How to treat a loose body in the elbow
loose body manipulation elbow

Loose body manipulation of the elbow

How to treat a loose body in the elbow

How to perform a manipulation for loose body / internal derangement in the elbow?

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Perhaps it looks a bit spectacular...but it is quite efficient. Keep in mind, this technique is not used in case of bony loose bodies.

The patient’s distal arm and thorax is stabilized (by the special supports on the OMCyriax treatment table or manually ; in the latter case we need an assitant). Pronation grip : for a right elbow, the right hand grasps the radius in pronation, the other hand applies strong pressure on the first hand to prevent gliding over the patient’s skin. Supination grip : now the right hand grasps the radius in supination ; the other hand acts as before. Execution : for a right elbow, the therapist stands on his left foot, applies traction with his body weight, both arms extended. He pivots from about 100° to 170° (the limitation should not be exceeded) and, during this movement, performs three full rotations, towards pronation or towards supination. The last rotation is combined with a right side bending of the trunk (in order to get an extra traction impulse). 

 It is important to perform full rotations and to come back to the neutral position each time. Also should there always be a visual control, so as not to exceed the limited range in extension. In practice, one manipulation is performed, immediately followed by checking the positive test. We assess the range of extension and the end feel. Then, a second manipulation follows, again with a test control. In this way, max. 10-12 manipulations are done in one session (we always start with the pronation technique ; we choose supination when pronation ceases to help). We expect good results in 2-3 treatment sessions. Extension will be painfree, and the softer end feel caused by the loose body will be disappeared.

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