Name: Proximal Radioulnar Joint Mobilizations
Uploaded: 2023-04-23T07:03:46.000Z
Duration: 16 min 23 s
Description: Learn the proper techniques for radioulnar joint mobilizations in this step-by-step instructional video designed for clinicians and movement professionals. These manual mobilization methods may help reduce elbow pain, improve forearm range of motion, and restore functional joint mechanics as part of a comprehensive upper extremity rehabilitation program.

English captions

https://stream.mux.com/Yv9ImlMXyAXkF9CiJpczghYIFnxAdmwIP9vviZotX900.m3u8

Learn the proper techniques for radioulnar joint mobilizations in this step-by-step instructional video designed for clinicians and movement professionals. These manual mobilization methods may help reduce elbow pain, improve forearm range of motion, and restore functional joint mechanics as part of a comprehensive upper extremity rehabilitation program.

Introduction to Manual Therapy Techniques

Patient Comfort and Positioning for Mobilization

Understanding the Anatomy of the Proximal Radial Ulnar Joint

Biomechanical Principles in Joint Mobilization

Executing Supination Techniques for Radial Head Mobilization

Alternative Techniques and Adjustments for Mobility

Reassessing Effectiveness of Mobilization Techniques

Emphasizing Practice and Continuous Learning in Manual Therapy

Proximal Radioulnar Joint Mobilizations

This is Brett of The brookbush Institute in this video. We're gonna go over a joint-based manual therapy technique. If you're watching this video, I'm assuming you're watching it for educational purposes and that you are a licensed professional with joint-based techniques within your scope. That means osteopaths chiropractors physical therapists. You're probably all in the clear Physical Therapy assistance athletic trainers massage therapists. You need to check with your governing body in your state or region to see whether this is within your scope of practice personal trainers. This is definitely not within your scope of practice. Of course all professions could use this video for purely educational purposes to help with learning biomechanics. Anatomy. And of course palpation this video we're going over proximal radial ulnar joint mobilizations. I'm gonna have my friend Melissa step out. She's gonna help me demonstrate this mobilization. Now anytime we do our mobilizations. We need to think about patient Comfort our comfort and mechanics. We need to think a little bit about palpation which is going to come a lot down to anatomy and then we're going to think a little bit about biomechanics so we can start to think about which direction we should be moving these joints. Now what you guys might know from watching me and other videos as I am fairly tall, so this table is very high. And the reason why this table is very high is for my own mechanics. I want to create a force that is going in this direction. So I want to try to get my arms straight so I can use my torso strength. To do this mobilization rather than trying to manhandle this poor proximal radial energy joint, which is actually just going to wear out my hands, especially if I do this patient after patient after patient. All right, the other thing you could do if you can't get your table high enough is go ahead and sit down right sit down and then you can just Bend forward at the waist from your chair right with a table a little lower to get your arms horizontal now, you'll notice that Melissa's supine with her hands on her belly. That's actually purposeful. These mobilizations are easiest to do at least to start with at about 80 degrees of elbow flexion. All right, so you'll notice here. She has about 80 degrees available flexion. We're going to be pushing in this direction and this direction to do one more step to get this a little bit better for your own mechanics what you can do. Let's take like a pillow. And or a dowel or a thick rolled up towel put it underneath their forearm Not underneath their humerus, but underneath their forearm so that now her humorous has a little bit of an angle upwards towards me which means now I can really get some good direction because my forearm is exactly the same direction. My arms are exactly the same direction as a humerus, which is what we want to do. Now we get into palpation which is where this starts to get a little tricky because this is a tiny little joint, right the the proximal radial ulnar joint is not like your hip. It's a tiny little joint and if you press on the wrong things, you're not going to get anything to happen. It is a fairly. The the radial head is a is a good bump though. It is a landmark. It is something that you can feel once you've had a little bit of practice. Let me give you guys a couple pointers. You could start with the electron process here. Right, everybody knows where they're electron process is the end of their elbow and then you could go Superior and medial a little bit right and right about in, you know, a third of the way up the mass of her forearm. I can feel this bump. I could go from olecranon fossa and go straight medial and probably run into it I could Pinch her brachioradialis guys this for muscle if I pinch or brachioradialis chances are what my thumb is on right here. If I like grab right at the top of her elbow chances are what my thumb on is a radial head. Once you think you found it though, I want you to do one test for me, right and one test for yourselves. Go ahead and find that radial head and then Double check yourself by pronating