Elbow

Regional Interdependence and UCL Tears

The following is a guest post from one of my entry level DPT students, Matt Tuttle.

Regional interdependence is defined by Wainner et al. as “the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint”. This hypothesis is gaining support due to an increase in the literature linking joints such as the hip/knee, thoracic spine/shoulder, and cervical/thoracic spine. Much of the current literature focuses on relationships between adjacent joints however recent evidence is beginning to investigate joints farther away.

In the October issue of JOSPT Garrison JC et al published an interesting study investigating a possible relationship between balance and UCL tears in baseball players. They looked at sixty male high school and collegiate baseball players in a cross sectional study. The study compared thirty players with a UCL tear to thirty players without a history of UCL tear. Participant’s balance was assessed with the Y-Balance Test. The results showed significantly less balance on lead and stance legs as well as a decrebalancease in total shoulder rotational motion in patients with UCL tears. The difference in composite Y-Balance Test scores between the two groups was 6.7 on the lead limb and 7.2 on the stance limb. The total rotation difference between groups was 5.6 degrees. A related study by Feigenbaum, LA also found a relationship between a distant body part (foot arch) and injury in baseball player’s upper extremities. As studies continue to emerge they may lead clinicians to investigate distant impairments that may have a relationship with their current complaint.

After a brief review of these two studies several questions come to mind. Is there an association present or is this simply a coincidence? If so, what are possible mechanisms for this association? A clinical question also comes to mind, should balance and foot arch posture be screened in baseball players and do you believe it could make a difference in upper extremity injury rates? Feel free to discuss these or any other questions in the comment section

Matt Tuttle, SPT

  Matt is a third year Doctor of Physical Therapy student at State University ofHeadShotTPI-1 New York- Upstate Medical   University in Syracuse, New York. He will be graduating this May following his upcoming clinical rotations based in Nashville, TN and Glens Falls, NY. Following graduation he plans on attending a sports and orthopedic based residency programs.  He particularly enjoys treating a  sports and orthopedic population and improving patients functional movements.

1.      Wainner RS, Whitman JM, Cleland J a, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. The Journal of Orthopedic & Sports Physical Therapy. 2007;37(11):658–60.

2.      Fukuda TY, Rossetto FM, Magalhães E et al. Short-term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. J. Orthop. Sports Phys. Ther. 2010;40(11):736–42

3.      Sueki DG, Chaconas EJ. The effect of thoracic manipulation on shoulder pain: a regional interdependence model. Phys. Ther. Rev. 2011;16(5):399–408.

4.      Cleland J a, Childs JD, McRae M, Palmer J a, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man. Ther. 2005;10(2):127–35

5.      Kibler WB, Sciascia A. Kinetic chain contributions to elbow function and dysfunction in sports. Clin Sports Med. 2004;23:545–552

6.      Garrison JC, Arnold A, Macko MJ, Conway JE. Baseball Players Diagnosed With Ulnar Collateral Ligament Tears Demonstrate Decreased Balance Compared to Healthy Controls. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(10):752–758.

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Categories: Elbow, research

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2 replies »

  1. I use the term inter-regional inter-dependence, did a very brief presentation at the October 2013 AAOMPT. An area that fascinates regarding this topic is that of reflex relationships that interact with biomechanical.

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