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Therapeutic Taping for the Elbow, Wrist and Hand Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS.

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Presentation on theme: "Therapeutic Taping for the Elbow, Wrist and Hand Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS."— Presentation transcript:

1 Therapeutic Taping for the Elbow, Wrist and Hand Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS

2 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 2 Carpal Tunnel Syndrome Modified Technique Single strip with moderate stretchSingle strip with moderate stretch –Diamond cut-outs over 2 nd & 3 rd –Apply in wrist extension –Extend up medial forearm Space CorrectionSpace Correction –On dorsum to open volar surface

3 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 3 Brachioradialis Kinesio® Technique Facilitate elbow flexion and forearm supinationFacilitate elbow flexion and forearm supination Kinesio® TechniqueKinesio® Technique –Supinate forearm and flex elbow to about 45 degrees –Apply with a mod to max stretch to the brachioradialism Modified Technique Practical ApplicationModified Technique Practical Application –Tape over brachioradialis moderate stretch with wrist in flexion and elbow extension, pronation

4 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 4 Supinator Kinesio® Technique Inhibit or Facilitate SupinationInhibit or Facilitate Supination Modified Kinesio® TechniqueModified Kinesio® Technique –Apply a single strip to the lateral epicondyle with the forearm in full pronation and slight elbow flexion –Apply the tape with appropriate stretch for functional outcome

5 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 5 Pronator Teres Kinesio® Technique Faciliate or inhibit pronationFaciliate or inhibit pronation Modified Kinesio® TechniqueModified Kinesio® Technique –With the forearm in supination and slight flexion, apply a single strip to the medial humeral epicondyle –Apply the tape with appropriate stretch towards the lateral forearm to the proximal third of the

6 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 6 Extensor Digiti Minimi Kinesio® Technique Facilitate finger extension and assist with wrist extensionFacilitate finger extension and assist with wrist extension Apply a ½ single strip with a split placing the tails on the 4 th & 5 th dorsal digitsApply a ½ single strip with a split placing the tails on the 4 th & 5 th dorsal digits With the hand and fingers in flexion, apply tape with a mod to max stretch towards the lateral epicondyle of the humerusWith the hand and fingers in flexion, apply tape with a mod to max stretch towards the lateral epicondyle of the humerus

7 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 7 Tenosynovitis Kinesio® Technique Decrease inflammation and inhibit overuseDecrease inflammation and inhibit overuse Apply an extensor pollicis longus taping with minimal stretch (for protection phase, during strengthening change to facilitation)Apply an extensor pollicis longus taping with minimal stretch (for protection phase, during strengthening change to facilitation) Space correction anatomical snuff boxSpace correction anatomical snuff box

8 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 8 Valgus Laxity of Elbow (Mechanical Correction) Athletic Training Reinforced for extreme laxity or throwing sportsReinforced for extreme laxity or throwing sports Two single strips maximal stretch medial elbowTwo single strips maximal stretch medial elbow Two single strips in X over medial elbowTwo single strips in X over medial elbow

9 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 9 Elbow Hyperextension Athletic Training Two single strips maximal stretch anterior elbowTwo single strips maximal stretch anterior elbow Two single strips in X over anterior elbowTwo single strips in X over anterior elbow

10 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 10 Olecranon Bursitis Space Correction Technique Space Correction strips over olecranon bursaSpace Correction strips over olecranon bursa

11 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 11 Lateral Epiconylitis (Tennis Elbow) Athletic, Mulligan & Kinesio® Place 2 nd & 3 rd digits through the diamonds and apply end of strip to palmar aspect of handPlace 2 nd & 3 rd digits through the diamonds and apply end of strip to palmar aspect of hand Apply single strip towards lateral epicondyle with appropriate stretchApply single strip towards lateral epicondyle with appropriate stretch –Protection, minimal –Strengthening, mod to max –Can also unload Mulligan lateral glideMulligan lateral glide

12 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 12 Taping for chronic Lateral Epicondylalgia Improvement in Grip & Pain Vicenzio B et al. Links Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther Jul;33(7):400-7.Vicenzio B et al. Links Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther Jul;33(7): The taping technique significantly improved pain- free grip strength by 24% from baseline (P =.028). The treatment effect was greater than that for placebo and control conditions. Changes in pressure pain threshold (19%), although positive, were not statistically significant.The taping technique significantly improved pain- free grip strength by 24% from baseline (P =.028). The treatment effect was greater than that for placebo and control conditions. Changes in pressure pain threshold (19%), although positive, were not statistically significant.

13 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 13 Kinesio® Taping for Lateral Epicondylalgia US Images Indicate Improved Motion Liu YH et al. Links Motion tracking on elbow tissue from ultrasonic image sequence for patients with lateral epicondylitis. Conf Proc IEEE Eng Med Biol Soc; 2007:95-8.Liu YH et al. Links Motion tracking on elbow tissue from ultrasonic image sequence for patients with lateral epicondylitis. Conf Proc IEEE Eng Med Biol Soc; 2007:95-8. The experimental results show that Kinesio® Taping makes the motion of muscle on the ultrasonic images enlarge. It means that the performance of muscle motion improves.The experimental results show that Kinesio® Taping makes the motion of muscle on the ultrasonic images enlarge. It means that the performance of muscle motion improves.