and supinating the wrist. You should feel that radial head move under your finger. Right? So while I'm palpating like this with my thumb her radial head is doing this under my finger. Which is going to feel like a little bit of Glide under there. now last and maybe trickiest get into a little bit of biomechanics, right? And I'm gonna go over this real quick with you guys. And then I'm gonna go over it again as I do these techniques, but you essentially have a radial head that is concave. at its end right on a convex capitulum, which is part of your humerus. But then in this direction right in this direction, it's round. on a concave Alma Now if you remember your convex on concave rules, that means if we're talking about flexion. and extension If that's what we're trying to work on we have a concave surface on a convex humorous which means Glide goes in the same direction. We're trying to get. if we're talking about supination pronation at the radio ulnar joint then Glide is Opposite the direction we're trying to get so if I want to go. this way Right, that would be rolling this direction, which means I should push in this direction to get more of it. If I want to go this way roll is in this direction, which means I should push it this way. To get more of it. Now. The unfortunate thing about the elbow is when we have elbow in forearm just function what we usually lose is extension and supination, which is Opposite directions, right? If we wanted more extension, we push this way if we want a more supination, we'd push this way. Sometimes biomechanics does not quite work out the way we'd hope to my biggest suggestion for you guys is obviously to test do your intervention and retest. You know, you could try both directions and keep the one that is working best for you. Now. Let's get into actually doing this technique. If I let's say for now, we're going to work on some supination, which means I want to push in this direction. I need to try to get some purchase underneath her radial head and this is where things take practice. So you found the radial head. Now. How do you push on it? It seems like it would be hard to get here because this actually is her ulna her radius is up here. And what you have to figure out how to do is pick up a little skin from over the top of a radius and get as underneath it as you can which means kind of pressing down in this direction. While trying to push up this way on the radial head. It's it's something that takes a little practice. again, guys the big the big thing you need to do here is pick up a little skin. You see how see how I did that I started on top of the radius and I slid a little skin over with me because if you don't and you just do this you start pushing and it just stretches all the skin this way and you'll get a lot of wincing and guarding and it has nothing to do with your mobilization. It has everything to do with skin stretch. So I'm going to pick up a little extra skin. I'm gonna put my thumb down. And see if I can get some purchase that way. Now if you really want to make your client comfortable, what I would do is I would actually put my writ the radial head right in my joint space here so that I'm comfortably wrapping the radial head. Right? Like I'm like wrapping my thumb around it. And then what I like to do for mobilizations is use my other hand. So now I got dummy thumb on this side. So I'm not going to use this hand because it's gonna be hard on my thumb. I'm gonna use pressure with this hand. And again, I'd find the end of our 13 pneumatic range and find the first resistance barrier. All right. So right when I first start feeling a little bit movement a little bit of movement of a radial head. in Glide find it till it won't move anymore. All right back off. And then of course, we have our grade three or grade four mobilizations to increase movement here grade four would be finding 50% between first resistance barrier and end and then doing those little tiny oscillations really small amplitude stuff or I could do my grade three's back off a little bit and that would be 50% but from the initial point of resistance. So I'm going to go initial point of resistance to 50% And those are a little bit bigger amplitude. You can see Melissa's actually moving a little bit more when I do those 50% now, what would it look like if I wanted to go this way? I literally just turn around and face the opposite direction. It is harder to get purchased this way than this way. And it tends to be a little tender. Right. We actually have a brachioradialis trigger point that is right over the top of our our radial head. So you may even have to do some soft tissue work first just to get that trigger point to calm down so that you can press on the radial head without any issue. you might even experiment with No Doubt right just to try to find a comfortable position where you can get that radial head wrap your thumb around it and then of course. Use this arm to apply pressure. Find the initial resistance barrier. end of arthracudabatic range And then decide whether you're going to do your grade three user grade fours, and do your oscillations. If you're following the Maitland Protocols, of course, you're doing one to two oscillations per second. I know some of you guys follow other protocols whether it's counting-born or I've even seen different versions of the CRX and Maitland mobilizations. I know different organizations like niant and IPA all have their own mobilization protocols. My biggest suggestion guys is not