Multiple Clinical Perspectives: A Look At The Elbow

I've spoken before about one of my favorite aspects of this residency: the variety of resources. We routinely utilize the APTA Ortho Section's monograph for each joint, Shirley Sahrmann's texts, and a lecture from the clinical faculty for each joint. Recently, we covered the elbow, wrist, and hand in a couple lectures taught by a Certified Hand Therapist (CHT). CHT's are commonly known as experts in regards to assessing and treating these joints, so I was pretty excited for those lectures. If you have read the clinical practice guidelines on various elbow/wrist/hand pathologies or the monograph for those joints, you likely are aware of many of the commonly described clinical presentations, assessment and treatment techniques. If followed correctly, these patterns typically lead to good results.

Recently, my mentor, the other resident, our students, and I got together for some lab practice at the end of the day (another one of my favorite parts). We got to a point where we were discussing alternative assessment, treatment, and even philosophies of the elbow. As I have mentioned before, my mentor is a FAAOMPT and he receives regular updates from his fellowship regarding new assessment and treatment techniques throughout the body. We began discussing the implications of assessing compression versus distraction at the radialhumeral joint. Many elbow injuries result from either a traction or compression force. Think about the patient swinging a tennis racket, carrying a heavy bag, or grabbing onto something superiorly when falling. These are all traction forces. Push ups, a fall on an outstretched hand, etc. are compression forces. We commonly see scripts or we diagnose elbow injuries as overuse injuries, such as tendinopathy. The theory lies in the idea that the tendon is overly stressed from those activities, resulting in pain. While this may be true in some instances, it may not always be correct.

Think about how we have previously discussed the effect abnormal spinal mobility can lead to altered neural function and thus changes in muscular activity. We may find a tender or weak muscle or flaired up nerve that is ultimately the result of a poorly functioning joint in the spine. Why can't similar things happen peripherally? They can. It can be argued that either a compressed or distracted radialhumeral joint can result in an irritated radial nerve and lead to altered function of the radial nerve-innervated muscles as a result of altered joint arthrokinematics. This may be presented as "tennis elbow," radial tunnel syndrome, or PIN syndrome. Unfortunately, since this is a relatively new approach, there hasn't been much research performed on the topic. However, I challenge you to assess this joint when treating these elbow conditions in order to help determine the potential contribution for that particular individual. More importantly, we should be thorough with our exams and treat any related joint dysfunctions!

The video below discusses how to assess and treat distracted and compressed radialhumeral joints. Additionally, I briefly discuss assessing elbow abduction and adduction. This again plays a role in checking joint mobility and may determine the need for some form of manual therapy or alternative treatment.

-Chris

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