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Elbow Introduction:
The elbow is comprised [url=http://www.sandvikfw.net/shopuk.php]hollister outlet sale[/url] of three bones; the humerus, ulna, and radius. This joint is a hinge joint with articulation from the humerus to the ulna and radius and from radius to ulna. The main ligaments of this joint are the lateral collateral ligament, medial collateral ligament, and annular ligament; the latter being the ligament that traps the radial head against the ulna and allows the pivot motion necessary for pronation and supination of the forearm. The elbow should have the following ranges of motion; flexion to 150 degrees, extension to 0 degrees, supination to 90 degrees, and pronation [url=http://www.ilyav.com/uggpascher.php]boots ugg pas cher[/url] to 90 degrees. The elbow's likely ailments could be sprains of the lateral and medial collateral ligaments or annular ligament, lateral epicondylitis, medial epicondylitis, median nerve entrapment, and ulnar nerve entrapment. Testing using my exam form would be as follows; after I have taken history, observed, and palpated I would perform the milk test looking for pain with the medial collateral ligament, I would perform radial compression test looking for annular ligament problems, I would apply a valgus and varus load on the arm to check both collateral ligaments, I would check wrist flexor and extensor tendons at the epicondyles, and would perform the rule of nine test to rule out any neurological entrapment. Again before beginning my rehab program I should look at the wrist and shoulder, as well as, other areas to see if mechanics are an underlying cause for this injury.
Elbow Phase 1:
Phase one of my rehabilitation program will include a focus on need modalities, proprioceptive loading and stability, passive range of motion, and cardio In phase one Russian stem may be used to maintain strength if ROM is not possible. I would use [url=http://www.rtnagel.com/louboutin.php]louboutin[/url] laser to promote healing if indicated for the particular injury. I could begin vibrational loading of the joint and put a magnetic field around it even with limited ROM. Passive range of motion exercises would begin to increase the range of motion to that of the uninjured side. Cardio would be performed on a mode that is indicative of the injury. I may also use Ice, compression, and NSAIDS to control any inflammation and pain associated with the injury in its earlier stages. Grasten, cross-friction massage, and Gra [url=http://www.1855sacramento.com/woolrich.php]woolrich[/url] Shua may be used if dealing with a chronic ligamentous injury or musculotendinous issues. Once the patient full passive range of motion and the pain and swelling are at tolerable levels to the individual then stage 2 will begin.
Elbow Phase 2:
Phase two [url=http://www.mquin.com/giuseppezanotti.php]giuseppe zanotti pas cher[/url] of my rehabilitation program includes; active range of motion exercise, isometric strength exercises progressing into thera-band® work, PIR/PNF as needed to maintain ROM, continued vibrational loading now with AROM, and continued cardiovascular work. The patient would be allowed to continue to the next phase once full AROM is reached, patient can tolerate weight bearing or loads on the joint, and break tests are grade 3 or higher in all ROM.
Elbow Phase 3:
Phase three introduces short-arc work, continues AROM exercises, continues thera-band® work, PIR/PNF, and cardiovascular work. To move to phase four the patient must show neuromuscular control and stability at the joint, perform all break tests at a 4 or higher and pass a functional screen chosen for each case.
Elbow Phase 4:
Phase 4 introduces isotonic resistive exercise working with isolation machines such as Cybex ® and progressing to body weight and free weight exercises. The patient will continue cardiovascular work and begin a mild to moderate ballistic program. The patient will perform all break tests to a score of 5, and have the ability to perform ballistic exercises before moving to the final phase.
Elbow Phase 5:
Phase 5 will consist of ballistic exercises, cardio, and progress into sport or occupational movements. The patient will be considered eligible for return to play status once they have full active range of motion, grade 5 on all break tests, can perform a ballistic exercise test chosen for the individual, have 90% or more strength compared to the non-injured side, and perform functional exams to clinician satisfaction.