Which mobile which protocol works the best it's just follow through with it. I had to see what I see for. Most people is they start their protocols and go. Oh, that was good. And before they even get any change in Arthur kinematic motion or follow through with the entire protocol, they kind of stop after 10 or 15 seconds. And then you really don't know if it was the protocol that didn't work for you or whether you just didn't follow through with it. Of course after I did one of these techniques I would retest whether it was elbow flexion extension supination pronation or potentially some special tests that I did and the concordant sign. Alright guys, so stay tuned for the close-up recap and now for our close-up recap first starting with how to palpate the radial head. I had mentioned that if you go up from the electronom process a little bit and then go medial you can find kind of the The Joint line and then it bumps up into the Radiohead. You can find the electron fossa, which is in here that little divot where the electron process fits into and you can go medial from there. Or you can grab the brachioradialis at the crease of the elbow and what your thumb is on is actually the radial head. So once you've found the radial head, you can check your palpation by supinating and pronating the arm. And you should feel that guy just kind of roll underneath your thumb like so. So I'm now confident. I'm on the radial head now. It's just a matter of trying to produce the direction of motion that I want to produce and I actually kind of want to go posterior to anterior here and that's actually kind of causal cranial in this in this case. We're kind of going towards the head. So I'm gonna start on the radial head and then I need to grab a little bit of skin and try to fall off it push into the elbow a little bit so I can get underneath I then like to kind of wrap the radial head in the first IP here and so the IP of my thumb and then I'm going to put my other hand over the top of it. And then I can do my mobilizations. Right and what I'm doing when I do those mobilizations guys again is is I'm gonna apply a little pressure find the first resistance barrier where I first feel little Glide or Motion in the direction, I'm going where I first feel it the first resistance barrier. That's the beginning and then where I can press harder but don't get any more motion. That's the end. I'm gonna back off to 50% of that. That's kind of the golden zone of oscillations. I want to kind of stay around there. So I'm either gonna go from first resistance barrier to 50% or stay really close to 50% and do really small oscillations. I'm going to do one to two oscillations per second. And I just don't have my hand over here guys so you can see it but my oscillations would actually look like this. And I'm going to keep going until I feel a change in tissue stiffness. Usually that takes about 20 or 30 seconds and then of course, I'd retest. Right, so whether it was elbow flexion, I was trying to go for or an increase in supination or a change in concordant sign I would want to retest. And see if this was the right way to mobilize, of course as I mentioned with this joint. The biomechanics don't work out as well as we'd like the the convex on Ken cave rules kind of. Fall apart a little bit, so I wouldn't be against trying the other direction if you didn't get the result you were looking for. And of course for that, I'm just going to come to the other side of the radio owner joint. So as I mentioned before if I grab the brachio radialis, my thumb is kind of right over the radial head. I'm gonna find a way to get some purchase over the top of the radial head and I mentioned that there is a trigger point here in the brachioradialis. You might have to do some static Release Technique on that muscle get that trigger point to calm down and then come back to this joint right once you you get a little purchase there. You're going to do your oscillations the same way. Where's your first resistance barrier? Find that first resistance barrier find the end where you get no matter how hard you're push you're not going to get more emotion back off to 50% And then of course I use dummy thumb. Other hand and then I'm actually rocking my torso back and forth to get my oscillations. If I'm going in this anterior to posterior Direction. I'm probably looking for either more pronation or more elbow extension. I would then retest. So there you have it assess a dress reassess. Make sure that every time you choose a joint-based manual therapy technique. It is based on an assessment and that you return to that assessment after you finish the intervention to see if it was effective for the individual the patient or client that you have in front of you ensure that you continue to learn your Anatomy because you're Anatomy is going to help you with your hand placement with understanding what a joint can do with understanding what you may gain from this particular technique and of course practice, you have to practice these techniques. Hopefully not for the first time on a patient or client who just walked in the door if you can. A more senior instructor or a mentor to give you some really good Hands-On instruction use your peers for some good feedback. And of course always look for live education. To help with your manual therapy techniques. I know these videos make education very convenient, but there is no substitute for learning manual therapy and a live setting. I look forward to talking to you guys again soon.

