1. 9-1 Kinesiology for Manual Therapies Chapter 9 The Radioulnar Riddle: Techniques for Repetitive Action McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

2. 9-2 Learning Outcomes o 9-1 Define key terms. o 9-2 List several median nerve disorders. o 9-3 Locate the medial and lateral epicondyles of the humerus to palpate muscles above and below the elbow and radioulnar joints. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

3. 9-3 Learning Outcomes (cont.)  9-4 Discuss symptoms of a subacute flare-up.  9-5 Practice safe body mechanics.  9-6 Demonstrate specific techniques on the muscles of the elbow and radioulnar joints. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

4. 9-4 Learning Outcomes (cont.)  9-7 Incorporate dimensional massage therapy techniques in a regular routine or use them when needed.  9-8 Determine safe treatment protocols and refer clients to other health professionals when necessary. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

5. 9-5 Introduction  The shoulder joint allows for movement that enables the elbow joint and the radioulnar joint to work synergistically together.  Muscles involved in the actions of the elbow and radioulnar joints span from the scapula to the wrist. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

6. 9-6 Introduction (cont.)  The mid-way position of the elbow and radioulnar joints provide origin sites for muscles that control the hand and wrist.  Repetitive actions provide a torque on the attachment sites making them a source of tenderness. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

7. 9-7 Injuries and Overuse Syndromes  Fractures and dislocations are problematic traumas for the elbow and radioulnar joints.  Massage is contraindicated for a fracture to the radial head to the area in the healing process due to the inability of the injury to be casted. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

8. 9-8 Injuries and Overuse Syndromes (cont.)  Bursitis is an inflammation of a bursa.  Bursitis of the elbow joint is often present with medial epicondylitis.  Medial epicondylitis, or golfer’s elbow, is tendonitis, an overuse condition, that is an inflammation of a tendon in the area. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

9. 9-9 Injuries and Overuse Syndromes (cont.)  Lateral epicondylitis or tennis elbow is commonly caused by overuse and is a tendonitis producing painful movement and discomfort in the hand and wrist. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

10. 9-10 Soft-Tissue Issues  A subacute flare-up is a response to a chronic injury that is not allowed to rest.  It may have all the symptoms of the acute stage of the inflammatory process.  An ice bar of ice massage is a good first aid measure. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

11. 9-11 Soft-Tissue Issues (cont.)  Hypertonic muscles are overused, sore, and fatigued muscles.  Forearm hypertonic muscles can be relieved by massage therapy and stretching.  Attachment sites will often be tender and sore to the touch. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

12. 9-12 Nerve Complaints  Ulnar nerve compression can occur with a narrow cubital tunnel in the elbow joint.  Radial nerve entrapment can occur in hypertonic triceps brachii or in the supinator. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

13. 9-13 Nerve Complaints (cont.)  Median nerve disorders include carpal tunnel syndrome, pronator teres syndrome, and double-crush syndrome.  Repetitive action can cause the median nerve to be entrapped by the pronator teres in pronator teres syndrome. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14. 9-14 Nerve Complaints (cont.)  Double entrapment of the median nerve by the pectoralis major and by the pronator teres is called the double-crush syndrome.  Median nerve inflammation in the carpal tunnel is called carpal tunnel syndrome. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

15. 9-15 Unraveling the Riddle  Always use treatment protocols to determine the sequence of a therapeutic session.  Palpate tissues.  Apply techniques to the uninvolved upper extremity first. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

16. 9-16 Unraveling the Riddle (cont.)  Use warm-up techniques first; determine pressure.  Follow a dimensional approach; think about the entire kinetic chain.  Passively shorten the muscles whenever possible. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

17. 9-17 Unraveling the Riddle (cont.)  Work on the shoulder girdle muscles first.  Move onto the arm muscles and their attachments next.  Approach the forearm methodically, superficial to deep. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18. 9-18 Unraveling the Riddle (cont.) Techniques should:  Reduce hypertonicities, lengthen fibers, separate tissues, reduce soreness and pain levels, increase flexibility, and increase movement to restricted areas. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

19. 9-19 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Supine Flexed Arm Position Rock and Roll McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

20. 9-20 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Elliptical Movement of the Biceps and Triceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

21. 9-21 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints  Humeral joint tease and jostling the deltoids, biceps, and triceps use the same flexed arm position.  See figure 9.2 for humeral joint tease.  See figure 9.4 for the hand position for jostling. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

22. 9-22 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints DTF of the Deltoid Tuberosity  Locate the deltoid tuberosity and apply deep transverse friction there. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

23. 9-23 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Alternating Compressive Effleurage for the Triceps and Biceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

24. 9-24 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Alternating Petrissage for the Triceps and Biceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

25. 9-25 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Petrissage the Elbow Joint with Distraction McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

26. 9-26 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Locate the Origin of the Long Head of the Triceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

27. 9-27 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Broad Strip Triceps Tendon McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

28. 9-28 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints DTF the Triceps Insertion McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

29. 9-29 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Locate and Strip the Biceps Radial Attachment McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

30. 9-30 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints  Supine – Compressive effleurage of the brachialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

31. 9-31 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Compression to the Forearm and Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

32. 9-32 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Jostle the Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

33. 9-33 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Elliptically Move the Forearm Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

34. 9-34 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Broaden the Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

35. 9-35 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Myofascial Stretch the Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

36. 9-36 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Parallel Thumbs on the Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

37. 9-37 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Compressive Effleurage on the Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

38. 9-38 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Stripping the Origin of the Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

39. 9-39 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints DTF the Anconeus McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

40. 9-40 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints Strip Radial Insertion of Brachioradialis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

41. 9-41 Dimensional Massage Therapy for the Muscles of the Radioulnar and Elbow Joints  Alternate petrissage to the brachioradialis.  Apply compressive effleurage to the entire extremity. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

42. 9-42 Chapter Summary  This chapter discussed the strategic location of the elbow and radioulnar joints.  Injuries and overuse syndromes including fractures and dislocations, bursitis, and tendonitis was reviewed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

43. 9-43 Chapter Summary (cont.)  Soft-tissue issues and nerve complaints were explored.  Treatment protocol and sequence of the elbow and radioulnar areas were outlined. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

44. 9-44 Chapter Summary (cont.)  Dimensional Massage Therapy techniques for the muscles of the radioulnar and elbow joints were depicted for the supine and flexed arm positions. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

45. 9-45 Chapter Review  The Chapter Review is divided into true and false, short answers, and multiple choice questions.  The questions are designed for the students to test their knowledge. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

46. 9-46 Explore and Practice  Activities in this section are for practice and demonstration.  Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

47. 9-47 Explore and Practice  Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved