Jill Thomas from the Upper Limb Unit at Wrightington Hospital presents on rehabilitation for elbow instability - presented to the North West Upper Limb Group (www.nwulg.org)
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
Elbow instability Jill Thomas NWULG may 2018
1. Jill Thomas
Elbow and Shoulder Clinical Specialist Physiotherapist
Wrightington Hospital
Elbow Instability
Rehabilitation
North West Upper Limb Group, May 2018
4. www.wrightington.com
Considerations for Rehabilitation
Acute
! Compensatory patterns
! Established apprehension
! Mechanical signs
Risk of Stiffness
Protection in a sling
Time off work for rehab’
Pain and swelling
Associated effects of trauma
Risk of H.O
Protective period
5. www.wrightington.com
Considerations for Rehabilitation
Acute
! Compensatory patterns
! Established apprehension
! Mechanical signs
Risk of Stiffness
Protection in a sling
Time off work for rehab’
Pain and swelling
Associated effects of trauma
Risk of H.O
Protective period
Chronic
Absence of acute post-op pain
No need for sling/protective period
Continue with normal bilateral function
" Mechanical signs
" Established stiffness
" Established compensatory patterns
é Proprioceptive deficit
Apprehension
13. www.wrightington.com
The Good News
Cutaneous receptors Collins et al, 2005, J Neurology; Proske and Gandevia, 2009, J. Physiology
Muscle spindles Proske and Gandevia, 2009, J. Physiology; Tsay et al, 2014,J of Physiology
Vision and imagery Fuentes and Bastian, 2010, J Neurophysiology; Tsay et al, 2014,J of
Physiology; Wang et al. 2013, J Rehabil Med
Functional multi-joint movements Tillery et al,1996, J. Neurophysiology
Bilateral activities Tsay et al, 2014,J of Physiology
Kinetic chain recruitment Sciascia and Cromwell, 2012, Rehabil Research and
Practice
14. www.wrightington.com
The Elbow & the Upper Limb
The Hand
• UL Compensates to achieve hand placement
Bland et al, 2008; Karduna and Sainburg, 2012
• Elbow restriction affects hand functionBland et al, 2008 J Hand
Therapy
• Visual pro/supination improves hand functionBland et al, 2008 J Hand Therapy
• Hand leads UL function van Andel et al., 2008 Gait & Posture
15. www.wrightington.com
The Elbow & the Upper Limb
Function
• Functionally pro and supination occur in
conjunction with humeral rotation
van Andel et al., 2008 Gait & Posture
25. www.wrightington.com
Progression
✓ Adequate soft tissue and fracture healing
✓ No compensatory patterns
✓ Good extension <20-25 degrees from 0
✓ Good awareness of elbow movement
✓ ‘Functional’ flexion
✓ No significant mechanical signs
32. www.wrightington.com
Get Up and Go
✓ Reduce biceps/
brachialis activity
✓ Promotes extension
✓ Visual feedback
✓ Kinetic chain
✓ Upper limb function
✓ Multi-joint
proprioception
✓ Strengthening
✓ Control
✓ Joint compression
✓ Hand function
✓ Valgus/Varus control
33. www.wrightington.com
Slide Outs ✓ Promotes extension
✓ Kinetic chain
✓ Upper limb function
✓ Multi-joint
proprioception
✓ Weight-bearing, joint
compression
✓ Control
✓ Hand function
✓ Varus/PLRI control
34. www.wrightington.com
Kneeling slide out
✓ Promotes extension
✓ Joint compression proprioception
✓ Multi-joint functional movement
✓ Kinetic chain
✓ Control
✓ Strengthening
✓ Varus/PLRI control
39. www.wrightington.com
Anconeus Loading
✓ Kinetic chain
✓ Upper limb function
✓ Multi-joint proprioception
✓ Control
✓ Hand function
✓ Anconeus activity
✓ Common extensor activity
✓ Varus control