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Joint mobilizations for the ankle and tibiofibular joint. Types of mobilizations, self-administered mobilizations, and interventions for upper body dysfunction (UBD), wrist, and elbow dysfunction. Optimal intervention for pain, grip strength, elbow and shoulder ROM, and lateral epicondylalgia (epicondylitis). The risk of adverse events, validity, efficacy, screening, and reliability of elbow and wrist/forearm mobs.

Joint Mobilization: Elbow and Proximal Radioulnar Joint

The patient should be supine, with the hand of the affected side resting on their stomach, and the practitioner standing on the patient's affected side.

Placing a dowel, foam roll, or pillow under the patient's forearm can be helpful for improving mechanics.

The table should be at a high level to allow the practitioner to apply force horizontally, without having to excessively bend or crouch. The dowel will change the position of the forearm enough to allow for a more natural angle to apply force for the practitioner (oblique angle that is both forward and down).

Palpate the radial head by falling of the olecranon process cranially and medially, or by gripping and palpating through the brachioradialis. Once you feel a hard bony protuberance, test your palpation by passively pronating and supinating the forearm with one hand, while palpating what you think is the radial head with the other hand. You should feel the radial head "spin" under your fingers.

Once, you have determined the location of the radial head, "gather some skin" from on top of the radial head and pull it posteriorly as you press into the extensor mass just posterior to the radial head.

If you do not "gather some skin", you can end up locally stretching the skin as you apply pressure, which may be painful for the patient.

Use one thumb to gain purchase on the back of the radial head. Wrap the radial head with the thumb to avoid "poking", by putting the radial head in the interphalangeal joint of the thumb.

Place the other palm over your thumb, straighten the arms, and ensure optimal body mechanics.

Generate force by leaning forward at the torso, using bodyweight, not grip or arm strength.

A study by Ohshiro et al. demonstrated that glide during anterior/medial radius mobilizations was greatest during 60° - 90° of elbow flexion, and glide during posterior/lateral radius mobilizations was similar at all elbow flexion angles (28). These findings suggest that for the mobilization technique above 60° - 90° of elbow flexion is likely best.

The technique for this is identical to the technique above. However, you are going to stand next to the patient's head and force will be applied in the opposite direction.

Once, you have determined the location of the medial head, "gather some skin" from on top of the radial head and pull it anteriorly as you press into the brachioradialis just anterior to the radial head.

Once you are comfortable with palpating joint motion, start with small test oscillations to identify articular motions and any exquisite tenderness.

When satisfied with the feel of the technique, identify the amount of pressure needed to feel the first resistance barrier just prior to articular motion, and then pressing harder, identify the amount of pressure at which any further pressure fails to increase articular motion.

Note: The end of articular motion is the end of glide. Locate the point at which the joint will not glide any further without additional extension.

Identify the mid-point between the first resistance barrier and articular end-range; approximately 50% resistance.

Grade III - Larger oscillations between the first resistance barrier and approximately 50% resistance.

Note, these oscillations are large compared to grade IV oscillations, but are still very small motions.

Grade IV - Small oscillations at 50% resistance or more.

Continue oscillating until you feel a change in tissue resistance/joint stiffness.

Note: Feeling resistance barriers and relative motion is challenging with this technique due to the hand position and relatively small amount of arthrokinematic motion allowed at the joint. Don't let perfect be the enemy of the good. Mobilizing the joint and decreasing stiffness is more important than a perfectly executed grade III, or being able to differentiate between a grade III and a grade IV.

Proximal Radioulnar Joint Mobilizations

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Ankle (Talus) Manual Joint Mobilization - Anterior to Posterior

Cervical Spine Posterior to Anterior Mobilization

Lumbar Spine Posterior to Anterior Mobilization

Thoracic Spine Mobilization: Posterior-to-Anterior and Transverse

Sacroiliac Joint Mobilization: Posterior to Anterior

Distal Tibiofibular Joint Anterior to Posterior Manual Mobilization

Proximal Tibiofibular Joint Posterior to Anterior Manual Mobilization

Hip Joint Lateral Manual Mobilization

Knee Joint Anterior to Posterior (Femur on Tibia) Manual Mobilization

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