Name: Radial Head Manipulation
Uploaded: 2023-04-26T00:59:12.000Z
Duration: 9 min 34 s
Description: "Learn the proper technique for radial head manipulation in this instructional video designed for clinicians and movement professionals. As part of an integrated program, this manual joint mobilization technique may aid in pain reduction, improving range of motion, and the management of elbow and forearm dysfunction"

English captions

https://stream.mux.com/Qs9b102DK1voVQb01Er02TH6lf02uyy4pECYr7RrHQDAq00c.m3u8

"Learn the proper technique for radial head manipulation in this instructional video designed for clinicians and movement professionals. As part of an integrated program, this manual joint mobilization technique may aid in pain reduction, improving range of motion, and the management of elbow and forearm dysfunction"

Introduction to Manipulations and Scope of Practice

Techniques for Radial Head Manipulations

First Manipulation Technique and Reassessing Effectiveness

Second Manipulation Technique and Its Advantages

Key Takeaways on Manipulation Practices

Radial Head Manipulation

This is Brent of the Brookbush Institute in this video we're going to go over manipulations or high-velocity thrust techniques. I assume that if you're watching this video you're watching it for educational purposes and that you are a licensed professional with high velocity thrust or manipulation techniques in your scope of practice. If you are not sure check with your state board. Most physical therapists, chiropractors and osteopaths you're in the clear. I believe that ATC's you can't do manipulations in the United States, although other countries again check your scope. Of course massage therapists and personal trainers these are generally not within your scope, of course you could continue to watch these videos just for educational purposes, learn a little Anatomy, learn a little biomechanics. If you're going to do these techniques please make sure that you have a good rationale for putting your hands on a patient, this should be based on assessment, and if you're going to assess I'm hoping that you'll assess, use these interventions and reassess to ensure that you're getting the result that you're looking for and have good reason to continue using this technique. In this video we're going to go over radial head manipulations. I'm going to have my friend Yvette come out, she's going to help me demonstrate. Now remember if we're doing manipulations we're doing them to increase joint mobility based on not just subjective symptoms, but some objective tests as well. So I might do some passive accessory motion but also maybe some elbow flexion extension, maybe some pronation supination goniometery so I have something to use for reassessment after this technique. Now I have seen a couple of different techniques for the radial head, and supposedly one of them's for the proximal radioulnar joint, the other ones for radial humeral joint, and the only consensus I have to tell you is they probably both do both. I think sometimes when we get a little too detailed about our biomechanics we actually lose a little bit of our accuracy. So what I'm going to tell you is try both of these techniques, they both probably work fairly well, and a lot of it probably depends on what you get comfortable with. You might find that you get a lock position in one and not in the other. You might find that it depends on which patient you have, whether you can find locked position. So they both have a few things in common, number one, all of them involve this underhand grip of the distal humerus with palpation of the radial head. Now if you've never palpated the radial head what you could do is just reach on either side of the brachial radialis real close to the elbow, and start pronating and supinating the wrist, and you'll actually get to a point where you feel the radius go out until like a disc shape, and you can feel it spin underneath your fingers. So once, once you have that thing spinning under your fingers right, now I want you to stick your thumb right there, alright so your thumb is going to be applying this type of force that is the big manipulative motion. Now the question is how do we get lock out? Lock out comes in one of two forms, you either see people do a lot of supination, or you see people do pronation. I really think if you get to the end of either one you end up locking out this joint. Alright so either here or here. So now we got that, we'll start with this one. All right this one I find tends to be a little bit more general elbow because you get so much of this snapping going on without as much radial head motion. But once you get here now the force is going to be kind of into extension while I press posterior to anterior with my thumb, and it's going to be a little varus force too, which is the equivalent of me trying to take her arm and break it this way. I'm not going break your arm I promise. Okay so just a little bit of force this way, we're just kind of like as we're pushing into extension we're kind of pushing this way with extension. So I said it's extension with a little bit of this way, and I'm going to go ahead and finish out with supination while keeping this thumb really rigid. So the first thing I'm going to do, is as I do this combination of techniques I got to find my lock, there we go we're getting there we're building off all that tension. All right you can tell Yvette love's manipulations, she's been so kind to volunteer for these videos, and then once I get there, that's it, it's just a little whip. All right sorry I did it to you twice. All right so there you have it. Now we didn't get a cavitation there, but don't forget that with manipulations the success comes from doing the manipulation not from hearing a sound. I would reassess and see what this did to her concordance sign, what it did to her continuous interval measures like goniometry and see if I got a successful manipulation before I just sit there and keep yanking on her arm. Could I have missed, absolutely. I'm far from perfect when it comes to these techniques, but you don't want to just keep grinding away at a technique assuming that you missed because you might have been very successful and now you're just flaring things up. Now the other technique all I'm going to do is use a little bit of wrist flexion, you don't have to do this, but just a little bit of wrist flexion this is kind of like a modification of what's called the Mills manipulation. It's still the same position here, I'm still kind of bringing into that same bit of varus force, so the bendiness, and this is actually the technique I prefer because I tend and find it a lot easier to get a lock position here, and I find that I don't have to get all the way into elbow extension, which on a humeral joint or a humeroulnar joint extension can be a little painful at the end range. Instead I can get locked out short of full extension and then once I'm there and I get all of it, and you you can see in Yvette's face we're there. All right and then it's just a whip, and we actually got a nice little cavitation on that one. All right good stuff. So the one I prefer again is just a modification that Mills technique, just a little bit of wrist flexion so you can just grab the hand like this, we're going to pronate all the way, and then I'm pressing up with this hand as I apply a posterior to anterior force this way, and then it's just a little whip right, and I'm not just so you are clear, I'm not pulling her all the way into elbow extension, we were actually short of elbow extension, and I think if you practice this a little bit slowly first, you will feel that if you twist all the way this way and push up a little this way, you actually hit lock before you hit full elbow extension if you were to let this relax. All right if you have any questions on this technique, it is tricky. It takes some practice, the lock position is deceptively hard to find on this particular technique, but practice with with some friends and some colleagues, and then maybe find some patients who aren't elbow patients to start. So what I mean by that is you know this could have a positive effect on an upper-extremity issue that's mostly shoulder, but you know you manipulated their elbow because you think it might help, this is a little trick I am teaching you, as in don't start practising on elbow patients, practice on patients that elbow manipulation might help some other symptoms somewhere else. If you have any other questions leave them in the comments box below. a couple of points to recap, knowing your anatomy and knowing your biomechanics will certainly help you choose the right technique for the right patient. if you're unsure whether manipulations are appropriate due to their higher intensity it's okay to do mobilizations, most research points to manipulations being slightly more effective, but mobilizations being very effective, and of course we have those videos for you if you want to start with those less intense techniques. Make sure that if you are doing any technique that it is based on assessment, and of course that you're reassessing ensuring that the technique is effective for the patient that you're working on, and when it comes to all manual techniques,  manipulations maybe more than any other, look for opportunities to get live education. Although I know videos are convenient and I'm happy to have these up for you to watch, it would be so much more helpful to use those videos as a recap of one-on-one attention with somebody who's experienced with manipulation techniques. At the very least grab a colleague, grab a friend and start practising these before you bring them into clinic and start using them on patients and clients. I hope you enjoyed this video, if you have any questions please leave them in the comments box below.

