JOINT MOBILIZATION OF THE ELBOW JOINT COMPLEX

Cập nhật lần cuối vào 24/11/2022

Joint Mobilisation techniques for the elbow joint complex from textbooks, mostly used to increase elbow flexion and extension and pronation/supination.

Các kỹ thuật di động phức hợp khớp khuỷu được trích từ trong các textbook để bạn đọc tham khảo, chủ yếu dùng để tăng gập và duỗi khuỷu, một phần quay sấp và ngửa. Khuyến cáo chỉ nên sử dụng các kỹ thuật đơn giản như kéo tách, kéo kèm trượt (scoop motion) khớp cánh tay- trụ/quay.

ANATOMY REVIEW

Notes:

• Physiologic Motions: vận động sinh lý, chuyển động xương
• Accessory Motions: vận động phụ trợ, chuyển động học khớp, joint play
• OPP: Open Packed Position/ Tư thế khớp mở = resting position, tư thế khớp nghỉ: là tư thế thường dùng bắt đầu để di động khớp. Ghi nhớ quy luật mặt lồi/lõm
• CPP: Closed Packed Position/ Tư thế khớp khoá
• OKC: open Kinetic Chain: Chuỗi động mở: Kỹ thuật di động khớp thường dùng ở chuỗi động mở để khu trú lên khớp được thực hiện
• Flex: Flexion/ gấp
• Ext: Extension/duỗi
• Glide: trượt
• Roll: lăn
• Distraction: kéo tách
• Trong kỹ thuật, kỹ thuật viên thực hiện cố định đầu gần/phần xương cố định: Dấu chéo đỏ
• Kỹ thuật viên thực hiện vận động phụ trợ: Mũi tên xanh
• Người bệnh có thể thực hiện vận động sinh lý phối hợp: Mũi tên vàng

HUMEROULNAR JOINT MOBILIZATIONS/ DI ĐỘNG KHỚP CÁNH TAY- TRỤ

Humeroulnar Distraction/Kéo khớp cánh tay-trụ

Indications: increase elbow flexion and extension (grade III or IV). / Chỉ định: tăng gấp và duỗi khuỷu

Accessory Motion Technique/ Kỹ thuật vận động phụ trợ

• Patient Position: supine position with the upper arm resting on the table or folded towel and the dorsal forearm resting on the clinician’s shoulder. The elbow is in the humeroulnar open-packed position. To stretch into either flexion or extension, position the joint at the end of its available range.
• Clinician Position and Hand Placement: Sit on the ipsilateral side of the elbow being mobilized. Your stabilization hand holds the upper arm in contact with the table. Your mobilization hand grasps the anterior aspect of the proximal ulna. Be sure that your forearm is in line with the direction of force.
• Force Application: While stabilizing the upper arm, force is exerted through the ulnar contact in a caudal direction. This technique may be progressed by moving the elbow in the direction of greatest restriction.

Accessory With Physiologic Motion Technique/ Kỹ thuật vận động phụ trợ kèm vận động sinh lý

• Patient Position: supine position.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized. Your mobilization hand is as described above. Your stabilization hand is on the posterior aspect of the distal forearm.
• Force Application: The patient actively moves into the direction of greatest restriction while you apply a distraction force that is perpendicular to the olecranon against the stabilizing force at the distal forearm. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Humeroulnar Medial and Lateral Glide/ Trượt khớp Cánh tay- trụ vào trong và ra ngoài

Indications/chỉ định:

• Humeroulnar medial glides: increase elbow flexion/ Vào trong: tăng gấp khuỷu
• Humeroulnar lateral glides: increase elbow extension/ Ra ngoài: tăng duỗi khuỷu

Accessory Motion Technique

• Patient Position: supine or sitting with the elbow flexed to approximately 90 degrees with the arm at the side or pre-positioned with the elbow at the point of restriction.
• Clinician Position and Hand Placement: Stand on the ispilateral side of the elbow being mobilized. Your stabilization hand contacts the distal humerus. Using a lumbrical grip contact, the thenar eminence of your mobilization hand is placed posteriorly over the olecranon and proximal ulna. Be sure that your forearm is in line with the direction of force.
• Force Application: Using a lumbrical gripping motion, perform a medial or lateral glide to the olecranon and ulna.

Accessory With Physiologic Motion Technique/ Kỹ thuật vận động phụ trợ kèm vận động sinh lý

• Patient Position: supine or sitting with the elbow flexed to 90 degrees.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized. Place your stabilization hand as described above and your mobilization hand, or mobilization belt, at the proximal radius and ulna.
• Force Application: The patient actively moves into the direction of greatest restriction or performs repeated gripping. During active movement, apply force in a medial or lateral direction through hand contacts, or belt. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range

HUMERORADIAL JOINT MOBILIZATIONS

Humeroradial Distraction/ Kéo khớp cánh tay-quay

(from Therapeutic Exercise Foundations and Techniques, Kisner and Colby)

Indications

To increase mobility of the humeroradial joint; to manipulate a pushed elbow (proximal displacement of the radius)./ Tăng vận động khớp cánh tay-quay; kéo nắn di lệch ép đầu trên xương quay.

• Patient Position: Supine or sitting, with the arm resting on the treatment table.
• Clinician Position and Hand Placement: Position yourself on the ulnar side of the patient’s fore-arm so you are between the patient’s hip and upper extremity. Stabilize the patient’s humerus with your superior hand. Grasp around the distal radius with the fingers and thenar eminence of your inferior hand. Be sure you are not grasping around the distal ulna.
• Force Application: Pull the radius distally (long-axis traction causes joint traction).

Humeroradial Anterior and Posterior Glide

Indications/chỉ định:

• Humeroulnar anterior glides: increase elbow flexion and pronation/ Trượt cánh tay-trụ ra trước để tăng gập khuỷu và quay sấp
• Humeroulnar posterior glides: increase elbow extension and supination/ Trượt cánh tay-trụ ra sau để tăng duỗi khuỷu và quay ngửa

Accessory Motion Technique

• Patient Position: supine position with the arm on the table and the elbow in the open-packed position. You may pre-position the elbow at the point of restriction.
• Clinician Position and Hand Placement: Sit on the ipsilateral side of the elbow being mobilized. Grasp the distal aspect of the humerus with your stabilization hand. Using a three-jaw pinch contact, grasp the proximal radius with your mobilization hand. Be sure that your forearm is in line with the direction of force.
• Force Application: Apply force in an anterior or posterior direction on the stabilized humerus.

Accessory With Physiologic Motion Technique/ Kỹ thuật vận động phụ trợ kèm vận động sinh lý

• Patient Position: supine position.
• Clinician Position and Hand Placement: Sit on the ipsilateral side of the elbow being mobilized. Use the same hand placement as described above   
• Force Application: The patient actively moves into the direction of greatest restriction. During active movement, apply force in an anterior or posterior direction through the same hand contacts for flexion/pronation and extension/supination, respectively. Be prepared to move during the mobilization to ensure correct force application. The force is maintained throughout the entire range of motion and sustained at end range.

PROXIMAL RADIOULNAR JOINT MOBILIZATIONS

Proximal Radioulnar Anterior and Posterior Glide/Trượt khớp quay-trụ trên ra trước và ra sau

Indications:

• Anterior radioulnar glides/ radius on a fixed ulna: increase elbow flexion/pronation (Trượt quay trụ ra trước với xương trụ cố định: tăng gấp khuỷu, quay sấp)
• Anterior radioulnar glides/ ulna on a fixed radius: increase elbow flexion/supination (trượt quay trụ ra trước với xương quay cố định: tăng gấp khuỷu, quay ngửa)
• Posterior radioulnar glides/ radius on a fixed ulna: increase elbow extension/supination (trượt quay trụ ra sau với xương trụ cố định: tăng duỗi khuỷu, quay ngửa)
• Posterior radioulnar glides/ulna on a fixed radius: increase elbow extension/pronation (trượt quay trụ ra sau với xương quay cố định: tăng duỗi khuỷu, quay sấp)

Accessory Motion Technique

• Patient Position: supine position, with the upper arm resting on the table with the elbow in the open-packed position. You may pre-position with the arm at point of restriction.
• Clinician Position and Hand Placement: Sit on the ipsilateral side of the elbow being mobilized. Using a lumbrical grip contact, grasp the proximal ulna or radius with your stabilization hand. Using a three-jaw pinch contact, grasp the proximal radius or ulna with your mobilization hand. Be sure that your forearm is in line with the direction of force.
• Force Application: For anterior glides, anterior force is applied to the proximal radius as the ulna is stabilized or anterior force is applied to the proximal ulna as the radius is stabilized. For posterior glides, posterior force is applied to the proximal radius as the ulna is stabilized or posterior force is applied to the proximal ulna as the radius is stabilized.

