Endra posisjon på skulderbladet kan gje endra svar på isometrisk test ved epicondyalgi
Year: 2012
Type: dissertation
Study design: Case Report
Abstract: Purpose: The purpose of this report is to show that altered position of the scapula can provide altered response due to isometric testing of extension of the wrist in persons with lateral epicondyalgia, without changing the position of the elbow. The scapula was assessed in three different positions; neutral, depression and elevation. Design: Case report Material: Pain-free grip force, measured with a dynamometer (Baseline Hydraulic Hand Dynamometer, Irvington, New York), and pain, using a numerical pain scale, in isometric testing of extension of the wrist. This was investigated with the scapula in neutral, depressed and elevated position. Potential reactions in the nervous system were measured by a neurodynamic test, palpation of peripheral nerves and neurological testing ("bed side"). Results: Reduced pains in isometric extension of the wrist were findings during the whole treatment period with depressed scapula. Pain in active flexion of the elbow was also decreased with depressed scapula. Gradually improvement in grip force, and gradually decreased pain in isometric extension of the wrist, were followed by increased range of motion due to neurodynamic testing, ULNT 2b (n. radialis). Exercising with pain worsened the symptoms, however severe mental stress led to no change. Discussion: The patient responded well to lateral glides of the forearm (Mobilization with Movement, Mulligan), but also to mobilization of the radial nerve. The mechanism behind the lateral glides is still unknown, however this management is considered to influence the central nervous system. The results of this report indicate that the subjects pain was mechanical driven. The results also assumed that the degree of peripheral and central sensitization were insignificant. Based on this the lesion was interpreted to be local. The local pain was influenced by changing the position of the scapula, which was considered as the radial nerve was affected. This may also explain why the subject had an effect of getting the radial nerve mobilized. This report points out that the position of the scapula may be important for the reliability of isometric testing of extension of the wrist. The report also questions whether the lateral glides may have a local effect or not. The results of the isometric testing implemented in this case report cannot be generalized. The intertester reliability has to be verified, and further research is needed, before this is interesting. Showing to be appropriate, this test may be a useful tool in the diagnostic process in epicondyalgia.
Author: Terje Bryn
Language: Norwegian
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2215514230