Physical Therapy on Non-structural Medial Elbow Pain

Effect of Regional Interdepence Physical Therapy Approach on Non-structural Medial Elbow Pain

This study is investigating the effect of using a regional interdependence approach of managing non-structural elbow pain with physical therapy.

Study Overview

• Status: Completed
• Conditions: Elbow Injuries and Disorders; Neuritis, Ulnar; Neuritis, Brachial; Neuritis; Nerve Root; Neuritis Median Nerve
• Intervention / Treatment: Other: Rehabiltiation using exercise and manual therapy

Detailed Description

Potential patients will be referred for physical therapy with elbow nerve pain arising from a non-structural lesion. We believe by addressing spine and trunk posture and mobility we can relieve elbow pain associated with a nerve compression with physical therapy.

Patients will be put on a staged exercise program to regain spinal mobility and strengthen proximal core musculature and scapular musculature. Manual therapy to facilitate mobility will be incorporated. Patients will undergo standard physical therapy by an unblinded therapist until resolution of symptoms.

• Study Type: Interventional
• Enrollment (Actual): 22
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tim L Uhl, PhD; Phone Number: 859-218-0858; Email: tluhl2@uky.edu

Study Locations

• United States
  • Kentucky
    • Lexington, Kentucky, United States, 40509
      • Bluegrass Orthopaedics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 50 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• The patient presents with elbow pain that is not exacerbated with resisted wrist flexion, extension, supination, or pronation.
• The patient presents with elbow pain that is not exacerbated with passive wrist flexion or extension.
• The patient presents with three of the four positive cervical radicular signs
• Patient presents with peripheral paresthesia

Exclusion Criteria:

• The patient reports a surgical history involving the elbow.
• The patient has an MRI that is positive for structural deficits within the upper extremity.
• The patient self-reports a diagnosis of rheumatoid arthritis or other neurological systemic diseases such as Parkinson's disease, cerebrovascular accident, multiple sclerosis, or similar conditions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Regional Interdepence Intervention for the upper quarter; Physical therapist will perform interventions to the entire uppper extremity and spine to treat elbow pain. Physical therapy intervention will include manual therapy and soft-tissue massage to the shoulder, cervical, and thoracic spine. Participants will be prescribed specific exercises using a phased approach.

Other: Rehabiltiation using exercise and manual therapy; A licensed Physical Therapist will provide manual therapy to help restore spinal and scapular mobility. In association with this patients will be prescribed home exercises using a phased approach. Phase 1 to gain mobility of the spine and scapular motor control Phase 2 to gain shoulder mobility to strengthen scapular and spine musculature Phase 3 shoulder strengthening with long lever arms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Cervical Range of Motion in extension	Inclinometer measurement of cervical extension	Baseline and every 5th visit up to discharge which is estimated to be 3 months on average
Change in Focus On Therapeutic Outcome (FOTO) Patient Outcme Score	Patient self-report of perceived level of function. Scores range from 0 = low function, to 100=high function.	Baseline and every 5th visit up to discharge which is estimated to be 3 months on average
Change in Lower Trapezius scapular muscle strength	Objectively measure with hand held dynamometer for scapular retraction	Baseline and every 5th visit up to discharge which is estimated to be 3 months on average

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Elbow Flexion Range of Motion in Ulnar Nerve Tension position	Goniometric measure using a standard plastic goniometer with patient plased In nerve tension position that bias tension on ulnar nerve. The standard upper limb tension test position described by Magee' Orthopaedic Physical Assessment 7th edition. The angle of elbow flexion that reproduces symptoms will be recorded. Values will range from 0-150 degrees with a higher numbers indicating less symptoms.	Baseline and every 5th visit up to discharge which is estimated to be 3 months on average
Change in Elbow Extension Range of Motion in Median Nerve Tension positoin	Goniometric measure using a standard plastic goniometer with patient plased In nerve tension position that bias tension on median nerve. The standard upper limb tension test position described by Magee' Orthopaedic Physical Assessment 7th edition. The angle of elbow extension that reproduces symptoms will be recorded. Values will range from 0-150 degrees with a lower numbers indicating less symptoms.	Baseline and every 5th visit up to discharge which is estimated to be 3 months on average

Collaborators and Investigators

• Sponsor: Timothy Uhl
• Collaborators: Bluegrass Orthopedics
• Investigators: Principal Investigator: Tim L Uhl, PhD, University of Kentucky

Publications and helpful links

General Publications

• Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. J Man Manip Ther. 2013 May;21(2):90-102. doi: 10.1179/2042618612Y.0000000027.
• Wickstrom BM, Oakley PA, Harrison DE. Non-surgical relief of cervical radiculopathy through reduction of forward head posture and restoration of cervical lordosis: a case report. J Phys Ther Sci. 2017 Aug;29(8):1472-1474. doi: 10.1589/jpts.29.1472. Epub 2017 Aug 10.
• Day JM, Willoughby J, Pitts DG, McCallum M, Foister R, Uhl TL. Outcomes following the conservative management of patients with non-radicular peripheral neuropathic pain. J Hand Ther. 2014 Jul-Sep;27(3):192-9; quiz 200. doi: 10.1016/j.jht.2014.02.003. Epub 2014 Feb 27.
• Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003 Jan 1;28(1):52-62. doi: 10.1097/00007632-200301010-00014.
• Nee RJ, Jull GA, Vicenzino B, Coppieters MW. The validity of upper-limb neurodynamic tests for detecting peripheral neuropathic pain. J Orthop Sports Phys Ther. 2012 May;42(5):413-24. doi: 10.2519/jospt.2012.3988. Epub 2012 Mar 8.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2022
• Primary Completion (Actual): August 30, 2023
• Study Completion (Actual): August 30, 2023

Study Registration Dates

• First Submitted: August 11, 2022
• First Submitted That Met QC Criteria: September 12, 2022
• First Posted (Actual): September 13, 2022

Study Record Updates

• Last Update Posted (Actual): November 22, 2023
• Last Update Submitted That Met QC Criteria: November 20, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: Posture; Physical Therapy; Regional Interdependence; Neural Tension
• Additional Relevant MeSH Terms: Nervous System Diseases; Wounds and Injuries; Neuromuscular Diseases; Mononeuropathies; Peripheral Nervous System Diseases; Arm Injuries; Brachial Plexus Neuropathies; Neuritis; Ulnar Neuropathies; Brachial Plexus Neuritis; Elbow Injuries
• Other Study ID Numbers: 60696

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No