Today’s OMM question involves a 21-year-old man who fell backward on his outstretched left hand. Which maneuver would correctly treat the somatic dysfunction at his elbow?
A 21-year-old man presents to the emergency department with one day of left elbow pain. He fell backward on his outstretched left hand yesterday while skateboarding. He describes the pain as a dull ache and rates it at 5/10 on a 10-point scale. It does not radiate anywhere and is not associated with numbness or tingling of the left forearm or hand. His past medical history is non-contributory, and he takes no medications. His temperature is 37.3 ºC (99.1 ºF), pulse is 90/min, respirations are 18/min, blood pressure is 136/79 mmHg. On physical examination there is tenderness to palpation at the left lateral elbow. The left forearm is restricted in pronation. X-rays of the left shoulder, elbow and wrist show no dislocation or fracture.
Which of the following would correctly treat the somatic dysfunction at his elbow?
A. Extend his wrist while he resists by trying to flex his wrist
B. Flex his wrist while he resists by trying to extend his wrist
C. Supinate his wrist while he resists by trying to pronate his wrist
D. Pronate his wrist and flex the elbow rapidly while you thrust posteriorly at the radial head
E. Supinate his wrist and extend the elbow rapidly while you thrust anteriorly at the radial head
Scroll down for the correct answer!
The correct answer to today’s OMM Question is…
D. Pronate his wrist and flex the elbow rapidly while you thrust posteriorly at the radial head
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
The incorrect answers to today’s OMM Question are…
A. Extend his wrist while he resists by trying to flex his wrist
This could be used to treat an extension restriction and/or lateral epicondylitis. Given the fall and difficulty with pronation, an anterior radial head dysfunction is much more likely.
B. Flex his wrist while he resists by trying to extend his wrist
This could be used to treat a flexion restriction and/or medial epicondylitis. Given the fall and difficulty with pronation, an anterior radial head dysfunction is much more likely.
C. Supinate his wrist while he resists by trying to pronate his wrist
He is restricted in pronation, meaning supination is a motion of ease for him. This technique would not help his somatic dysfunction.
E. Supinate his wrist and extend the elbow rapidly while you thrust anteriorly at the radial head
This HVLA maneuver is used to treat a posterior radial head. His radial head has an anterior dysfunction.
Main Explanation
Radial head dysfunctions are common after falls on an outstretched hand. Normally, the radial head moves anteriorly during supination and posteriorly during pronation. The opposite occurs at the distal radius. Falls forward on an outstretched hand force the radial head posteriorly and can cause restriction in supination. Falls backward on an outstretched hand force the radial head anteriorly and can cause restriction in pronation. Recall the “SAPP” mnemonic (Supination is the motion of ease for an Anterior radial head, and Pronation is the motion of ease for a Posterior radial head).
This patient’s restriction is in posterior motion and pronation, implying he has an anterior radial head dysfunction. Treatment with HVLA involves flexing and pronating the elbow quickly while applying a posteriorly directed thrust at the anterior radial head.
Major Takeaway
An anterior radial head dysfunction presents with a restriction in both posterior glide of the radial head and pronation. It can occur after a fall backward on an outstretched hand. HVLA treatment involves flexing the elbow and pronating while thrusting posteriorly at the radial head.
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