longitudinally approximate the radius to the humerus, we have a long lever for this (compress, approximate into radial humeral joint)
Humero-Radial and Superior Radioulnar Dorsal Glide: I
NCREASE ELBOW EXTENSION
- Patient Position: seated or supine, forearm extended and supinated
a. Resting position of humeroradial joint
b. Dorsal glide of the radial head
c. Easier to find radial head in flexion - Stabilize: dorsal aspect of distal humerus
- Mobilize: radial head with thumb and index finger (need to pull soft tissue out of the way and get the thumb on front of radius and finger on back of radius) [pinch front and back of radial head: if supine we can use a wedge]
- Force/Direction: glide radial head in dorsal direction (let it roll backwards and then bring it back to neutral)
- **Help elbow extension
Superior Radial Ulnar Joint Dorsal and Volar Glide:
volar glide increase supination, dorsal glide increase pronation
- Patient Position: seated, elbow flexed 70, supination 35
Resting position of superior radial-ulnar joint - Stabilize: distal humerus
- Mobilize: grasp radial head with thumb and index finger
- Force/Direction: glide radial head in volar then to neutral and dorsal direction to neutral (think about moving the head of the radius)
- **Indication:
volar glide: increase supination
dorsal glide: increase pronation
Inferior Radioulnar Joint Ventral Glide:
restricted pronation
- Patient Position: seated, forearm in resting position
- Stabilize: fixate distal part of the ulna from the ulnar side, stabilize against the table
- Mobilize: distal radius using thumb and index finger
- Force/Direction: glide in a ventral direction
- **Indication: restricted pronation
Inferior Radioulnar Joint Dorsal Glide:
restricted supination
1. Patient Position: seated, forearm in resting position
- Stabilize: fixate distal part of ulna from ulnar side, stabilize against the table
- Mobilize: distal radius using thumb and index finger
- Force/Direction: glide in dorsal direction
- Indication: restricted supination
Cozen Test:
resisted
- Stabilize elbow
- Patient is pronated, radial deviated, make a fist
- Test: resist wrist extension and hold it
- Ask the patient where it hurts: on the muscle or lateral epicondyle where the mass inserts
- Positive: pain or weakness
Tennis Elbow Tests: lateral epicondylitis: do at least 2 to see where in extensors is the issue: 2 with resistance (resist the muscle to pull on the insertion), one with stretch: in all cases we palpate the extensor mass
Mills Test:
stretch (this can be active or passive)
- Palpate lateral epicondyle
- Pronate, flex wrist
- and then extend the elbow
- Positive: painful, where along the extensor muscles are the symptoms
Tennis Elbow Tests: lateral epicondylitis: do at least 2 to see where in extensors is the issue: 2 with resistance (resist the muscle to pull on the insertion), one with stretch: in all cases we palpate the extensor mass
