OMM for Repetitive Use Injuries of the Upper Extremity - Elbow Pain Developed for OUCOM CORE by Brad Werrell, D.O. Edited by David Eland, D.O. and the CORE Osteopathic Principles and Practices Committee Session #8 – Series B

History of Illness Insidious onset of pain Progressive course Exacerbated by certain actions, with a history of repetition of those actions over time Alleviated by rest No paresthesias No acute trauma

Examination Through Observation Have patient demonstrate the location of the pain, and the motion which exacerbates that pain. 2. Compare the injured limb to the uninjured limb. Make note of structural, pigmentary and soft tissue differences by observation. 3. Observe the habitual function of the joint proximal to the injured joint.

Examination Through Palpation Palpate the bones – check for tenderness to palpation: Medial and lateral epicondyles Radial head Olecranon process of the ulna Palpate soft tissues: For bogginess For tenderness For temperature

Examination Through Palpation Positional diagnosis of the radial head Posterior vs Anterior Fluctuance Fluid in the joint or bursa Tenderness -- Temperature Changes

Functional Examination Active Range of Motion Elbow Flexion and Extension Forearm supination and pronation Look for: Limitations of range of motion Pain with motion

Passive Range of Motion Elbow flexion and extension Forearm supination and pronation Range of motion (compare sides) End-feel of motion

Neurologic Examination 1. Tinnel’s Test of the Olecranon Tunnel - Tinnel’s Test of the Carpal Tunnel 2. Evaluation of the sense of touch comparing both upper extremities 3. Brachioradialis reflex bilaterally - Triceps reflex bilaterally 4. Observation of the hands and wrists for muscular wasting

Ligamentous Articular Release Treatment Options HVLA Muscle Energy Counterstrain Ligamentous Articular Release Functional Technique

Radial Head dysfunction Active Tenderpoint Potential Diagnoses Radial Head dysfunction Active Tenderpoint Ligamentous Articular Strain Medial/Lateral Epicondylitis

HVLA of the Posterior Radial Head

HVLA of the Anterior Radial Head

Ligamentous Articular Release of the Elbow

Counterstrain Treatment of the Radial Tenderpoint

Counterstrain Treatment of the Medical Coronoid Process Tenderpoint

Counterstrain Treatment of the Lateral Coronoid Tenderpoint

Counterstrain Treatment of the Medical Olecranon Tenderpoint

Counterstrain Treatment of the Lateral Olecranon Tenderpoint

References Counterstrain: A Handbook of Osteopathic Technique, Herbert A. Yates, D.O., F.A.A.O. and John Glover, D.O., F.A.A.O.; Y Knot Publishers, Tulsa, OK, 1995. Foundations for Osteopathic Medicine, Robert C. Ward, D.O., F.A.A.O., Williams & Wilkins, Baltimore, MD, 1997 (1st Edition); 2003 (2nd Edition). OMT Review, Robert G. Savarese, D.O., Robert G. Savarese, D.O., USA, 2003. An Osteopathic Approach to Diagnosis and Treatment, Eileen L. DiGiovanna, D.O., F.A.A.O., Lippincott Williams & Wilkins, Philadelphia, 2005. View-OMT Osteopathic Multimedia Reference Collection, Bradley H. Werrell, D.O., Bamboo Data Systems, Inc., Ashburn VA, 2006.