Wrist and hand Introduction:
The wrist and hand are made up of the phalanges, metacarpals, and carpal bones which all articulate with the radius. It is important to understand that there are not only two rows of carpals, the proximal and distal, but there are also pillar systems that translates force from the hand and wrist, as well as, works to articulate for movements. These pillars are the lunate pillar and scaphoid pillar. Ranges of motion at the wrist include ulnar and radial deviation; flexion and extension. Digits 2-5 can flex, extend, abduct, and adduct while the 1st can also oppose. Injuries that my exam form will try to identify include; carpal tunnel syndrome, ulnar neuropathy, vascular disorders, tenosynovitis, instability, TFC tear, contracture, and fracture. My tests consist of flexion and extension tests, mobilization of the proximal and distal row of carpal bones, a grip test, and unlar/radial deviation test. As stated before I will use bottom-up or top-down rehabilitation to confront most issues that seem to be of chronic nature. All of my rehab principles will remain constant, as well as, that of the ideas and principles of taping, bracing, mattressing, and modalities.
Wrist and hand Phase 1:
Phase one of my rehabilitation program will include a focus on need modalities, proprioceptive loading and stability, passive range of motion, and cardio. It is important to note that my phase one starts post surgery if [url=http://www.mxitcms.com/abercrombie/]abercrombie[/url] applicable. [url=http://www.rtnagel.com/airjordan.php]nike air jordan pas cher[/url] In the case that the patient requires surgery I would have a pre-phase that would include cardio, modalities to control pain [url=http://www.mxitcms.com/tiffany/]tiffany outlet[/url] such as TENS, Interferential, ice, compression, NSAIDS; and modalities to maintain strength such as Russian stem etc. In phase one Russian stem may be used to maintain strength if ROM is not possible. I would use laser to promote healing if indicated for the particular injury. I could begin vibrational loading of the joint and put a magnetic field around it even with limited ROM. Passive range of motion exercises would begin to increase the range of motion to that of the uninjured side. Cardio would be performed on a mode that is indicative of the injury. I may also use Ice, compression, and NSAIDS to control any inflammation and pain associated with the injury in its earlier stages. Grasten, cross-friction massage, and Gra Shua may be used if dealing with a chronic ligamentous injury or musculotendinous issues. Once the patient [url=http://www.achbanker.com/homes.php]hollister[/url] full passive range of motion and the pain and swelling are at tolerable levels to the individual then stage 2 will begin.
Wrist and hand Phase 2:
Phase two of my [url=http://www.mxitcms.com/tiffany/]tiffany[/url] rehabilitation program includes; active range of motion exercise, isometric strength exercises progressing into thera-band® work, PIR/PNF as needed to maintain ROM, [url=http://www.mxitcms.com/abercrombie/]abercrombie milano[/url] continued vibrational loading now with AROM, and continued cardiovascular work. The patient would be allowed to continue to the next phase once full AROM is reached, patient can tolerate weight bearing or loads on the joint, and break tests are grade 3 or higher in all ROM.
Wrist and hand Phase 3:
Phase three introduces short-arc work, continues AROM exercises, continues thera-band® work, PIR/PNF, and cardiovascular work. To move to phase four the patient must show neuromuscular control and stability at the joint, perform all break tests at a 4 or higher and pass a functional screen chosen for each case.
Wrist and hand Phase 4:
Phase 4 introduces isotonic resistive exercise working with isolation machines such as Cybex ® and progressing to body weight and free weight exercises. The patient will continue cardiovascular work and begin a mild to moderate ballistic program. The patient will perform all break tests to a score of 5, and have the ability to perform ballistic exercises [url=http://www.ilyav.com/isabelmarant.php]isabel marant pas cher[/url] before moving to the final phase.
Wrist and hand Phase 5:
Phase 5 will consist of ballistic exercises, cardio, and progress into sport or occupational movements. The patient will be considered eligible for return to play status once they have full active range of motion, grade 5 on all break tests, can perform a ballistic exercise test chosen for the individual, have 90% or more strength compared to the non-injured side, and perform functional exams to clinician satisfaction.
Scott McKinney is the Vice President at Midwest Institute for Addiction. He holds a Master's degree in sports rehabilitation and a degree in exercise physiology. He is nationally certified in strength and conditioning and corrective exercise. Scott has directed fitness facilities, trained trainers, and taught as a professor in biomechanics.
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