Transcript The Elbow and Forearm Complex - PHT 1228c Therapeutic Exercise II

The Elbow and Forearm Complex
Anatomy of the Elbow
Muscles of the Elbow
Nerves of the Upper Extremity
Joint Positions and Capsular
Patterns
Loose Packed
Position/resting
position
Closed-Pack
Position
Capsular
Pattern
Ulnohumeral
Joint (elbow)
70 degrees flexion,
10 degrees
supination
Extension
Flexion, Extension
Radiohumeral
Joint
Full Extension, Full
Supination
Elbow flexed 90
deg, forearm
supinated 5 deg.
Flexion, Extension,
Supination,
Pronation
Proximal
Radioulnar Joint
70 deg. flexion,
35 deg. supination
5 deg. supination
Supination,
Pronation
Distal
Radioulnar Joint
10 deg. supination
5 deg. supination
Full ROM, pain at
extremes of rotation
Total Elbow Arthroplasty
• This picture depicts the
prosthesis for a total elbow
arthroplasty (TEA)
• This is the most common
surgery when there is joint
destruction (such as with RA)
• This procedure includes a
humeral and ulnar implant and
the head of the radius may be
replaced as well.
• Cement is used for placement
(don’t do US over a TEA)
Figure 18.5 Kisner & Colby page 568
Joint Surgery and Post-op
Management
• Some specific motions of the joint may be limited
after surgery to prevent stress on the capsule,
ligaments, tendons, etc.
• Consult with the PT, KNOW THE LIMITATIONS!
Lateral Epicondylitis
•
Lateral Epicondylitis (Tennis
Elbow)
-pain in the common wrist
extensor tendons along the lateral
humeral epicondyle
-typically brought on by repetitive
movements of the wrist or
activities requiring stability of the
wrist (tennis backhand)
http://www.hss.edu/conditions_tennis-elbowoverview.asp
Medial Epicondylitis
Medial Epicondylitis
(Golfer’s Elbow)
-pain at the common wrist
flexor tendon along the medial
humeral epicondyle
-due to repetitive movements
into wrist flexion (golf swing,
gripping, throwing a ball, etc.)
-ulnar neuropathy can also
occur
http://www.aidmyelbow.com/common-elbow-strains.php
General Considerations for
Overuse Syndromes
• PROTECTION PHASE
-Immobilize: rest the muscles, can use a splint
-Avoid provoking activities: repetitive wrist motions, gripping
-Cryotherapy: ice massage, cold pack
-Multi-angle muscle setting (low-intensity isometrics)
-Cross-fiber massage
-Maintain mobility / strength in unaffected joints (shoulder, etc)
General Considerations for
Overuse Syndromes
• CONTROLLED MOTION AND RETURN TO FUNCTION PHASE
*Progress to this stage only when inflammation is controlled
-Manual stretching
-Self-stretching
-Cross-fiber (friction) massage
-Isometrics progressing to Theraband, free weights, etc.
-Isolated motions progressing to functional patterns
-General strengthening and conditioning
-Simulation of work or recreational activities
-Plyometrics (if returning to sports, etc)
-Activity Modification / Patient Education
Self Stretching to Increase Elbow
Extension and Flexion
Self Stretching- Muscles of the
Lateral and Medial Epicondyles
• This figure demonstrates
stretching of the wrist
extensors (from the lateral
epicondyle)
• Stretching the wrist flexors
involves extension at the wrist
with the elbow in full extension
•
•
See HEP handouts as well for more pictures
Figure 18.10 Kisner & Colby page 579
Resistance Exercises for the
Elbow, Forearm, and Wrist
Functional Exercises for the UE
UE Theraband Exercises for Elbow
Strengthening
Combined Pushing Motions
Case Study
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John is a 45 y/o painter who comes to your clinic with a diagnosis
of left ‘elbow pain’. During the PT evaluation the therapist
palpates tenderness and inflammation at the lateral epicondyle of
the humerus and testing reveals tight wrist extensors with 4/5
MMT. Pain is a 4/10 in the morning and an 8/10 after working all
day (painting). The patient is left hand dominant. His grip strength
is weaker in his left hand by 30% when compared to the right.
What term (pathology) would best describe the patient’s
condition?
What mechanics (actions) likely initiated his symptoms?
What patient education would you give John?
Create a home management program for this patient.
What are the key components to this patient’s treatment?