14 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 14 Medial Epicondylitis (Golfer’s Elbow) Kinesio® & Mulligan Same as lateral epicondyle with diamond cut-out, but over flexor groupSame as lateral epicondyle with diamond cut-out, but over flexor group Mulligan medial glideMulligan medial glide

15 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 15 Trigger Finger Athletic Training Facilitate extensionFacilitate extension Apply a ½ single strip with split tails around the involved distal phalanxApply a ½ single strip with split tails around the involved distal phalanx With the wrist and fingers in flexion, apply tape with a mod to max stretchWith the wrist and fingers in flexion, apply tape with a mod to max stretch

16 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 16 Mallet Finger Athletic Training Apply a ½ single strip to distal palmar aspect of involved digit and wrap around to the dorsal finger with no tensionApply a ½ single strip to distal palmar aspect of involved digit and wrap around to the dorsal finger with no tension While holding the distal phalanx in extension, apply maximum tension to approximately 1” distal to MCPWhile holding the distal phalanx in extension, apply maximum tension to approximately 1” distal to MCP Continue lying tape down with minimal tension with the finger flexedContinue lying tape down with minimal tension with the finger flexed Anchor tip of fingerAnchor tip of finger

17 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 17 Taping Fingers 1” or ½ single strip tape can be utilized for mallet/trigger /swan-neck/ boutonnière, tendonosis, immobilization.1” or ½ single strip tape can be utilized for mallet/trigger /swan-neck/ boutonnière, tendonosis, immobilization. –Tape according to what you want to accomplish: Extension of DIP – maximal stretch dorsal jointExtension of DIP – maximal stretch dorsal joint Normal motion of PIP – no stretchNormal motion of PIP – no stretch Flexion of DIP – maximal stretch volar jointFlexion of DIP – maximal stretch volar joint Collateral ligament protection / Unload one joint with space corrections on either side of joint, anchor the endsCollateral ligament protection / Unload one joint with space corrections on either side of joint, anchor the ends

18 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 18 Taping Fingers –Tape according to what you want to accomplish: Decrease strain on flexor tendon – tape with moderate stretch on volar surface of digit along muscleDecrease strain on flexor tendon – tape with moderate stretch on volar surface of digit along muscle Immobilize a digit – “Buddy Tape” two fingers together with two 1” stripsImmobilize a digit – “Buddy Tape” two fingers together with two 1” strips Space correction over entrapment siteSpace correction over entrapment site

19 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 19 Ulnar Collateral Ligament Sprain (Gamekeeper’s / Skier’s Thumb) Athletic Training & Kinesio® Technique Ligament correction to the ulnar side of the 1 st MCP with 1” or ½ straight strip with maximal stretchLigament correction to the ulnar side of the 1 st MCP with 1” or ½ straight strip with maximal stretch Second 1” strip in a figure 8 around the thumb and wrist to provide adduction pressureSecond 1” strip in a figure 8 around the thumb and wrist to provide adduction pressure Edema strips can be used in the acute phase for swellingEdema strips can be used in the acute phase for swelling

20 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 20 Clinical Evidence-Based Select pre/post test based on your purpose of taping:Select pre/post test based on your purpose of taping: –Pain rating scales (VAS)rating scales (VAS) % perceived improvement% perceived improvement at rest / re-test aggravating activitiesat rest / re-test aggravating activities –Strength testing grip / pinch dynamometergrip / pinch dynamometer Number of reps against a fixed resistance (endurance)Number of reps against a fixed resistance (endurance)

21 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 21 Clinical Evidence-Based AROM – increased range, improved painAROM – increased range, improved pain Dexterity Tests (standardized)Dexterity Tests (standardized) Functional ActivitiesFunctional Activities –Grip, lift, slice, chop, cut with scissors, typing, writing –ADL and occupational Outcome MeasuresOutcome Measures Volumetric MeasuresVolumetric Measures

22 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 22 Upper Quarter Summary Evidence-Based PracticeEvidence-Based Practice –Research is limited to lower tiers of pyramid Small Subject Size, Case StudiesSmall Subject Size, Case Studies Significant portion based on “normal” subjectsSignificant portion based on “normal” subjects Lacking Large Subject, RCT, published in peer- reviewed journalsLacking Large Subject, RCT, published in peer- reviewed journals Very few articles comparing similar techniquesVery few articles comparing similar techniques –Utilize Objective Measures (* Sign) to document efficacy and validate use –Tape for function, then pain (pain generally follows function)

23 Scott & Dyanna Rezac - Taping Elbow, Wrist & Hand 23 Questions, Comments, Discussion


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