Today's reference article is an older one. However, the content and concepts are timeless and very helpful. Explore the article by clicking, HERE.
Mentoring Minutes: Cubital Tunnel Syndrome
Cubital Tunnel Syndrome:Part 1
Cubital Tunnel Syndrome: Part 2
REFERENCES & notes:
Wojewnik B, Bindra R. Cubital tunnel syndrome — Review of current literature on causes, diagnosis and treatment. Journal of Hand and Microsurgery. 2009;1(2):76-81. doi:10.1007/s12593-009-0020-9.
- Most don’t need surgery, unless traumatic injury to elbow structure
- SOL: bone spur, ganglions, callus,
- Froment sign: weakness of adductor pollicus muscle, pt given a piece of paper and holds it together between the thumb and index finger (key pinch) with flexion of the thumb IP joint (because weakness of add poll muscle.
-Positive flexion sign at the elbow with supination and wrist extension reproducing the symptoms up to 60 seconds and ulnar nerve subluxation with elbow flexion can also be seen.
- Treatment: braces, to limit flexion
Cutts S. Cubital tunnel syndrome. Postgraduate Medical Journal. 2007;83(975):28-31. doi:10.1136/pgmj.2006.047456.
- 2nd most common peripheral nerve entrapment
- The cubital tunnel is formed by the cubital tunnel retinaculum which straddles a gap of about 4 mm between the medial epicondyle and the olecranon
- intraneural pressure associated with elbow flexion are believed to be key issues
-shape of the tunnel changes from an oval to an ellipse with elbow flexion. narrows the canal by 55%. , this compression can hinder blood flow;
-Elbow flexion, wrist extension and shoulder abduction increases intraneural pressure by six times.
- persons at risk_ holding prolonged flexion, prolonged position (tools, phones), pitchers at late cocking phase stresses nerve and tend to have mild boney changes at the elbow;
- 4th and 5th fingers parasthesia, or motor changes (clawing or abduction of little fingers
- elbow flexion test, tinnel, ULTT ulnar
-treatments: avoid prolonged flexion, nerve mobility,
-Cent Eur Neurosurg. 2011 May;72(2):90-8. doi: 10.1055/s-0031-1271800. Epub 2011 May 4.
Cubital tunnel syndrome - a review and management guidelines.
Assmus H1, Antoniadis G, Bischoff C, Hoffmann R, Martini AK, Preissler P, Scheglmann K, Schwerdtfeger K, Wessels KD, Wüstner-Hofmann M.
-J Hand Ther. 2014 Jul-Sep;27(3):192-9; quiz 200. doi: 10.1016/j.jht.2014.02.003. Epub 2014 Feb 27.
Outcomes following the conservative management of patients with non-radicular peripheral neuropathic pain.
Day JM1, Willoughby J2, Pitts DG2, McCallum M2, Foister R2, Uhl TL3.
- J Manipulative Physiol Ther. 2010 Feb;33(2):156-63. doi: 10.1016/j.jmpt.2009.12.001.
Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases.
Oskay D1, Meriç A, Kirdi N, Firat T, Ayhan C, Leblebicioğlu G.
Mentoring Minutes: Achilles Tendinopathies
Notes & References
- wrong use vs over use - Not every tendon problem is the same; location matters
o Midsubstance- Most common: associated with over/wrong use; treat with load and reload;
-Most common (have ICF guidelines); goal is to stiffen it (so isometrics/eccentrics verse stretches)
-Can use tape, soft tissue, heel lifts, some modalities, all can help with pain (for the itis), but do not reload tendon, needed for Osis treatment
-Treatment: slow and controlled, involving cognition (think about it), need to exceed elongation than during walking (on step); high volume required, and overload it;
- Progression from flat ground to step to adding weight
- Goal with treatment is to make tendon more organized, thinner, faster reaction time;
-Palpation: if very localized, may more degeneration/thickening, verse entire tendon than more related to inflammation;
o Tenosseous junction (insertional)- associated with collagen disease, wide age range- teat surgery, casting, shockwave; Avoid resistive exercises, more to rest and boot/immobilize
-Running technique/skill training (change how they load the foot/calcaneus);
- Look at rear foot and mid foot mechanics.
Muscle Tendinous Junction: associated with immobilization (deprived loading); treat with progressive reloading- more rare, often inflammatory and need rest first
Sports Med. 2012 Nov 1;42(11):941-67. doi: 10.2165/11635410-000000000-00000.
Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning.
Rowe V1, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D.
MID PORTION ACHILLES
- Evidence was strong for eccentric loading exercises and extracorporeal shockwave therapy; moderate for splinting/bracing, active rest, low-level laser therapy and concentric exercises (i.e. inferior to eccentric exercise). In-shoe foot orthoses and therapeutic ultrasound had limited evidence.
J Orthop Sports Phys Ther. 2015 Nov;45(11):876-86. doi: 10.2519/jospt.2015.5885. Epub 2015 Sep 21.
A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation.
Mid protion; 2-6 cm proximal to insertion (55-65%)
Eccentric protocol: 15x3, knee straight and 15x 3 knee bent; 2x a day, 7 days, no more than 5/10 during and after next day, slowly add load.
Return to sport: 3x15 with weight off step SL heel raises; 3x15 eccentric off step with weight, and 3x20 quick rebounding heel raises - 3 days recovery - need to load heavy, and speed
Clin J Sport Med. 2009 Jan;19(1):54-64. doi: 10.1097/JSM.0b013e31818ef090.
Nonoperative treatment of midportion Achilles tendinopathy: a systematic review.
Magnussen RA1, Dunn WR, Thomson AB.
Eccentric exercises have the most evidence of effectiveness in treatment of midportion Achilles tendinopathy.
Sports Med. 2013 Apr;43(4):267-86. doi: 10.1007/s40279-013-0019-z.
Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness.
Malliaras P1, Barton CJ, Reeves ND, Langberg H.
- CONCLUSION: There is little clinical or mechanistic evidence for isolating the eccentric component,
- Concentric- eccentric loading better (3 sec up, 3 sec down)- time under tension- 3 sets of 10-20, enough load to be painful in third set
J Orthop Sports Phys Ther. 2016 Aug;46(8):664-72. doi: 10.2519/jospt.2016.6494. Epub 2016 May 12.
Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running.
Willy RW, Halsey L, Hayek A, Johnson H, Willson JD.
- Treadmill running resulted in greater achilles tendon loading compared with overground running ; peak concentric ankle power greater with Treadmill runnning
Am J Sports Med. 2015 Jul;43(7):1704-11. doi: 10.1177/0363546515584760. Epub 2015 May 27.
Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial.
Beyer R1, Kongsgaard M2, Hougs Kjær B3, Øhlenschlæger T2, Kjær M2, Magnusson SP4.
- chronic mid portion achilles tendinopathy;
- eccentric training 3x15 7x week, 12 weeks vs: Heavy slow resitance 3x week, knee flexed seated, and knee extended standing (15 rep max to 6 rep max);
- sports allowed if < 3; 4-5/10 while training if subsides next session
- Both groups: improved pain, and sports assessments, reduction in tendon thickness and neovascularization
- Patient satisfaction > in heavy slow resistnace group (96 vs 76%), with higher compliance (96% vs 76%))
Mentoring Minutes: Ulnar Nerve Entrapment
Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.
Understanding peripheral nerve anatomy is critical in order to help maximize patient function and quality of life. In today’s episode of Mentoring Minutes, Dr. Michael Wong will be discussing the common entrapment sites of the Ulnar Nerve and how movement can contribute to this nerve problem.