elbow and forearm complex 관절가동, 수기 저항운동, 자가 운동, 기능적 운동 - 정리중

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Elbow and Forearm Complex (Fig. 5.26)

N O T E : The elbow and forearm complex consists of four joints: humeroulnar, humeroradial, proximal radioulnar and

distal radioulnar. For full elbow flexion and extension, accessory motions of varus and valgus (with radial and ulnar glides) are necessary. The techniques for each of the joints as well as accessory motions are described in this section. For a review of the joint mechanics, see Chapter 18.

- 팔꿈치 전완 복합체는 상완척골관절, 상완요골관절, 요척관절로 이루어짐. 

- 팔꿈치를 완전 굴곡신전을 할때, varus and valgus의 부가적 움직임이 필요함. 

상완척골관절(Humeroulnar Articulation) 

The convex trochlea articulates with the concave olecranon fossa. 

Resting Position

Elbow is flexed 70, and forearm is supinated 10.

Treatment Plane

The treatment plane is in the olecranon fossa, angled approximately 45 from the long axis of the ulna (Fig. 5.27).

Stabilization

Fixate the humerus against the treatment table with a belt or use an assistant to hold it. The patient may roll onto his or her side and fixate the humerus with the contralateral hand if muscle relaxation can be maintained around the elbow joint being mobilized.

1. 상완척골 distraction (Humeroulnar Distraction and Progression) (Fig. 5.28A)

Indications

Testing; initial treatment (sustained grade II); pain control (grade I or II oscillation); to increase flexion or extension (grade III or IV).

Patient Position

Supine, with the elbow over the edge of the treatment table or supported with padding just proximal to the olecranon

process. Rest the patient’s wrist against your shoulder, allowing the elbow to be in resting position for the initial treatment. To stretch into either flexion or extension, position the joint at the end of its available range.

Hand Placement

When in the resting position or at end-range flexion, place the fingers of your medial hand over the proximal ulna on the volar surface; reinforce it with your other hand. When at end-range extension, stand and place the base of your proximal hand over the proximal portion of the ulna and support the distal forearm with your other hand. 

Mobilizing Force

Force against the proximal ulna at a 45 angle to the shaft of the bone.

2. 상완척골 관절 말단 활주(Humeroulnar Distal Glide) (Fig. 5.28B)

Indication

To increase flexion.

Patient Position and Hand Placement

Supine, with the elbow over the edge of the treatment table. Begin with the elbow in resting position. Progress by positioning it at the end range of flexion. Place the fingers of your medial hand over the proximal ulna on the velar surface; reinforce it with your other hand.

Mobilizing Force

First apply a distraction force to the joint at a 45 angle to the ulna, then while maintaining the distraction, direct the force in a distal direction along the long axis of the ulna using a scooping motion.

3. 상완척골 요골측 활주(Humeroulnar Radial Glide)

Indication

To increase varus. This is an accessory motion of the joint that accompanies elbow flexion and is therefore used to progress flexion.

Patient Position

Side-lying on the arm to be mobilized, with the shoulder laterally rotated and the humerus supported on the table.

Begin with the elbow in resting position; progress to end-range flexion.

Hand Placement

Place the base of your proximal hand just distal to the elbow; support the distal forearm with your other hand.

Mobilizing Force

Force against the ulna in a radial direction.

4. Humeroulnar Ulnar Glide

Indication

To increase valgus. This is an accessory motion of the joint that accompanies elbow extension and is therefore used to

progress extension.

Patient Position

Same as for radial glide except a block or wedge is placed under the proximal forearm for stabilization (using distal stabilization).

Initially, the elbow is placed in resting position and is progressed to end-range extension.

Mobilizing Force

Force against the distal humerus in a radial direction, causing the ulna to glide ulnarly.

상완요골관절(Humeroradial Articulation)

The convex capitulum articulates with the concave radial head (see Fig. 5.26).

Resting Position

Elbow is extended, and forearm is supinated to the end of the available range.

Treatment Plane

The treatment plane is in the concave radial head perpendicular to the long axis of the radius.

Stabilization

Fixate the humerus with one of your hands.

1. 상완요골 disctraction(Humeroradial Distraction) (Fig. 5.29)

Indications

To increase mobility of the humeroradial joint; to manipulate a pushed elbow (proximal displacement of the radius).

Patient Position

Supine or sitting, with the arm resting on the treatment table.

Therapist Position and Hand Placement

Position yourself on the ulnar side of the patient’s forearm 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 your are not grasping around the distal ulna.

Mobilizing Force

Pull the radius distally (long-axis traction causes joint traction).

2. Humeroradial Dorsal/Volar Glides (Fig. 5.30)

Indications

Dorsal glide head of the radius to increase elbow extension; volar glide to increase flexion.

Patient Position

Supine or sitting with the elbow extended and supinated to the end of the available range.

Hand Placement

Stabilize the humerus with your hand that is on the medial side of the patient’s arm.

Place the palmar surface of your lateral hand on the volar aspect and your fingers on the dorsal aspect of the radial head.

Mobilizing Force

Move the radial head dorsally with the palm of your hand or volarly with your fingers.

If a stronger force is needed for the volar glide, realign your body and push with the base of your hand against the dorsal surface in a volar direction.

3. Humeroradial Compression (Fig. 5.31)

Indication

To reduce a pulled elbow subluxation.

Patient Position

Sitting or supine.

Hand Placement

Approach the patient right hand to right hand, or left hand to left hand. Stabilize the elbow posteriorly with the other hand. If supine, the stabilizing hand is under the elbow supported on the treatment table. Place your thenar eminence against the patient’s thenar eminence (locking thumbs). 

Mobilizing Force

Simultaneously, extend the patient’s wrist, push against the thenar eminence, and compress the long axis of the radius

while supinating the forearm.

N O T E : To replace an acute subluxation, a quick motion (thrust) is used.

4. Proximal Radioulnar Joint Dorsal/Volar Glides (Fig. 5.32)

The convex rim of the radial head articulates with the concave radial notch on the ulna (see Fig. 5.26).

Resting Position

The elbow is flexed 70 and the forearm supinated 35. 

Treatment Plane

The treatment plane is in the radial notch of the ulna, parallel to the long axis of the ulna.

Stabilization

Proximal ulna is stabilized.

Indications

Dorsal glide to increase pronation; volar glide to increase supination.

Patient Position

Sitting or supine, with the elbow and forearm in resting position.

Progress by placing the forearm at the limit of the range of pronation prior to administering the dorsal glide or at the limit of the range of supination prior to administering the volar glide.

Hand Placement

Fixate the ulna with your medial hand around the medial aspect of the forearm.

Place your other hand around the head of the radius with the fingers on the volar surface and the palm on the dorsal surface.

Mobilizing Force

Force the radial head volarly by pushing with your palm or dorsally by pulling with your fingers.

If a stronger force is needed for the dorsal glide, move around to the other side of the patient, switch hands, and push from the volar surface with the base of your hand against the radial head.

5. Distal Radioulnar Joint, Dorsal/Volar Glides (Fig. 5.33)

The concave ulnar notch of the radius articulates with the convex head of the ulna. 

Resting Position

The resting position is with the forearm supinated 10.

Treatment Plane

The treatment plane is the articulating surface of the radius, parallel to the long axis of the radius.

Stabilization

Distal ulna.

Indications

Dorsal glide to increase supination; volar glide to increase pronation.

Patient Position

Sitting, with the forearm on the treatment table. Begin in the resting position and progress to end-range pronation or supination.

Hand Placement

Stabilize the distal ulna by placing the fingers of one hand on the dorsal surface and the thenar eminence and thumb

on the volar surface. Place your other hand in the same manner around the distal radius.

Mobilizing Force

Glide the distal radius dorsally or volarly parallel to the ulna.

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