Elbow Trauma and Manual Therapy (10.2)

what does DOTS stand for

- deformity

- open wounds

- tenderness

- swelling

what does DOTS rule out

red flags for acute trauma

four way range of motion test

active extension to 0°, active flexion to at least 90°, active pronation and supination to full range of motion (80°) with elbow flexed to 90°

what does the four way range of motion test help rule out

need for imaging

signs and symptoms of acute compartment syndrome

- pain out of proportion

- paresthesia

- pallor

- paralysis

- pulselessness

what is the most common large joint dislocated in children

elbow joint

what is the second most common joint dislocated in adults

elbow joint

what is the fat pad sign

intra-articular effusion --> pushes fat pads around elbow out, seen on x-ray

essex-lopresti fracture

fracture of radial head with proximal radius migration, disruption of distal radioulnar joint and interosseous membrane

nursemaid's elbow

inferior subluxation of radial head with displacement of annular ligament

monteggia fracture

ulna fracture with radial head dislocation, often direct blow to forearm or FOOSH with hyperextension (highly complicated)

what age of patient usually experiences a medial epicondyle avulsion fracture

adolescent athlete, due to the bone not being as strong as the muscle/tendon/ligament pulling on it

what elbow motion is commonly lost after acute elbow injuries

extension

what is heterotopic ossification

bone formation at an atypical site

how to treat heterotropic ossification

passive range of motion slowly and progressively, surgical excision if unsuccessful

what are three treatments that could be used for mobility deficits of the elbow

- splinting

- TERT

- static progressive splinting

what is TERT

- total end range time

- low load long duration stretch of 60 minutes/day

what are the four basic rehabilitation principles for physical therapy management

- respect patient presentation

- respect tissue healing time frames

- minimize physiologic effects of disuse

- address entire movement chain

what are interventional strategies to minimize effects of disuse

- muscles: isometric activation at varying levels (usually submaximal), advancing as able to concentric and eccentric strengthening

- bones: muscle activation and specific loading (usually compressive)

- joints: movement and POLICE

- acknowledge pain and use it as a guide

what are appropriate parameters for joint mobilization when attempting to improve mobility

grade III, IV, and V mobilizations

how do you know if your manual therapy is making an impact

use a brief trial, then reassess symptoms and/or motion restrictions

arthrokinematics for the humeroradial joint

- concave on convex

- in open chain, radius (concave) rolls and glides in the same direction on the humerus (convex)

arthrokinematics for the humeroulnar joint

- concave on convex

- in open chain, ulna (concave) rolls and glides in the same direction on the humerus (convex)

arthrokinematics for the proximal radioulnar joint

- open chain: radial head spins on radial notch of ulna

- closed chain: ulna rotates on fixed radial head

arthrokinematics for the distal radioulnar joint

- open chain: ulnar notch of radius (concave) rolls/slides same direction on ulnar head (convex)

- closed chain: ulnar head (convex) rolls/slides in opposite directions on the ulnar notch of radius (concave)

what motions does the humeroradial anterior glide improve

elbow flexion

what motions does the humeroradial posterior glide improve

elbow extension

what motions does the humeroradial traction glide improve

elbow flexion and extension

what motions does the humeroulnar distraction glide improve

elbow flexion and extension

what motions does the proximal radioulnar anterior glide improve

forearm supination

what motions does the proximal radioulnar posterior glide improve

forearm pronation

when might you use soft tissue massage techniques as an intervention

- muscle tightness/shortening

- trigger points

- myofascial restrictions

- tendon restrictions

- scar tissue or soft tissue adhesions

- painful or guarded muscles