Accessory With Physiologic Motion Technique/ Kỹ thuật vận động phụ trợ kèm vận động sinh lý

• Patient Position: a supine position with the arm at the side and the elbow flexed to 90 degrees.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized. Grasp the wrist with your stabilization hand. Your mobilization hand contact is the same as that described above.
• Force Application: Apply an anterior or posterior force to the radius as the patient actively moves into elbow flexion/ pronation or elbow extension/supination, respectively. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Proximal Radioulnar Inferior Glide/ Trượt quay trụ gần xuống dưới

Indications:

• increase elbow extension and wrist flexion. (Tăng duỗi khuỷu và gấp cổ tay)

Accessory Motion Technique

• Patient Position: supine position with the upper arm resting on table and the elbow in the open-packed position. You may preposition the  elbow at the point of restriction.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized. Your stabilization hand secures the distal humerus on the table. Using a “golfer’s grip” contact, the mobilization hand grasps the distal aspect of the radius being sure to remain proximal to the wrist. Be sure that your forearm is in line with the direction of force.
• Force Application: While maintaining all hand contacts, rotate your body away from the patient, imparting an inferiorly directed force of the radius on the stabilized humerus.

Accessory With Physiologic Motion Technique/ Kỹ thuật vận động phụ trợ kèm vận động sinh lý

• Patient Position: supine position as described above.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized as described above. Utilize all hand contacts as described above.
• Force Application: The patient actively moves into progressively greater ranges of elbow extension. During active movement, apply an inferiorly-directed force. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Proximal Radioulnar Superior Glide/ Trượt quay trụ gần lên trên

Indications:

increase elbow flexion and wrist extension. (Tăng gấp khuỷu và duỗi cổ tay)

Accessory Motion Technique

• Patient Position: supine position, with the upper arm resting on the table and the elbow in the open-packed position. You may pre-position the elbow at the point of restriction.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized facing cephalad. Your stabilization hand secures the distal humerus on the table. Using a “saw grip” contact, the patient’s wrist is positioned into extension for the purpose of providing support for compressive forces.
• Force Application: While stabilizing the distal humerus, apply a superiorly directed force through the “saw grip” hand contact.

Accessory With Physiologic Motion Technique/ Kỹ thuật vận động phụ trợ kèm vận động sinh lý

• Patient Position: supine position as described above.
• Clinician Position and Hand Placement: Stand on the ipsilateral side of the elbow being mobilized as described above. Use all hand contacts as described above.
• Force Application: The patient actively moves into progressively greater ranges of elbow flexion with some pronation and supination. During active movement, apply a superiorly-directed force. Be prepared to move during the mobilization to ensure correct force application. Force is maintained throughout the entire range of motion and sustained at end range.

Proximal Radioulnar Anterior High-Velocity Thrust (Mill Manipulation)/ Đẩy quay trụ gần ra trước tốc độ cao, kéo nắn Mill

Indications: increase mobility, or to reduce pain, may be effective for chronic cases of recalcitrant lateral epicondylalgia./ Tăng vận động, giảm đau, có thể hiệu quả trong đau lồi cầu ngoài kháng trị

• Patient Position: standing position with the elbow in 20 degrees of flexion, the forearm fully pronated, and the wrist flexed and ulnarly deviated.
• Clinician Position and Hand Placement: Stand behind the patient and on the ipsilateral side of the elbow being mobilized. Place the thumb of your mobilization hand at the posterior aspect of the radial head as your other hand flexes and ulnarly deviates the patient’s wrist and controls the position of the elbow.
• Force Application: Apply an anteriorly directed force through the radial head contact as you bring the elbow toward end-range extension with your other hand. At end range, apply a short amplitude, high velocity thrust to the radial head while maintaining wrist flexion and ulnar deviation.

Mill Manipulation

Some more videos:

Refferences:

• Christopher H. Wise, Dawn T. Gulick. Mobilization Notes: Rehabilitation Specialist’s Pocket Guide. F. A. Davis Company, 2009.
• Christopher H. Wise. Orthopaedic Manual Physical Therapy: FROM ART TO EVIDENCE. F. A. Davis Company. 2015.
• Carolyn Kisner, Lynn Allen Colby, John Borstad. Therapeutic exercise : foundations and techniques, Seventh edition. F.A. Davis Company. 2018