Elbow interventions - Lecture 2

Question 1

What 4 motions can be acomplished at the elbow joint?

Answer 1

Pronation
Supination
Flexion
Extension

Question 2

What would we use an elbow medial glide for?

Answer 2

pt w/ reduced flexion

Question 3

What would we use an elbow lateral glide for?

Answer 3

pt w/ reduced elbow extension

Question 4

Which kind of mobilization is best for having pain free grip strength?

Answer 4

Latearl mobilization of the elbow

Question 5

What kind of glide is best for lateral epicondylagia?

Answer 5

Lateral glide

Question 6

An anterior glide of the radius on the humerus helps w/ what?

Answer 6

Flexion (concave on convex)

Question 7

When would we use an anterior radiohumeral glide? (2)

Answer 7

To help w/ elbow flexion and pronation

Question 8

When would you do a posterior radiohumeral glide?

Answer 8

To help w/ reduced elbow extension and supination

Question 9

What would an anterior glide of the ulna do?

Answer 9

help pt w/ reduced flexion and supination

Question 10

What would an antrior glide of the radus do?

Answer 10

help w/ flexion and pronation

Question 11

What would a posterior glide of radius do?

Answer 11

help w/ extension and supination

Question 12

What would a posterior glide of the ulna do?

Answer 12

help w/ extension and pronation

Question 13

When would you do a radioulnar inferior glide (distraction)

Answer 13

restricted elbow extension

Question 14

When would you do a radioulnar superior glide (approximation)

Answer 14

used for pts w/ reduced elbow flexion

Question 15

KNOW: PTs used to use cross friction massage w/ lateral / medial epicondyalgia - but it would actually be more beenficial to do a latearl and medial glide

Question 16

What is iontophoresis used for?

Answer 16

Its a patch (negatively and positively charged) that treats inflammation

Question 17

What does stretching address?

Answer 17

restores mobility (reduces protective tone)

Question 18

What are the stretching principles (3)

Answer 18

20-30 seconds in duration
5 repetitions
Non-painful range

Question 19

Does stretching increase sarcomere length?

Answer 19

No

Question 20

Does serial casting increase sacromere length?

Answer 20

Yes

Question 21

What does a dynosplint do? When is it used

Answer 21

Holds them in some ROM at the elbow (can change the degrees its held at)
*its a prolonged stretch
* this actually lengthens sacromere and m tissue

used w/ muscle contractures to try and legthen it back out

Question 22

pt has elbow flxn 2/5 will they get full range in the impage below?

Answer 22

Partial ROM (cant go against gravity in a 2/5)

Question 23

at what MMT should you add resistive movements?

Answer 23

4/5

Question 24

Isometrics –> eccentric / concentric –> plyometrics = tendon loading principles

Question 25

Whats good for isolating 1 muscle at a time --> open kinetic chain activities vs closed kindetic chain activities?

Answer 25

Open

Question 26

When going up in this image what motion is it?

Answer 26

Resisted supination?

Question 27

KNOW: If someone is having a hard time pouring something work on reissted supination / pronation

Question 28

Whats best for recruitment and utilization of multiple groups of muscles - OKC or CKC?

Answer 28

Closed kinetich chain

Question 29

What reduces protective tone / spasticity OKC or CKC?

Answer 29

CKC

Question 30

KNOW: Common causes of elbow pain: * Medial epicondylalgia * Ulnar collateral ligament injury * Lateral epicondylalgia * Elbow fracture/dislocatoin * Olecranon bursitits * Bicipital tendinopathy * Triceps tendinopathy Nerve entrapment: * Ulnar nerve entrapment: (cubital tunnel syndrome) * Radial n entrapment * Median n entrapment

Question 31

What two muscles are primarily involved in medial epicondylalgia? * NOTE: this affects the tendon bundle so what kind of progression of EX should we have them doing?

Answer 31

Flexor carpi radialis Pronator teres Lesser extent: PL, FCU, FDS We need our tendon loading principles! * Isometrics --> heavy slow eccentric / concentric --> low load fast concentric / eccentric --> high load fast concentric / eccentric

Question 32

Tendon loading principles (correct)

Answer 32

Isometric --> heavy but slow eccentric / concentric --> low load fast concentric / eccentric (looks more like plyometrics) --> high load fast concentric / eccentric (looks a lot like plyometrics)

Question 33

This is resisted pronation or supination? What condition would we use this for?

Answer 33

resisted pronation

Question 34

is this resisted flexion or extension

Answer 34

resisted flexion used for medial epicondyalagia

Question 35

What 5 exercises / interventions should we do for someone w/ acute medial epicondyalagia?

Answer 35

Mobility work (AAROM / PROM / AROM) Joint mobilization Distal/proximal joint EX (work in areas other than just elbow) Isometrics (it is a tendon) Ice massage / e stem NOTE: Never to early to do resisted activity

Question 36

w/ moderate irritability medial epicondylagia = improve tolerance to load (utlize a variety of grips) Low irritability goals = * regular strengthening / power development * specific to patient functional requirements

Question 37

What two things cause UCL injury (elbow)

Answer 37

valgus w/ shoulder ER * NOTE: if I have limited ER i increase my valgus at the elbow

Question 38

What kind of traumatic injurys often cause UCL issues?

Answer 38

FOOSH (go into valgus when you fall)

Question 39

What stress test do we do to find UCL issues?

Answer 39

Moving valgus stress test

Question 40

If we have UCL issues what nervy condition can develop?

Answer 40

Cubital tunnel syndrome (Ulnar n)

Question 41

What motion would we want to avoid w/ acute UCL injuryies? why?

Answer 41

full extension because were going into valgus (further putting stress on that ligament)

Question 42

what is the carrying angle?

Answer 42

Angle between the humerus and ground and humerus and forearm when in full extension * indicates the amount of valgus * bigger angle = more valgus

Question 43

throwing injuries are normally where?

Answer 43

UCL (go into valgus when throwing)

Question 44

NOTE: treat UCL/MCL like any other tendinopathy (work on ROM/pain modualtion/isometrics acute then progress to more loading)

Question 45

What percent of UCL repairs have ulnar nerve issues?

Answer 45

12%

Question 46

What is the typical immobilization position (holding it in one spot) of UCL repair? WHy?

Answer 46

around 90 degrees of flexion for 7 days and working on ROM because we dont want them to fall into extension and have valgus

Question 47

KNOW: crossover affects from strengthening = strengthen contralateral side and get cross over effects to the ipsialteral side (ipsilatearl side will get stronger [i think this is mind muscle related / nerve related]) Good thing to do if someone is immobilized on ipsilateral side

Question 48

ballistic = concentric and high velocity eccentric

Question 49

What % of global upper extremity limb semmetry index do we want them to have before going to return to sport?

Answer 49

70%

Question 50

what text measures side to side UE stregnth?

Answer 50

seated shock put