Lecture 12: Elbow/forearm Complex Treatment Flashcards
• Protect injury site
• ↑ pain-free ROM in entire kinetic chain
• Improve pt comfort by ↓ pain and
inflammation
• Retard muscle atrophy
• Minimize detrimental effects of
immobilization and activity restrictions
• Maintain general CV fitness
• Ensure pt is independent w/ HEP
These describe what phase of goals
Acute
How is the PT management different for elbow sx vs conservative
Sx: u move them
Conservative : they move their arm
What does PRICE stand for
- protect
- rest
- ice
- compression
- elevate
What must be avoided int eh acute phase interventions
Elbow flexion contractures
What kind oof isometrics can u do for acture phase interventions
Sub max
In the acute phase interventions once full pain free AROM is restored what do u do
Progressive resistance exercseis (concentric 1st then eccentric)
What is the criteria for a pateint to move from acute —> subacute phase
- Full pain-free ROM achieved
- Muscle strength >/= 70% of
contralateral limb
What kind of activities di u introduce in the sub acute phase interventions
CKC
When can u progress to UE plyometrics
Sub acute phase with 70-90% of strength back
What does resisted shoulder ER increased at the elbow
Increase valgus strsss at elbow
When can a patient return to gradual return to sport
Strength , power and endurance > 90% of contra limb
What is the most common lateral elbow pain
Lateral epi
What is lateral elbow tendinopathy
Degeneration of extensor
tendon origin
What kind of management is more common for laterla elbow tendinopathy
Conservative
Sx only if symptoms > 6 month
What are the CPG recommendations for therapeutic exercises for lateral elbow pain
B: use isometric , concentric and/or eccentric ther ex resisted exercises of the wrist extensors with subacute or chronic patients
What is the multimodal interventions: including therapeutic exercises for lateral elbow pain CPG recommendations
B: use resisted wrist extension strengthening exercises in combination with other interventions like manual therapy for patients in subacute or chornic
C: may include shoulder and scapular stabilizer mm training exercises
What is the interventions: manual therapy joint mobility/maip for lateral elbow pain CPG recommendations
B: should use local elbow joint manip or mobs to reduce pain and increased pain free grip strength
C: may use manip or mob directed at the c spin , t spin and/or wrist
What is the interventions: manual therapy soft tissue mobs for lateral elbow pain CPG recommendations
C: may use soft tissue mobs like manual release therapy to improve pain and function for chronic patients
C: may us instrument assisted soft tissue mobs combinated with exercise for chronic
What modalities for lateral elbow pain are recommendaed by CPG
- dry needling - B
- taping -B
What is the clinical presentation for lateral elbow tendinopathy
• Lateral elbow pain w/ active wrist extension and
supination
• Gripping tasks or end range stretch
What is the treatment for lateral elbow tendinopathy
• No consensus
• ↓ inflammation (consider activity modification)
• Joint mobs
• Progressive resistive ex’s
• Gradual return to function
What is the clinical presentation for medial elbow tendinopathy
• Medial elbow pain w/ active wrist flexion and
pronation
• Gripping tasks or end range stretch
What is the treatment for medial elbow tendinopathy
• No consensus – must determine ALL structures
involved to effectively manage
• ↓ inflammation (consider activity modification)
• Joint mobs
• Progressive resistive ex’s
• Gradual return to function
What are 4 causes from elbow stiffness
• Post-trauma, fracture and/or dislocation
• Following cast/sling/brace use
• Joint arthropathy (OA, etc)
• Pathologic bone formation (HO, myositis ossificans, etc
What is the clinic al presentation for elbow stiffness
• Significant loss of elbow ROM in >1 directions
• Pain may or may not limit ROM
What is the treatment for elbow stiffness
• Joint mobs
• Low load, long duration stretches
• Dynamic splints as needed
What is the clinical presentation for UCL sprain— medial elbow instability
• Dull ache → sharp pain at H-U joint line
(medial)
• Medial elbow pain w/ valgus stress (throwing, overhead lifts, etc)
• May or may not have ulnar n. paresthesias
• ↓ grip strength w/ or w/o pain
What is the prognosis from UCL sprain- medial elbow instability
- typically 3-5 months to return to activity
Can progress to sx if symptoms continue
What is the treatment for UCL sprain- medial elbow instability
- optional braving in pain free ROM ~ 3 weeks
- avoid ER stretching and IR strengthening initially
- restore full pain free UE ROM
What stretching and strengthening for u wasn’t to avoided initially for UCL Sprain – Medial Elbow Instability
ER stretching
IR strengthening
What are the casues from RCL Sprain – Posterolateral (Rotary) Elbow Instability
- axial compression + ER + valgus force applied to elbow
What are the clinical presentation for RCL Sprain – Posterolateral (Rotary) Elbow Instability
- dull ache —> sharp pain at HR joint line (posterior lateral)
- feeling of joint slipping or unstable
- pain and symptoms w CKC UE tasks
- decreased grip strength w or w/o pain
What are the treatment for RCL Sprain – Posterolateral (Rotary) Elbow Instability
- avoid provocative positions
- optimal braving fro 4-6 weeks
- strengthen biceps , brachilais , triceps
What is the 5 item classification system for elbow instability
- Timing (acute, chronic, recurrent)
- Articulations involved (1, 2 or 3
joints) - Direction of displacement (valgus,
varus, anterior, posterolateral) - Degree of displacement
(subluxation vs dislocation) - Presence or absence of associated
fractures
What N is most commonly affect in the elbow
ulnar
What N does the Cubital tunnel syndrome involve
Ulnar
What kind of management is recommended for pts w intermittent SYMTOMS for cubital tunnel syndrome
conservative
SX if symptoms dont get between in 3-4 months
What is the timeline for a ORIF (Ffx management)
~4-5 months
What is the timeline for a UCLR
~9-12 months
What is the timeline for a arthroscopic debridement/loose body removal
~ 2-3 months
What is the timeline for a distal biceps repair
~ 6+ months
What is the timeline for a total elbow arthroplasty
~ 3 months
What is important to get after a sx
Operative report
What are u doing in phase 1 (weeks 1-2) for an ORIF
• Early ROM of shoulder, wrist and
hand
• Active ROM of elbow
• Minimize edema
What are u doing in phase 2 (weeks 2-6) for an ORIF
• ↑ elbow ROM
• Progression to light functional
activities
What are u doing in phase 3 (weeks 6-12) for an ORIF
• Regain full elbow ROM
• Regain functional strength of
involved UE
• Return to PLOF
What are u doing in phase 4 (weeks 12-20) for an ORIF
• Advanced strengthening
• RTS or RTW
What are u doing in phase 1- immediate post op phase for a UCL reconstruction
- Protect healing tissue
- Reduce pain and inflammation
- Decrease mm atrophy
- Regain full wrist/shoulder motion
What are u doing in phase 2- ___ ____phase for a UCL reconstruction
Controlled mobility
- Gradually restore elbow joint ROM
2.improve mm strength and endurance - Normalized joint arthokinematics
What are u doing in phase 3- ____phase for a UCL reconstruction
Intermediate
- Maintain/restroe UE mobility I
- Improve mm strengthen and endurance
- Re establish NM control
- Continue functional progression of activity
What are u doing in phase 4- ____ ____phase for a UCL reconstruction
Advanced strgthneing
- Gradually increase strength , power, endurance and NM control
What are u doing in phase 5 - ____ ____phase for a UCL reconstruction
Return to activity
- Progress towards return to play
What are u doing in phase 5 - ____ ____phase for a UCL reconstruction
