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Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

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Old 18-06-2012, 08:23 PM   #1
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Default Stiff elbow

Hi folks,
Hoping I can get some further ideas from you all.

39 y.o. electrician, male, fell onto L elbow, rad head fracture, casted 6 weeks, fracture healed.
I took this patient over from another physio, and I have been treating for past 6 weeks.

Pain not really an issue, only mild at ulna groove after a round of golf, resolves within 24 hrs.

Carrying angle is increased, unable to achieve end range extension and flexion is lacking 30º.
Sup and pro mild end range restricted. Pt is functional and has fully returned to work.

I have used the usual physio jt mobs / MET which has helped to regain much of the ROM, but have plateaued. I use DNM extensively for most of my other patients, but have not used it so far with this pt. I tried it today.

My other PT colleagues have suggested I manipulate it but I'm not a big fan of this.
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Old 18-06-2012, 08:51 PM   #2
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Manipulate what?

Treat his nervous system, not his elbow.
Barrett L. Dorko P.T.
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Old 19-06-2012, 02:13 AM   #3
John W
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Based on what you presented, Jake, it doesn't sound like he needs much treatment at all.

I might follow up with him in a month or so, see how he's doing with regard to his leisure and functional use of the extremity, and then let him go- particularly if he's happy with his golf score.
John Ware, PT
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Old 19-06-2012, 02:41 AM   #4
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from what you said, it seems that your pt does not care aboout the range????

But if you care about it then you pt will care about it , maybe more than you.......

Since you mentioned functionally he is fine, what's the point to improve the ROM; also considering he is 39 now......I would expect some ROM loss after a fracture.....

If you really think you can gain some improvement (What makes you think of that??), as Barrett suggested i would recommend "Mirror therapy" to fresh his brain awareness of control and see if the stiffness and ROM could be improved.......


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Old 19-06-2012, 03:48 AM   #5
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Thanks all for your inputs,
Pt would like to improve the ROM, he is self-employed so is highly motivated.

My next thought was to use mirror therapy.

Might have to be a full length one - for the golf swing...

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Old 19-06-2012, 04:34 AM   #6
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Agree 100% with John. Barrett probably has a theory about this, but I see ROM issues like this "magically" disappear after about a year on their own. If not back to 100% - very close. Same with stiff shoulders, knees, etc... Give it time and, in the absence of persistent pain, pesky ROM problems solve themselves.

Please don't manipulate this man's elbow.
Rod Henderson, PT, ScD, OCS
It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift
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Old 19-06-2012, 05:07 AM   #7
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I agree with the above posts; it will recover in time especially as he is in a consistently active job. Mirror therapy is worth a trial as well as assuring him that he cannot harm the arm by hard work.

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