post# rehabilitation

[arkesh_physio]

hi
i have a patient aged 52 yrs wid the history of fall at elbow and fracture olecranon pro., lower end of humerus , medial epicondyle.
pop casting was done for around 40 days and after removal of pop cast around 2 months later he came to me wid complaint of pain at elbow joint and painfull movements and tenderness over medial epicondyle and ole. process wid AROM 40 degree and PROM 43 degree .After 20days of treatment wid wax, u/s, mobilization,mild massaage, biceps stretching, endrange hold relax tech.,and flexion extension wid half kg weight in supine lying the range came to 71 degree actively and 75 degree passively.but now since last 15-16 days the case is not improving further and range is also not increasing . please suggest some thing ..


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[binmath]

hello,
taking into consideration the age,time span after fracture what you where doing was right.if possible ask the patient to get an x ray.sometimes myositic ossification may be a limiting factor .

[Physiobase]

I would imagine 40 days in an elbow cast is enough to give anyone 'pain' expecially on the medial epicondyle. Be careful not to overtreat the area if it is already in a state of discomfort. Range is going to be blocked by one of two things; joint, or muscle hyperactivity (or both). You need to see what is the true cause of the restricted range. Mobilisation of the joint through movement (like Mulligan's MWM's) might assist.

Also take a look at the proximal radioulnar joint in forearm pronation and supination and perhaps mobilise that whilst releasing the forearm/wrist/finger flexor component.

Is pain limiting the range or is pain one feature and reduced range a second feature. Maybe a local topic agent might assist reduce the medial epicondyle pain as this bone is rather superficial in that area and so topical agents are likely to penetrate enough into the painful structures.

Remember to check neck and shoulder girdle (1st rib) for dysfunctions as he will have been carrying the arm in the cast for the 40 days as well and so the overall mvt pattern would have been one towards flexion. Good luck and please give us an update as time goes by.

[arkesh_physio]

hi physiobase,
thanx for the advice.
will update u later about this patient,
regards
ark..