Case of the Week 12-16-13: I Just Want to Clean and Press | Modern Manual Therapy Blog

Case of the Week 12-16-13: I Just Want to Clean and Press


Anyone who visits for a little mentoring always gets the offer of an evaluation and treat. Last week, Jas said he has been missing left elbow flexion for quite a while now.

Naturally as a chiropractic student, his elbow has been manipulated a lot. He thought it may have been some sort of plica due to the abnormal end feel. Manipulation into both flexion and extension did not help.

Gray Cook says to have someone else assess you. I learned this first hand as I was literally doing the same thing over and over and wondering why the condition wasn't improving.

Back to my visitor, a quick UQ screen revealed
  • major loss of cervical retraction with sidebending to the left - the same side as elbow flexion loss
  • there was also a DN in left shoulder IR (mod) and in left forearm supination (sev loss) 
  • repeated retraction with SB left rapidly improved this motion but there was no change for the elbow flexion actively or passively
  • he had a scar on the involved forearm from a previous wrist fracture from years ago
    • he never noticed the loss of supination, but it was only about 10 degrees compared to the 90
    • it's possible the previous fracture lead to a gradual loss of forearm supination
  • after working on some anterior and posterior left forearm soft tissue patterns, his supination improved about 40 degrees
  • there was still a major hard end feel around the distal radio-ulnar joint to posterior glide - when was the last time you heard me talk about glides and end feels?
    • next was AROM MWM with simultaneous posterior glide of distal RU and anterior glide of proximal RU
    • followed by a good ol' interosseus membrane stretch - E1 USA in the house!
    • only managed to improve the supination by about another 10 degrees
    • I told him the first half of the motion was rapid responding, and the last half was most likely slow responding and he need to stretch into supination with passive overpressure hourly
    • with active supination and elbow flexion his left fingertips now touched his shoulder, which is how he was measuring it compared to the right side - it wasn't just a guns end feel
A colleague of his worked on his supination some more in the clinic and said by the end of the week it was restored, which means it wasn't slow responding as the remodelling would have taken several more weeks. Elbow flexion is better, but not sure if he can clean and press safely just yet as there is still that loss of shoulder motion... Bottom line, don't assess and treat yourself!

Keeping it Eclectic...

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