Physical Therapy on Non-structural Medial Elbow Pain

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

Detailed Description
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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.

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

Conditions
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Elbow Injuries and Disorders, Neuritis, Ulnar, Neuritis, Brachial, Neuritis; Nerve Root, Neuritis Median Nerve

Intervention / Treatment
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* Other: Rehabiltiation using exercise and manual therapy


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Cohort longitudinal
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Regional Interdepence Intervention for the upper quarter<br>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<br>* 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.<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Regional Interdependence, Posture, Neural Tension, Physical Therapy