PTH 646 Therapeutic Interventions I Clinical Application Worksheet - Elbow, Wrist & Hand Instructions: See Clinical App Worksheet Instructions ‘52-year-old presenting with signs and symptoms of lateral elbow tendinopathy. Symptoms began ins approximately 7 months ago. Pain is rated a 0 at rest and a 6/10 at worst with gripping, woodworking and carrying a suitease. ously 1. Pain and weakness with resisted wrist extension Protection Phase/Rational Intervention We are in the chronic/minimal protection phase, focusing on a moderate intensity ‘exercise. The patient is stuck in a repeated cycle of chronic inflammation and needs to break up the adhesions, The goal for this phase is to promote healing, modify activity, and to return to function. The intent is to progressively stress the tissue to strengthen it and to stretch the wrist flexors and extensor. We referenced the tennis elbow rehabilitation protocol from the International Journal of Sports Physical Therapy referenced below. Weighted wrist extension Patient isto sit in a stationary chair with their forearm rested on a support surface. With a 2 Ib, weight, the patient will have their palm facing the floor and they will grip the weight, They will slowly contract the wrist into full extension, bringing the weight towards them, and slowly lower to full wrist flexion and repeat. Brief Rationale/Intent With these deficits in the chronic stage, the goal is to begin controlled stress to strengthen the wrist extensor muscles. ! A 2b weight was chosen because we are unsure what the patience tolerance will be yet. If the patient responds without pain or obvious muscle fatigue to this controlled stress, then the patient will be bumped up in weight up to 5 Ibs. “Mode/Dosage ‘The goal of this resistive exercise is to strengthen the wrist extensor muscles. ‘The dosage is 18-22 reps, 3 sets repeated 3-Sx a week for a goal of 70% IRM. ‘The starting resistance is a 21b. dumbbell, starting low and working up in weight based ‘on tolerance and response to strengthening. We will be watching for muscle fatigue ‘and substitutions from nearby muscles. Reference Day JM, Lucado AM, Uhl TL. A comprehensive rehabilitation program for treating lateral elbow tendinopathy. Int J Sports Phys Ther. 2019;14(5):818-829.