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PHTY3120 > L18: Clinical reasoning in management of the elbow 2 > Flashcards

L18: Clinical reasoning in management of the elbow 2 Flashcards

1
Q

What are 3 evidences for MWM in lateral elbow tendinopathy (LET)?

A
  1. MWM is better than placebo in immediate improvement of pain-free grip (~50% during and post) and pressure pain thresholds (10-15% post)
  2. Excitatory effect on SNS function with MWM (e.g. HR, BP, skin temperature)
  3. MWM is effective for tennis elbow, and it might be more than local effect at elbow.
    1. Reduce abnormal afferent input - reduce pain - allow more gripping
    2. Endogenous pain relief
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2
Q

What is the evidence for therapeutic exercises in lateral elbow tendinopathy (LET)?

A
  1. Therapeutic exercise improves pain, strength and disability over time
  2. Resistance exercise is effective for LET. But optimal mode and dosage are unclear.
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3
Q

What are the 5 staged exercise approaches for therapeutic exercises for lateral elbow tendinopathy (LET)?

A
  1. Pain-free during & after exercise
  2. Slow concentric & eccentric contractions (8 seconds in total)
  3. First 2-3 weeks endurance focus: Light load, >15 reps
  4. Next 4-6 weeks, endurance-strength focus: 10-15 reps > 8-10 reps, 3 sets, short rest
  5. May progress to high strength: 4-6 reps, 3 sets, long rest
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4
Q

What are 2 evidence for isometric exercises for therapeutic exercises for lateral elbow tendinopathy (LET)?

A
  1. Conflicting evidence for Achilles tendinopathy, plantar heel pain)
  2. Limited, inconsistent evidence for LET pain relief.
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5
Q

What are 4 considerations for isometric exercises for therapeutic exercises for lateral elbow tendinopathy (LET)?

A
  1. Can use isometric exercise if patient cannot tolerate load (e.g. Reactive tendinopathy or irritable symptoms)
  2. Position: Elbow F supported on table
  3. 4 reps of 30-45s holds
  4. Progress intensity low > high
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6
Q

What is a short term result as evidence for multimodal program for lateral elbow tendinopathy (LET)?

A

Corticosteroid or physiotherapy were better than wait-and-see

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7
Q

What are 3 long term results as evidence for multimodal program for lateral elbow tendinopathy (LET)?

A
  1. Wait & see and physiotherapy were better than corticosteroid.
    • 90% improved by 1 year regardless of physiotherapy or wait-and-see
  2. Poor outcome with corticosteroid injection (from 3 months onwards compared to physiotherapy or wait-and-see
  3. 72% recurrence with corticosteroid injection
    • Because injection masks pain - overload?
    • Because injection impedes healing?
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8
Q

What are 2 evidence for deload tape for lateral elbow tendinopathy (LET)?

A
  1. Deload tape improved pain-free grip strength (24%) compared to placebo and control
  2. Effect lasts 30 minutes
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9
Q

What are 4 major management for lateral elbow tendinopathy (LET)?

A
  1. Advice & education
  2. Manual therapy
  3. Exercise prescription
  4. External physical devices
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10
Q

What are 2 advice and education as management for lateral elbow tendinopathy (LET)?

A
  1. Pain management (RICE)
  2. Activity and biomechanical modifications (e.g. ADL, work, sport)
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11
Q

What are 2 manual therapy as management for lateral elbow tendinopathy (LET)?

A
  1. MWM lateral or radial glide with gripping
  2. MWM lateral or radial glide with elbow F/E
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12
Q

What are 3 exercise prescriptions as management for lateral elbow tendinopathy (LET)?

A
  1. Motor control exercises
  2. Progressive wrist strengthening
  3. Global UL strengthening
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13
Q

What are 2 external physical devices as management for lateral elbow tendinopathy (LET)?

A
  1. Deload taping
  2. Lateral glide or P-A radius tape if TDT +ve
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14
Q

What are 2 evidence for non-surgical and surgical management for medial collateral ligament sprain?

A
  1. No studies have compared surgical and non-surgical management
  2. No RCT
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15
Q

What are 3 low quality studies for medial collateral ligament sprain?

