Instrument assisted soft tissue mobilization (IASTM) is a very effective and powerful treatment modality that addresses a variety of soft tissue dysfunction. It is utilized on a daily basis in my hand/upper extremity clinic with much success. Addressing soft tissue restriction is imperative to excellent clinical outcomes, as demonstrated by the following case study on elbow dislocation.
The patient is a 44-year-old right-handed male who presented six weeks and four days post-left posterior elbow dislocation, with multiple musculoskeletal injuries. The clinical examination identified: c/o mechanical pain along proximal radio-ulnar joint (PRUJ) 6/10 at end range of motion (EROM) elbow flexion/extension, tenderness at coracoid process of scapula, and constant median nerve paresthesias, negative valgus/varus stress test, – radiocapitellar dysfunction, + Tinel’s sign at TRL.
His range-of-motion (ROM) values (Figure 1) were: elbow flexion 110 degrees – 40 degrees extension (capsular end feel), forearm supination/pronation 85/75 with soft end feel (passive range of motion greater than active range).
Tissue Assessment & Treatment
The soft tissue assessment included scanning the shoulder, upper arm, and forearm. Significant superficial gritty soft tissue restrictions noted in biceps, muscle belly and musculotendinous junction. Adaptive shortening from six weeks and four days in a sling. Soft tissue restrictions noted after scanning at bicipital aponeurosis and decreased activation of triceps.
The treatment plan included moist heat, IASTM utilizing HawkGrips (Figure 2) and proprioceptive/therapeutic exercise. There was significant soft tissue reaction and release at the antecubital fossa/brachioradialis proximally. The patient was seen twice a week for six weeks along with completion of a home exercise program (HEP).
The following measures were taken at discharge: no report of pain, paresthesia in left upper extremity, 140 degrees active elbow flexion – 10 degrees active elbow extension with no limitation in forearm rotation (Figure 3). The patient’s goals were met and he successfully returned to all occupations.
Every patient we treat has unique and individual concerns. To be effective clinicians in our healthcare system today, we must be efficient. Multiple treatment modalities were utilized in the care of this individual. Addressing the soft tissue passive and dynamic stabilizers in this case made all the difference. IASTM with HawkGrips instruments helped this individual regain function following elbow dislocation in a much more effective and efficient manner.
Dr. Jim Wagner is an occupational therapist and certified hand therapist who has specialized in treating upper-extremity and sports-related injuries for 24 years. He is currently team leader at the hand/upper-extremity center of The Guthrie Clinic in Sayre, PA, as well as an adjunct professor in the occupational therapy programs at both Keuka College in Keuka Park, NY, and Ithaca College in Ithaca, NY.
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