1. OMM for Repetitive Use Injuries of the Upper Extremity - Elbow Pain
Developed for OUCOM CORE
by Brad Werrell, D.O.
Edited by David Eland, D.O.
and the
CORE Osteopathic Principles and Practices Committee
Session #8 – Series B

2. History of Illness
Insidious onset of pain
Progressive course
Exacerbated by certain actions, with a history of repetition of those actions over time
Alleviated by rest
No paresthesias
No acute trauma

3. Examination Through Observation
Have patient demonstrate the location of the pain, and the motion which exacerbates that pain.
2. Compare the injured limb to the uninjured limb.
Make note of structural, pigmentary and soft tissue differences by observation.
3. Observe the habitual function of the joint proximal to the injured joint.

4. Examination Through Palpation
Palpate the bones – check for tenderness to palpation:
Medial and lateral epicondyles
Radial head
Olecranon process of the ulna
Palpate soft tissues:
For bogginess
For tenderness
For temperature

5. Examination Through Palpation
Positional diagnosis of the radial head
Posterior vs Anterior
Fluctuance
Fluid in the joint or bursa
Tenderness
-- Temperature Changes

6. Functional Examination
Active Range of Motion
Elbow Flexion and Extension
Forearm supination and pronation
Look for:
Limitations of range of motion
Pain with motion

7. Passive Range of Motion
Elbow flexion and extension
Forearm supination and pronation
Range of motion (compare sides)
End-feel of motion

8. Neurologic Examination
1. Tinnel’s Test of the Olecranon Tunnel
- Tinnel’s Test of the Carpal Tunnel
2. Evaluation of the sense of touch comparing both upper extremities
3. Brachioradialis reflex bilaterally
- Triceps reflex bilaterally
4. Observation of the hands and wrists for muscular wasting

9. Ligamentous Articular Release
Treatment Options
HVLA
Muscle Energy
Counterstrain
Ligamentous Articular Release
Functional Technique

10. Radial Head dysfunction Active Tenderpoint
Potential Diagnoses
Radial Head dysfunction
Active Tenderpoint
Ligamentous Articular Strain
Medial/Lateral Epicondylitis

11. HVLA of the Posterior Radial Head

12. HVLA of the Anterior Radial Head

13. Ligamentous Articular Release of the Elbow

14. Counterstrain Treatment of the Radial Tenderpoint

15. Counterstrain Treatment of the Medical Coronoid Process Tenderpoint

16. Counterstrain Treatment of the Lateral Coronoid Tenderpoint

17. Counterstrain Treatment of the Medical Olecranon Tenderpoint

18. Counterstrain Treatment of the Lateral Olecranon Tenderpoint

19. References
Counterstrain: A Handbook of Osteopathic Technique, Herbert A. Yates, D.O., F.A.A.O. and John Glover, D.O., F.A.A.O.; Y Knot Publishers, Tulsa, OK, 1995.
Foundations for Osteopathic Medicine, Robert C. Ward, D.O., F.A.A.O., Williams & Wilkins, Baltimore, MD, 1997 (1st Edition); 2003 (2nd Edition).
OMT Review, Robert G. Savarese, D.O., Robert G. Savarese, D.O., USA, 2003.
An Osteopathic Approach to Diagnosis and Treatment, Eileen L. DiGiovanna, D.O., F.A.A.O., Lippincott Williams & Wilkins, Philadelphia, 2005.
View-OMT Osteopathic Multimedia Reference Collection, Bradley H. Werrell, D.O., Bamboo Data Systems, Inc., Ashburn VA, 2006.