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Download The Elbow and Forearm Complex - PHT 1228c Therapeutic Exercise II
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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 • 1) 2) 3) 4) 5) 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?
