9-1

Kinesiology for Manual Therapies

Chapter 9

The Radioulnar Riddle: Techniques for Repetitive Action

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-2

Learning Outcomes

o 9-1 Define key terms.o 9-2 List several median nerve disorders.o 9-3 Locate the medial and lateral epicondyles of the humerus to palpate muscles above and below the elbow and radioulnar joints.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-3

Learning Outcomes (cont.)

9-4 Discuss symptoms of a subacute flare-up.

9-5 Practice safe body mechanics. 9-6 Demonstrate specific

techniques on the muscles of the elbow and radioulnar joints.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights © 2011 by The McGraw-Hill Companies, Inc. All rights reservedreserved

9-4

Learning Outcomes (cont.)

9-7 Incorporate dimensional massage therapy techniques in a regular routine or use them when needed.

9-8 Determine safe treatment protocols and refer clients to other health professionals when necessary.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights © 2011 by The McGraw-Hill Companies, Inc. All rights reservedreserved

9-5

Introduction

The shoulder joint allows for movement that enables the elbow joint and the radioulnar joint to work synergistically together. Muscles involved in the actions of the elbow and radioulnar joints span from the scapula to the wrist.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-6

Introduction (cont.)

The mid-way position of the elbow and radioulnar joints provide origin sites for muscles that control the hand and wrist. Repetitive actions provide a torque on the attachment sites making them a source of tenderness.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-7

Injuries and Overuse Syndromes

Fractures and dislocations are problematic traumas for the elbow and radioulnar joints. Massage is contraindicated for a fracture to the radial head to the area in the healing process due to the inability of the injury to be casted.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-8

Injuries and Overuse Syndromes (cont.)

Bursitis is an inflammation of a bursa. Bursitis of the elbow joint is often present with medial epicondylitis. Medial epicondylitis, or golfer’s elbow, is tendonitis, an overuse condition, that is an inflammation of a tendon in the area.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-9

Injuries and Overuse Syndromes (cont.)

Lateral epicondylitis or tennis elbow is commonly caused by overuse and is a tendonitis producing painful movement and discomfort in the hand and wrist.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-10

Soft-Tissue Issues

A subacute flare-up is a response to a chronic injury that is not allowed to rest. It may have all the symptoms of the acute stage of the inflammatory process. An ice bar of ice massage is a good first aid measure.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-11

Soft-Tissue Issues (cont.)

Hypertonic muscles are overused, sore, and fatigued muscles. Forearm hypertonic muscles can be relieved by massage therapy and stretching. Attachment sites will often be tender and sore to the touch.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-12

Nerve Complaints

Ulnar nerve compression can occur with a narrow cubital tunnel in the elbow joint. Radial nerve entrapment can occur in hypertonic triceps brachii or in the supinator.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-13

Nerve Complaints (cont.)

Median nerve disorders include carpal tunnel syndrome, pronator teres syndrome, and double-crush syndrome. Repetitive action can cause the median nerve to be entrapped by the pronator teres in pronator teres syndrome.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-14

Nerve Complaints (cont.)

Double entrapment of the median nerve by the pectoralis major and by the pronator teres is called the double-crush syndrome. Median nerve inflammation in the carpal tunnel is called carpal tunnel syndrome.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-15

Unraveling the Riddle

Always use treatment protocols to determine the sequence of a therapeutic session. Palpate tissues. Apply techniques to the uninvolved upper extremity first.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-16

Unraveling the Riddle (cont.)

Use warm-up techniques first; determine pressure. Follow a dimensional approach; think about the entire kinetic chain. Passively shorten the muscles whenever possible.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-17

Unraveling the Riddle (cont.)

Work on the shoulder girdle muscles first. Move onto the arm muscles and their attachments next. Approach the forearm methodically, superficial to deep.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-18

Unraveling the Riddle (cont.)

Techniques should: Reduce hypertonicities, lengthen fibers, separate tissues, reduce soreness and pain levels, increase flexibility, and increase movement to restricted areas.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-19

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Supine Flexed Arm Position Rock and Roll

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-20

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Elliptical Movement of the Biceps and Triceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-21

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Humeral joint tease and jostling the deltoids, biceps, and triceps use the same flexed arm position. See figure 9.2 for humeral joint tease. See figure 9.4 for the hand position for jostling.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-22

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

DTF of the Deltoid Tuberosity

Locate the deltoid tuberosity and apply deep transverse friction there.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-23

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Alternating Compressive Effleurage for the

Triceps and Biceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-24

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Alternating Petrissage for the Triceps and Biceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-25

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Petrissage the Elbow Joint with Distraction

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-26

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Locate the Origin of the Long Head of the Triceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-27

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Broad Strip Triceps Tendon

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-28

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

DTF the Triceps Insertion

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-29

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Locate and Strip the Biceps Radial Attachment

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-30

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Supine – Compressive effleurage of the brachialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-31

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Compression to the Forearm and Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-32

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Jostle the Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-33

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Elliptically Move the Forearm Muscles

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-34

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Broaden the Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-35

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Myofascial Stretch the Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-36

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Parallel Thumbs on the Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-37

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Compressive Effleurage on the Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-38

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Stripping the Origin of the Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-39

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

DTF the Anconeus

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-40

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Strip Radial Insertion of Brachioradialis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-41

Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints

Alternate petrissage to the brachioradialis. Apply compressive effleurage to the entire extremity.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-42

Chapter Summary

This chapter discussed the strategic location of the elbow and radioulnar joints. Injuries and overuse syndromes including fractures and dislocations, bursitis, and tendonitis was reviewed.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-43

Chapter Summary (cont.)

Soft-tissue issues and nerve complaints were explored. Treatment protocol and sequence of the elbow and radioulnar areas were outlined.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-44

Chapter Summary (cont.)

Dimensional Massage Therapy techniques for the muscles of the radioulnar and elbow joints were depicted for the supine and flexed arm positions.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-45

Chapter Review

The Chapter Review is divided into true and false, short answers, and multiple choice questions. The questions are designed for the students to test their knowledge.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-46

Explore and Practice

Activities in this section are for practice and demonstration. Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9-47

Explore and Practice

Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved