Universitat Internacional de Catalunya

Manual Therapy for the Upper Extremities

Manual Therapy for the Upper Extremities
7
13883
1
First semester
OB
Main language of instruction: Spanish

Other languages of instruction: Catalan, English

Teaching staff


Dra. PÉREZ GUILLÉN, Silvia - sperezgu@uic.es

Introduction

This subject includes practical and theoretical content related to the development and application of manual therapy techniques for the lower extremity. The student will learn and improve abilities and skills to evaluate and treat joint, neural and muscular dysfunctions located in the lower extremity. The course includes both manual and instrumental assessment and treatment methodologies.

Pre-course requirements

No prerequisites are specified.

Objectives

  1. To demonstrate palpatory skills in the identification of the different structures of the upper extremity.
  2. To carry out an inspection of the upper extremity under load, both statically and dynamically, and interpret the findings.
  3. To perform and interpret the clinical tests necessary to assess the specific function of the physiological and anatomical joints of the upper extremity {active and passive rotatory movements, translational movements of joint play, resisted movements, passive soft tissue movements [physiological and accessory movement, muscle and compartmental play)].
  4. To execute treatment techniques according to the therapeutic objective of pain modulation or function improvement.
  5. To know the clinical presentation of the most typical syndromes and clinical categories of the upper extremity.

Competences/Learning outcomes of the degree programme

General and basic competencies:

  • CB7: To develop the skills to apply the knowledge acquired and their ability to solve problems in new or little-known environments within broader (or multidisciplinary) contexts related to their area of study.
  • CB8: To have the skills to integrate knowledge and face the complexity of formulating judgments based on information that, being incomplete or limited, includes reflections on the social and ethical responsibilities linked to the application of their knowledge and judgments.
  • CB9: To have the skills to communicate their conclusions as well as the knowledge and ultimate reasons that support them, aimed at specialized and non-specialized audiences in a clear and unambiguous way.
  • CB10: To have the ability to develop learning skills that allow them to continue studying in a way that will be largely self-directed or autonomous.
  • CG2: To know how to effectively manage professional and clinical situations that require the integration of knowledge of biomedical, clinical and behavioral sciences in the area of specialization of Manual Orthopedic Physiotherapy.
  • CG3: Knowing how to carry out specific evaluation and treatment procedures for arthro-neuro-muscular dysfunctions, establishing a diagnosis of Orthopedic Manual Physiotherapy based on the findings.

Transversal competencies:

  • CT1: Being able to communicate effectively and to carry out an anamnesis, an evaluation and treatment of arthro-neuro-muscular dysfunctions, in interpersonal relationships so that they lead to enhancing the health status of the patient/user and the collaboration of the multidisciplinary team.  

Specific competencies:

  • CE1: To determine and apply the most appropriate treatment, taking into account the indications, contraindications, precautions and effects of Manual Orthopedic Physiotherapy in the framework of the management of pain mechanisms and dysfunctions of the arthro-neuro-muscular system.  
  • CE4: To have the ability to specifically execute the principles of mobilization, manipulation, motor learning, exercise physiology, ergonomic strategies, among other therapeutic modalities, for the treatment of pain and function of the arthro-neuromuscular system specifically, such as multimodal elements of the therapeutic approach of Orthopedic Manual Physiotherapy.

Learning outcomes of the subject

Students will:

  • Demonstrate advanced and specialized knowledge of the specific anatomy, physiology, and biomechanics of the musculoskeletal, neurological, vascular, and lymphatic systems of the upper extremity.
  • Demonstrate palpatory skills in identifying the different structures of the upper extremity.
  • Perform an inspection of the upper extremity under load, both statically and dynamically, and interpret the findings.
  • Demonstrate advanced knowledge and abilities and skills in performing and interpreting the clinical tests necessary to assess the specific function of the physiological and anatomical joints of the upper extremity {active and passive rotatory movements, translatory movements of joint play, resisted movements, passive movements of soft tissue [physiological and accessory movement (muscular play and compartmental play)].
  • Demonstrate advanced knowledge and abilities and skills in the execution of treatment techniques according to the therapeutic objective of pain modulation or function improvement.
  • Demonstrate critical awareness of the need and importance of specificity in the execution of the evaluation and treatment of osteo-arthro-neuro-myofascial dysfunctions of the lower extremity.
  • Demonstrate advanced knowledge of the clinical presentation of the most typical syndromes and clinical categories of the upper extremity, as well as specific abilities and skills in their evaluation and treatment.

Syllabus

  1. Functional anatomy and biomechanics of the wrist, elbow and shoulder regions.
  2. Structural and functional palpation of the wrist, elbow and shoulder regions.
  3. Static and dynamic inspection of the upper extremity
  4. Functional evaluation of the upper extremity
  5. Treatment techniques for the lower extremity according to therapeutic objective:
    1. Symptom relief: pain modulation techniques, clinical neurodynamics, functional taping.
    2. To increase joint mobility: slow joint mobilization of traction and sliding and joint manipulation.
    3. To increase muscle mobility: dry needling, diacutaneous fibrolysis, functional massage and muscle stretching.
    4. To decrease mobility: passive stabilization and mobilization of adjacent regions.
  6. Evaluation and treatment of the most frequent clinical presentations (clinical subgroups) of the upper extremity:
    1. Wrist region:
      1. Wrist instability
      2. Carpal tunnel syndrome
      3. Ulnar tunnel syndrome
      4. Thumb arthritis
      5. Dupuytren's disease
      6. De Quervain's  disease
      7. Finger pulley dysfunction
      8. Trigger finger dysfunction
    2. Elbow region
      1. Pronator teres tunnel syndrome
      2. Radial tunnel syndrome
      3. Elbow hypomobility
      4. Lateral elbow pain syndrome
    3. Shoulder and shoulder girdle region:
      1. Shoulder instability
      2. Adhesive capsulitis
      3. Shoulder impingement
      4. Thoracic outlet syndrome

Teaching and learning activities

In person



  • TC (Theoretical classes): The teacher is the one who exposes in a systematic and orderly manner the information corresponding to the different subjects and the student has a role mainly as a receiver. The scenario in which the teacher transmits knowledge is the classroom and he does it to the entire group of students. The theoretical class format allows the introduction of group activities in the classroom and the development of strategies that encourage the active participation of students.
  • PC (Practical classes):  It includes any type of classroom and/or laboratory practice (practices among students, case studies, problems, activities in the computer room, search for information,...)
  • SLA (Self-learning activities: These activities are designed so that the student solves problems on their own with the help of the material provided and the information from the face-to-face activities and/or available in the virtual environment in which the online subjects are developed.
  • SIS (Student independent study): It is a process aimed at the formation of an autonomous student capable of learning to learn; It consists of developing study skills, establishing educational goals and objectives based on the recognition of the weaknesses and strengths of the individual, which will respond to the needs and expectations of each one. It implies the possibility that each student makes their own decisions in relation to the organization of their time and their learning pace, which is why it requires a high degree of responsibility to make the most of resources.Includes study of contents related to "theoretical classes" and "practices" (studying exams, carrying out individual and group theoretical work, library work, complementary reading, etc.).
  • MC (Master Class): Transmission of knowledge and activation of cognitive processes in the student.
  • CL (Cooperative learning): Development of active and significant learning cooperatively.
  • FL (Flipped learning): Systems based on new technologies as basic knowledge tools outside the classroom, so that when students arrive to class they put their ideas and impressions together, giving teachers the opportunity to personalize their instruction according to the needs of each one.
  • PBL (Problem based learning): Development of active learning through problem solving.
  • RP (Role playing): Transfer to the classroom of situations typical of reality that will serve the student to apply them in their future life.

Evaluation systems and criteria

In person



  • Theoretical evaluation: 10%
  • Practical evaluation: 25%
  • Oral evaluation: 5%
  • Narrative report: 20%
  • Self-assessment: 20%
  • Co-assessment: 20%

The grading system will be used in accordance with current legislation.

Actually, according to RD 1.125/2003 del 5 de septiembre.

  • 0-4,9 Fail.
  • 5,0-6,9 Pass.
  • 7,0-8,9 Notable.
  • 9,0-10 Outstanding.

The Honor Roll mention may be awarded to students who have obtained a grade equal to or greater than 9.0. Their number may not exceed 5% of the students enrolled in a subject in the corresponding academic year, unless the number of students enrolled is less than 20, in which case a single Honors may be awarded.

