Joint Mobilization: Elbow and Proximal Radioulnar Joint

Introduction

This course describes joint mobilizations for the elbow joint (a.k.a. humeroulnar joint) and proximal radioulnar joint (a.k.a. RU joint or ulnoradial joint). Several terms and definitions have been used to describe the "mobilizations" (e.g. mobilisations) that are taught in this course. The Brookbush Institute uses a conventional definition of "mobilization" that includes low amplitude, low-velocity, oscillatory techniques intended to reduce the stiffness of joints exhibiting a decrease in passive accessory range of motion (a.k.a. arthrokinematic motion and specifically glide or slide). Note that "manipulation" is reserved for high-velocity techniques taught in a separate set of courses.

This course includes mobilization techniques that intend to improve excessive stiffness of the elbow and proximal RU joints, improve flexion, extension, pronation, and supination range of motion, and reduce forearm, elbow, and upper extremity dysfunction. For example, wrist and forearm dysfunction has been correlated with scapular dyskinesis (altered shoulder blade motion), and a reduction in upper extremity function (e.g. negative impact on activities of daily living and sport). These techniques may also be used in an integrated approach for cervicothoracic dysfunction and upper body dysfunction (UBD) including radiculopathy, double crush syndrome, upper thoracic pain, acromioclavicular (AC) joint pain, frozen shoulder (post-acute phase), lateral epicondylitis (tennis elbow), and postural dysfunctions including rounded shoulder posture and excessive forearm pronation. Several studies even demonstrate that treating elbow dysfunction (e.g. lateral epicondylalgia) with conventional treatment (ultrasound, stretching, and strengthening exercises) and the addition of these mobilizations, resulted in significantly larger improvements in grip strength, function, and/or pain when compared to conventional therapy alone.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Elbow Joint Mobilization
• Radioulnar Joint Mobilization

Related Courses

Additional Joint Mobilization Courses

• Joint Mobilizations: Ankle and Tibiofibular Joints
• Joint Mobilizations: Knee and Hip Joints
• Joint Mobilizations: Lumbar Spine and Sacroiliac Joints
• Joint Mobilizations: Cervical and Thoracic Spine
• Joint Mobilizations: Shoulder, Sternoclavicular, and Acromioclavicular Joints
• Joint Mobilizations: Elbow and Proximal Radioulnar Joints

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Occupational Therapists - Intermediate
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

1. Ganesh, B. R., Gurav, G., Gonsalves, J., & Patel, J. (2016). EVALUATION OF THE EFFECT OF MOBILIZATION WITH MOVEMENT ON PAIN, KINESIOPHOBIA AND ACTIVITIES OF DAILY LIVING IN LATERAL EPICONDYLITIS-AN EXPERIMENTAL STUDY. International Journal of Therapies and Rehabilitation Research, 5(5), 23.
2. Kim, L. J., Choi, H., & Moon, D. (2012). Improvement of pain and functional activities in patients with lateral epicondylitis of the elbow by mobilization with movement: a randomized, placebo-controlled pilot study. Journal of Physical Therapy Science, 24(9), 787-790.
3. Martínez-Cervera, F. V., Olteanu, T. E., Gil-Martínez, A., Díaz-Pulido, B., & Ferrer-Peña, R. (2017). Influence of expectations plus mobilization with movement in patient with lateral epicondylalgia: a pilot randomized controlled trial. Journal of exercise rehabilitation, 13(1), 101.
4. Vicenzino, B., Paungmali, A., Buratowski, S., & Wright, A. (2001). Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia. Manual therapy, 6(4), 205-212.
5. Abbott, J. H., Patla, C. E., & Jensen, R. H. (2001). The initial effects of an elbow mobilization with movement technique on grip strength in subjects with lateral epicondylalgia. Manual therapy, 6(3), 163-169.
6. Abbott, J. H. (2001). Mobilization with movement applied to the elbow affects shoulder range of movement in subjects with lateral epicondylalgia. Manual Therapy, 6(3), 170-177.
7. Vicenzino, B., Smith, D., Cleland, J., & Bisset, L. (2009). Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia. Manual therapy, 14(5), 550-554.
   • Mobilizations and Injection for LE
8. Ibc, K. D. B., Smidt, N., Tulder, M., & Bouter, L. (2001). COST‐EFFECTIVENESS OF INTERVENTIONS FOR LATERAL EPICONDYLITIS: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL IN PRIMARY CARE. Value in Health, 4(2), 62-63.
9. Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R., & Vicenzino, B. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Bmj, 333(7575), 939.
10. Coombes, B. K., Bisset, L., Brooks, P., Khan, A., & Vicenzino, B. (2013). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. Jama, 309(5), 461-469.
    • Mobilizations and Conventional Therapy
11. Burton, A. K. (1988). A comparative trial of forearm strap and topical anti-inflammatory as adjuncts to manipulative therapy in tennis elbow. Manual medicine, 3(4), 141-143.
12. Afzal, M. W., Ahmad, A., Waqas, M. S., & Ahmad, U. (2016). Effectiveness of therapeutic ultrasound with and without Mulligan mobilzation in lateral epicondylitis. Annals of King Edward Medical University, 22(1), 47-47.
13. Kochar, M., & Dogra, A. (2002). Effectiveness of a specific physiotherapy regimen on patients with tennis elbow: clinical study. Physiotherapy, 88(6), 333-341.
14. Belomazheva-Dimitrova, S. (2013). Study of the Effect of Mobilization and Muscle-inhibitory Techniques on an Elbow Arthrokinematics after Conservative Treatment of Intra-articular Fractures of the Elbow Joint. Scientific Report Physical Education and Sport, 19, 98-103.
15. Amro, A., Diener, I., Isra’M, H., Shalabi, A. I., & Dua’I, I. (2010). The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis. Hong Kong Physiotherapy Journal, 28(1), 19-23.
    • Wrist Manipulation compared to Elbow Treatment
16. Manchanda, G., & Grover, D. (2008). Effectiveness of movement with mobilization compared with manipulation of wrist in case of lateral epicondylitis. Indian J Physiother Occup Ther, 2(1), 16-25.
17. Patel, N. (2013). Effectiveness of mobilization with movement of elbow compared with manipulation of wrist in patients of lateral epicondylitis. Int J Physiother Res, 1(4), 177-82.
    • Comparing Mobilization
18. Dasm, P. G. (2012). Comparative analysis of Cyriax approach versus mobilization with movement approach in the treatment of patients with lateral epicondylitis. Physiotherapy and Occupational Therapy, 6(1).
19. Hariharasudhan, R., & Balamurugan, J. (2015). Effectiveness of muscle energy technique and Mulligan's movement with mobilization in the management of lateral epicondylalgia. Archives of Medicine and Health Sciences, 3(2), 198.
    • Analgesia
20. Paungmali, A., O'Leary, S., Souvlis, T., & Vicenzino, B. (2003). Hypoalgesic and sympathoexcitatory effects of mobilization with movement for lateral epicondylalgia. Physical therapy, 83(4), 374-383.
21. Paungmali, A., O’Leary, S., Souvlis, T., & Vicenzino, B. (2004). Naloxone fails to antagonize initial hypoalgesic effect of a manual therapy treatment for lateral epicondylalgia. Journal of manipulative and physiological therapeutics, 27(3), 180-185.
22. Paungmali, A., Vicenzino, B., & Smith, M. (2003). Hypoalgesia induced by elbow manipulation in lateral epicondylalgia does not exhibit tolerance. The Journal of Pain, 4(8), 448-454.
23. Slater, H., Arendt-Nielsen, L., Wright, A., & Graven-Nielsen, T. (2006). Effects of a manual therapy technique in experimental lateral epicondylalgia. Manual therapy, 11(2), 107-117.
    • Radioulnar Joint Mobilization
24. Lal, R. K., Bhat, K., & Sanjay, P. Efficacy of Passive Mobilization and Home Exercises in Post Immobilization Period of Distal Radius Fracture.
25. Coyle, J. A., & Robertson, V. J. (1998). Comparison of two passive mobilizing techniques following Colles' fracture: a multi-element design. Manual therapy, 3(1), 34-41.
26. Drechsler, W. I., Knarr, J. F., & Snyder-Mackler, L. (1997). A comparison of two treatment regimens for lateral epicondylitis: a randomized trial of clinical interventions. Journal of Sport Rehabilitation, 6(3), 226-234.
27. Kay, S., Haensel, N., & Stiller, K. (2000). The effect of passive mobilisation following fractures involving the distal radius: a randomised study. Australian journal of physiotherapy, 46(2), 93-102.
28. Ohshiro, S., Hidaka, E., Miyamoto, S., Aoki, M., Yamashita, T., & Tatsumi, H. (2009). Influence of elbow flexion angle on mobilization of the proximal radio-ulnar joint: A motion analysis using cadaver specimens. Manual therapy, 14(3), 278-282.