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Joint manipulations for the wrist and elbow. Types of manipulations, manipulations vs. mobilizations of the wrist and elbow. Optimal intervention for elbow pain, lateral epicondylitis (epicondylalgia), wrist pain, and carpal tunnel syndrome. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of wrist and elbow manips.

Joint Manipulation: Elbow (Radial Head) and Wrist

Ideally, the patient's shoulder should be at about the height of the practitioner's chest.

The practitioner should be standing on the patient's affected side.

Arthrokinematic motion of the radial head can be assessed using posterior-to-anterior (PA) or anterior-to-posterior (AP) 

Arthrokinematic motion of the humeroulnar (elbow) joint can be assessed using the PA 

The practitioner should use the hand furthest from the patient to control the patient's arm, by grabbing the patient's wrist using a lumbrical grip.

The practitioner then passively moves the patient's arm into a comfortable amount of shoulder abduction and neutral external rotation, with the elbow near end-range extension.

The practitioner then uses the hand closest to the patient, to approach the distal aspect of the humerus from the posterior side. The practitioner will assume an under-handed grip of the distal humerus, while simultaneously palpating the posterior aspect of the radial head using the thumb of the same hand.

Note: This is a crucial step in the set-up of this technique. This hand placement is critical for achieving lock-out and applying the desired direction of force.

Lockout position of the radial head can be achieved with full supination or pronation. The motion that results in lock-out most comfortably, should likely be used. Clinically, BI has found that full supination tends to be easiest in most cases, and is less likely to require manipulating into terminal elbow extension (which can be painful).

The practitioner will find lock-out position using a "wind-up"; slowly moving from mid-range to near end-range elbow extension, elbow varus, forearm supination, and a PA force on the radial head.

Again, lock-out position is not end-range elbow extension (which can be painful), it is a soft lock that can be felt a few degrees from terminal elbow extension when the end of supination (or pronation), varus force, and PA force on the radial head, has taken up all tissue "slack".

Important Note: 90% of the manipulation technique is set-up. If you have not achieved lock-out in the previous steps, having great "thrust technique" will be rendered useless.

The high-velocity portion of this technique is a quicker version of the "wind-up" described above, which is a combination of near end-range forearm elbow extension, elbow varus, forearm supination, and PA force on the radial head.

This combination of forces is a little tricky at first, but with a little practice, the motion should start to feel natural. Note, the motion feeling natural is dependent on achieving the correct hand position described in step 3 above.

Once slow wind-up motions aid in identifying the "lock-out" position, the wind-up motion is done quickly in a small whip-like motion with the intent of moving just past lock-out.

The elbow is NOT a stubborn or inherently stiff joint. This manipulation requires speed and accuracy, but not a large amount of force or pressure. If you are tempted to use more force, first start by trying to increase your speed, and if that does not result in a successful manipulation, then start the technique over. Also, remember that cavitation is not necessary for a successful manipulation. Success is an increase in arthrokinematic motion and a measurable change in ROM.

Radial Head Manipulation

Cuboid Manipulation

Sacroiliac Joint Chicago Technique

Thoracic Pistol Manipulation

Upper Cervical Manipulation

Shotgun (Pubic Symphysis) Manipulation

Lumbar Spine Joint Manipulation (High Velocity Thrust)

Wrist Manipulation

Talocalcaneal Manipulation

Talonavicular and Cuneonavicular Joint Manipulations

Proximal Tibiofibular Joint Manipulation

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