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