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What do you guys do to try to regain ext. in a stubborn elbow
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What do you guys do to try to regain ext. in a stubborn... - April 5, 2007 12:14:00 PM
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clydesdale6
Posts: 65
Joined: January 2, 2006
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I have tried dynasplints, exercise and general stretches. But this is one thing that over the years still seems to give me a lot of trouble. What do you guys do to stretch out your elbow patients? This is one joint where ROM does not seem to come back so easy.
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Re: What do you guys do to try to regain ext. in a stub... - April 5, 2007 2:24:00 PM
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physioo
Posts: 184
Joined: June 26, 2006
From: Canada
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AP radial head
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Re: What do you guys do to try to regain ext. in a stub... - April 5, 2007 2:27:00 PM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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there is some research that shows if ORIF the elbow will always be lacking 17 degrees on average. How much extension do you need for function anyway, I pretty much got as much as I could and let nature do the rest over time.
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Re: What do you guys do to try to regain ext. in a stub... - April 5, 2007 5:10:00 PM
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Chocco
Posts: 58
Joined: September 5, 2006
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I like mulligan elbow ext mobes, But elbow extension is tough.
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Re: What do you guys do to try to regain ext. in a stub... - April 6, 2007 2:19:00 AM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Agree....hardest thing I ever have to treat. I have learned that once the discomfort felt with passive stretching occurs in the olecranon region, and no longer in the antecubital fossa or medial/lateral area, the "end is near" At that point, I'll try more Mulligan techniques, radial mobilization, etc as noted above. However, it becomes a fulcrum dysfunction, and over doing things can lead to a notch being carved ino the olecranon fossa from forcing too much passive extension.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: What do you guys do to try to regain ext. in a stub... - April 6, 2007 3:12:00 AM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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I have had a really hard time with these. For stubborn extension, I usually try to put a very light weight on the hand, support under the elbow and let them stretch passively for 20-30 min. I usually add moist heat and even, at times, tens to make it more comfortable.
However, from what you are describing, this may only make things worse. So, aside from manual, I dont' have much to add. Are you saying that there is a tissue build up between the olecranon and the oloecranon fossa? Is that the fulcrum? If so, there could be some possibilities such as soft tissue techniques when the elbow is in flexion. But....I would have to hear more about what you think is going on.
Marc
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Re: What do you guys do to try to regain ext. in a stub... - April 6, 2007 3:37:00 AM
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certMDT
Posts: 155
Joined: April 5, 2004
From: Durham, NC
Status: offline
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Duffy -
Do you have any sort of reference for the olecranon damage you described? Not a challenge - of anyone, I figure you actually do.
I think I've read the same studies about lacking elbow extension after surgery, and I know that lacking terminal elbow extension is a frequent non-limiting occupational hazard among professional baseball pitchers (I assume from the eccentric biceps contraction, but feel free to contradict me).
I tend to follow the same as above - instruct in a general stretching program for a few weeks with some overpressure and mobilizations in the clinic, discharging to a long term TERT (Time at End Range Tension) program similar to what Marc describes once functional motion is achieved.
I can only think of one patient who regained 100% of his elbow extension: a guy came in a month or so status/post dislocation - I did a posterior glide to assess joint play, felt a pop, and he immediately had the last 15 degrees of motion. He thought I was a genius. Never came back.
Charlie
_____________________________
Charles Sheets PT OCS Dip MDT
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Re: What do you guys do to try to regain ext. in a stub... - April 6, 2007 6:35:00 AM
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ehanso
Posts: 356
Joined: September 14, 2004
From: Minnesota
Status: offline
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AP mobs of the radial head. Don't forget to clear the upper thoracic spine.
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