Bibliography and resources

  • Manual Mobilization of the Joints, Volume III: Traction-Manipulation of the Extremities and Spine: Amazon.es: Kaltenborn, Freddie.
  • Manual Mobilization of the Joints. Volume I : joint examination and basic treatment : The extremities (Libro, 2011) [WorldCat.org]. 7th ed.
  • Shacklock MO, Neurodynamic Solutions. Biomechanics of the nervous system : Breig revisited. 2007;218.
  • Hing W, Hall T, Rivett D, Vicenzino B, Mulligan B. The Mulligan Concept of Manual Therapy: Textbook of Techniques, 1e : Hing PhD MSc(Hons) ADP(OMT) DipMT Dip Phys FNZCP, Wayne, Hall PT PHD MSc FACP, Toby, Mulligan FNZSP (Hon.) Dip MT, Brian.
  • E. Hengeveld, K. Banks. MAITLAND. Manipulación periférica. 8th ed.
  • Anatomy | THIEME Atlas of Anatomy, Three Volume Set, Third Edition. Third Edition. https://www.thieme.com/books-main/anatomy/product/5701-thieme-atlas-of-anatomy-three-volume-set-third-edition. Published December 2020. Accessed July 4, 2021.
  • Netter. Exploración clínica en ortopedia: Un enfoque basado en la evidencia eBook: Cleland, Joshua, Koppenhaver, Shane, Cleland, Joshua, Koppenhaver, Shane, Su, Jonathan, DRK EDICION, SL.
  • Simons DG, Travell JG, Simons LS. Dolor y disfunción miofascial V.1: El manual de los puntos gatillo, mitad ... - David G. Simons, Janet G. Travell.
  • Travell JG, Simons DG. Dolor y disfunción miofascial. El manual de los puntos gatillo. Volumen 2: extremidades inferiores. Medica Panam. 2004;752. 
  • Agudiez-Calvo S, Ballesteros-Frutos J, Cabezas-García HR, Pecos-Martin D, Gallego-Izquierdo T. Cross-Cultural Adaptation and Validation of the Pain Scale for Plantar Fasciitis to Spanish. J Foot Ankle Surg. 2021;60(2):247-251. doi:10.1053/j.jfas.2020.02.011
  • Barouk P. Recurrent metatarsalgia. Foot Ankle Clin. 2014;19(3):407-424. doi:10.1016/j.fcl.2014.06.005
  • Buchanan BK, Kushner D. Plantar Fasciitis.; 2021. http://www.ncbi.nlm.nih.gov/pubmed/28613727. Accessed July 4, 2021.
  • Chaudhry FA. Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review. Eur J Orthop Surg Traumatol. 2017;27(4):441-448. doi:10.1007/s00590-017-1957-1
  • Couppé C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP. Eccentric or concentric exercises for the treatment of tendinopathies? J Orthop Sports Phys Ther. 2015;45(11):853-863. doi:10.2519/jospt.2015.5910
  • Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L. Morton’s interdigital neuroma of the foot: A literature review. Foot Ankle Surg. 2018;24(2):92-98. doi:10.1016/j.fas.2017.01.007
  • Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51(2):113-125. doi:10.1136/bjsports-2016-096178
  • Fantino O, Bouysset M, Pialat JB. Can the axial cross-sectional area of the tibial nerve be used to diagnose tarsal tunnel syndrome? An ultrasonography study. Orthop Traumatol Surg Res. 2020. doi:10.1016/j.otsr.2020.02.021
  • Gougoulias N, Lampridis V, Sakellariou A. Morton’s interdigital neuroma: Instructional review. EFORT Open Rev. 2019;4(1):14-24. doi:10.1302/2058-5241.4.180025
  • Knupp M, Lang TH, Zwicky L, Lötscher P, Hintermann B. Chronic Ankle Instability (Medial and Lateral). Clin Sports Med. 2015;34(4):679-688. doi:10.1016/j.csm.2015.06.004
  • Larkins LW, Baker RT, Baker JG. Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examination. Arch Rehabil Res Clin Transl. 2020;2(3):100072. doi:10.1016/j.arrct.2020.100072
  • López-de-Celis C, Caudevilla Polo S, González-Rueda V, et al. Dimensional Changes of the Tarsal Tunnel During Foot and Ankle Positions: Anatomical Study. J Foot Ankle Surg. 2020;59(4):763-767. doi:10.1053/j.jfas.2020.02.001
  • López-López D, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, et al. Relationship between decreased subcalcaneal fat pad thickness and plantar heel pain. a case control study. Pain Physician. 2019;22(1):109-116. doi:10.36076/ppj/2019.22.109
  • Maceira E, Monteagudo M. Mechanical Basis of Metatarsalgia. Foot Ankle Clin. 2019;24(4):571-584. doi:10.1016/j.fcl.2019.08.008
  • Vaquero J, Longo UG, Forriol F, Martinelli N, Vethencourt R, Denaro V. Reliability, validity and responsiveness of the Spanish version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with chondral lesion of the knee. Knee Surgery, Sport Traumatol Arthrosc. 2014;22(1):104-108. doi:10.1007/s00167-012-2290-1
  • Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802. doi:10.1111/J.1600-0838.2009.00949.X
  • Fanlo-Mazas P, Bueno-Gracia E, Ruiz de Escudero-Zapico Alazne, et al. The Effect of Diacutaneous Fibrolysis on Local and Widespread Hyperalgesia and Muscle Length in Patients With Patellofemoral Pain Syndrome: Secondary Analysis of a Pretest-Posttest Clinical Trial. J Sport Rehabil. 2021;30(5):804-811. doi:10.1123/JSR.2020-0176
  • Fanlo-Mazas P, Bueno-Gracia E, Ruiz de Escudero-Zapico Alazne, Tricás-Moreno Jose Miguel, Lucha-López Maria Orosia. The Effect of Diacutaneous Fibrolysis on Patellar Position Measured Using Ultrasound Scanning in Patients With Patellofemoral Pain Syndrome. J Sport Rehabil. 2019;28(6):564-569. doi:10.1123/JSR.2017-0272
  • Ma, Li, Han, et al. Effects of Trigger Point Dry Needling on Neuromuscular Performance and Pain of Individuals Affected by Patellofemoral Pain: A Randomized Controlled Trial. J Pain Res. 2020;13:1677-1686. doi:10.2147/JPR.S240376
  • Ghourbanpour A, Talebi GA, Hosseinzadeh S, Janmohammadi N, Taghipour M. Effects of patellar taping on knee pain, functional disability, and patellar alignments in patients with patellofemoral pain syndrome: A randomized clinical trial. J Bodyw Mov Ther. 2018;22(2):493-497. doi:10.1016/J.JBMT.2017.06.005
  • Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. Clin J Sport Med. 2002;12(6):339-347. doi:10.1097/00042752-200211000-00004
  • Mendonça LD, Ocarino JM, Bittencourt NFN, Macedo LG, Fonseca ST. Association of hip and foot factors with patellar tendinopathy (Jumper’s Knee) in Athletes. J Orthop Sports Phys Ther. 2018;48(9):676-684. doi:10.2519/jospt.2018.7426
  • Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: A systematic review. Foot Ankle Surg. 2014;20(3):154-159. doi:10.1016/j.fas.2014.02.010
  • Sprague AL, Smith AH, Knox P, Pohlig RT, Grävare Silbernagel K. Modifiable risk factors for patellar tendinopathy in athletes: A systematic review and meta-analysis. Br J Sports Med. 2018;52(24):1575-1585. doi:10.1136/bjsports-2017-099000
  • Rosen AB, Ko J, Simpson KJ, Brown CN. Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy. Phys Ther Sport. 2017;24:13-19. doi:10.1016/j.ptsp.2016.09.007
  • Rio E, Van Ark M, Docking S, et al. Isometric contractions are more analgesic than isotonic contractions for patellar tendon pain: An in-season randomized clinical trial. Clin J Sport Med. 2017;27(3):253-259. doi:10.1097/JSM.0000000000000364
  • Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan’s Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018. J Manipulative Physiol Ther. 2019;42(6):439-449. doi:10.1016/j.jmpt.2019.04.001
  • Teyhen DS, Robertson J. Optimizing Recovery After Knee Meniscal or Cartilage Injury. J Orthop Sports Phys Ther. 2018;48(2):125. doi:10.2519/jospt.2018.0301
  • Giles LS, Webster KE, McClelland JA, Cook J. Does quadriceps atrophy exist in individuals with patellofemoral pain? A systematic literature review with meta-analysis. J Orthop Sports Phys Ther. 2013;43(11):766-776. doi:10.2519/JOSPT.2013.4833
  • Pappas E, Wong-Tom WM. Prospective Predictors of Patellofemoral Pain Syndrome: A Systematic Review With Meta-analysis. Sports Health. 2012;4(2):115-120. doi:10.1177/1941738111432097
  • Gaitonde DY, Ericksen A RR. Patellofemoral Pain Syndrome. Am Fam Physician. 2019;99(2):88-94. https://pubmed.ncbi.nlm.nih.gov/30633480/. Accessed July 8, 2021.
  • Prins, MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9-15. doi:10.1016/S0004-9514(09)70055-8
  • Ceballos-Laita L, Estébanez-de-Miguel E, Martín-Nieto G, Bueno-Gracia E, Fortún-Agúd M, Jiménez-del-Barrio S. Effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review. Complement Ther Med [Internet]. 2019;42:214–22. Available from: https://doi.org/10.1016/j.ctim.2018.11.021
  • Ceballos-Laita L, Jiménez-del-Barrio S, Marín-Zurdo J, Moreno-Calvo A, Marín-Boné J, Albarova-Corral MI, et al. Effects of dry needling in HIP muscles in patients with HIP osteoarthritis: A randomized controlled trial. Musculoskelet Sci Pract [Internet]. 2019;43:76–82. Available from: http://dx.doi.org/10.1016/j.msksp.2019.07.006
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