A
  1. Return to sport in 90% of quarterbacks with impact-related MCL injury
    • RTS ~27.4 days (1-17 weeks)
  2. RTS in 42% of throwing athletes
    • RTS ~24.5 weeks (range: 13-54 weeks)
  3. RTS in 66% baseball pitchers
    • 88% with high grade and distal tear failed non-op management
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16
Q

What are 2 evidence for surgical management for medial collateral ligament sprain?

A
  1. Partial MCL tears may be managed conservatively
    • Time to return=4-6 months
  2. Complete MCL tears with significant valgus instability may require surgery in overhead athletes
    • Surgery is effective for MCL injury, but also longer rehab and complication rates
17
Q

What/how long is management for partial medial collateral ligament sprain?

A
  • May be managed conservatively
  • Time to return=4-6 months
18
Q

What/how long is management for complete medial collateral ligament sprain?

A
  • Significant valgus instability may require surgery in overhead athletes
  • Surgery is effective for MCL injury, but also longer rehab and complication rates
19
Q

What are 4 features of management for 83% of throwers who are able to return to pre-level of competition for collateral ligament sprain?

A
  1. Time to return 10-26 months
  2. Post-op rehab: Progressive strengthening and throwing over 4 months to 1 year
  3. Complication rate 10% (6% ulnar neuropathy)
  4. They had 1 year conservative management before surgery
20
Q

What are 5 major management for medial collateral ligament (MCL) sprain?

A
  1. Advice & Education
  2. Manual Therapy
  3. Therapeutic Exercise
  4. Electrophysical Agents
  5. External Physical Devices
21
Q

What are 4 advice and education as management for medial collateral ligament (MCL) sprain?

A
  1. Pain management (RICE)
  2. Anti-inflammatories
  3. Rest from throwing
  4. Ice
22
Q

What are 2 manual therapy as management for medial collateral ligament (MCL) sprain?

A
  1. No evidence of manual therapy for MCL injury
  2. Elbow flexor contracture/tightness - manual techniques to improve ROM
23
Q

What is an electrophysical agent as management for medial collateral ligament (MCL) sprain?

A

Can use as adjunct. No evidence.

24
Q

What is 2 external physical devices as management for medial collateral ligament (MCL) sprain?

A
  1. MCL taping to increase stability
  2. Splinting if elbow F contracture unresponsive to manual therapy to improve elbow E
25
Q

What are 8 therapeutic exercises as management for medial collateral ligament (MCL) sprain?

A
  1. Consider treatment aims, stages of healing
  2. Pain-free ROM exercise
  3. Strengthening wrist flexors and forearm pronators to stabilize the medial elbow
  4. Function-specific strengthening of shoulder and elbow muscles
  5. Power training
  6. Correction of throwing biomechanics - liaise with coach
  7. Gradual return to full activity
  8. Interval sport program, particularly for athletes
26
Q

What are 4 features of “function-specific strengthening of shoulder and elbow muscles” for therapeutic exercises as management for medial collateral ligament (MCL) sprain?

A
  1. Muscles required for functional tasks
  2. Progress from general strength postures to functional positions
  3. Eccentric control
  4. Thrower’s Ten Exercise Program
27
Q

What are 4 features of “power training” for therapeutic exercises as management for medial collateral ligament (MCL) sprain?

A
  1. Wrist flexors and forearm pronators
  2. Shoulder and elbow muscles
  3. 8-12 reps, 3-4 sets, high velocity
  4. Consider function needs and positions
28
Q

What are 3 features of “correction of throwing biomechanics - liaise with coach” for therapeutic exercises as management for medial collateral ligament (MCL) sprain?

A
  1. e.g. Rotating the body out of the late cocking phase too early
  2. Elbow lagging behind - increased valgus stress on elbow
  3. Scapula dyskinesis - decreased shoulder abd - throwing side on - increased valgus stress on elbow
29
Q

What are 7 features of “interval sport program, particularly for athletes” for therapeutic exercises as management for medial collateral ligament (MCL) sprain?

A
  1. Progressively apply forces to healing structures
  2. Gradually return athlete to full athletic
  3. Competition as quickly and safely as possible
  4. Start once full ROM, minimal pain/tenderness
  5. Sufficient strength & dynamic stability
  6. No set timetable
  7. Stop if sharp pain
30
Q

What is the Thrower’s Ten Exercise Program for therapeutic exercises as management for medial collateral ligament (MCL) sprain?

A

Designed to exercise major muscles necessary for throwing

PHTY3120 (29 decks)

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