Skip to main content
SpringerLink
Log in

Proprioception After Elbow Injury, Surgery, and Rehabilitation

  • Chapter
  • First Online:
Proprioception in Orthopaedics, Sports Medicine and Rehabilitation

Abstract

Upper extremities do fine motor activities on a daily basis with high precision. In daily life, many activities such as writing, using computer, eating and dressing are being done repetitively. In order to do these activities function of elbow joint leads to change in hand position with flexion, extension, pronation and supination movements. To achieve this much preciseness in movement, proprioception is the key element. Even though elbow proprioception is not investigated comprehensively, it is a crucial element in rehabilitation of the whole arm.

Injuries to the elbow, affect structural elements providing integrity including proprioceptive afferents. Depending on injury severity, treatment options may include surgery or conservative treatment. In conservative approach it is important to know the proprioception concepts and proprioceptive structures besides elbow anatomy and mechanics. In rehabilitation phase, therapists should be aware of proprioceptive loss. In this chapter, elbow proprioception concept involving assessment methods and applications is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Neumann DA. Kinesiology of the musculoskeletal system-E-book: foundations for rehabilitation. London: Elsevier Health Sciences; 2013.

    Google Scholar 

  2. Werner FW, An KN. Biomechanics of the elbow and forearm. Hand Clin. 1994;10(3):357–73.

    CAS  PubMed  Google Scholar 

  3. Cooper JE, Shwedyk E, Quanbury AO, Miller J, Hildebrand D. Elbow joint restriction: effect on functional upper limb motion during performance of three feeding activities. Arch Phys Med Rehabil. 1993;74(8):805–9. https://doi.org/10.1016/0003-9993(93)90005-U.

    Article  CAS  PubMed  Google Scholar 

  4. Brukner P. Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill; 2012.

    Google Scholar 

  5. Skirven TM, Osterman AL, Fedorczyk J, Amadio PC. Rehabilitation of the hand and upper extremity, 2-volume set E-book: expert consult. London: Elsevier Health Sciences; 2011.

    Google Scholar 

  6. Shumway-Cook A, Woollacott MH. Motor control: theory and practical applications. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  7. Ghez C, Krakauer J. Voluntary movement. Princ Neural Sci. 1991;3:609–25.

    Google Scholar 

  8. Regan WD, Korinek SL, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop Relat Res. 1991;271:170–9.

    Google Scholar 

  9. Dugas JR, Ostrander RV, Cain EL, Kingsley D, Andrews JR. Anatomy of the anterior bundle of the ulnar collateral ligament. J Shoulder Elb Surg. 2007;16(5):657–60. https://doi.org/10.1016/j.jse.2006.11.009.

    Article  Google Scholar 

  10. Callaway GH, Field LD, Deng XH, Torzilli PA, O'Brien SJ, Altchek DW, et al. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am. 1997;79(8):1223–31.

    Article  CAS  PubMed  Google Scholar 

  11. Olsen BS, Søjbjerg JO, Dalstra M, Sneppen O. Kinematics of the lateral ligamentous constraints of the elbow joint. J Shoulder Elb Surg. 1996;5(5):333–41. https://doi.org/10.1016/S1058-2746(96)80063-2.

    Article  CAS  Google Scholar 

  12. Goodwin GM, McCloskey DI, Matthews PB. Proprioceptive illusions induced by muscle vibration: contribution by muscle spindles to perception? Science (New York, NY). 1972;175(4028):1382–4.

    Article  CAS  Google Scholar 

  13. Burke D, Hagbarth KE, Lofstedt L, Wallin BG. The responses of human muscle spindle endings to vibration of non-contracting muscles. J Physiol. 1976;261(3):673–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Roll JP, Vedel JP. Kinaesthetic role of muscle afferents in man, studied by tendon vibration and microneurography. Exp Brain Res. 1982;47(2):177–90.

    Article  CAS  PubMed  Google Scholar 

  15. Ferrell WR, Gandevia SC, McCloskey DI. The role of joint receptors in human kinaesthesia when intramuscular receptors cannot contribute. J Physiol. 1987;386:63–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Edin BB. Cutaneous afferents provide information about knee joint movements in humans. J Physiol. 2001;531(Pt 1):289–97. https://doi.org/10.1111/j.1469-7793.2001.0289j.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Edin BB, Abbs JH. Finger movement responses of cutaneous mechanoreceptors in the dorsal skin of the human hand. J Neurophysiol. 1991;65(3):657–70.

    Article  CAS  PubMed  Google Scholar 

  18. Martin JH, Jessell TM. Modality coding in the somatic sensory system. Princ Neural Sci. 1991;3:341–52.

    Google Scholar 

  19. Yahia LH, Rhalmi S, Newman N, Isler M. Sensory innervation of human thoracolumbar fascia. Acta Orthop Scand. 1992;63(2):195–7. https://doi.org/10.3109/17453679209154822.

    Article  CAS  PubMed  Google Scholar 

  20. Rothwell JC. Control of human voluntary movement. Netherlands: Springer Science & Business Media; 2012.

    Google Scholar 

  21. Röijezon U, Clark NC, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 1: basic science and principles of assessment and clinical interventions. Man Ther. 2015;20(3):368–77.

    Article  PubMed  Google Scholar 

  22. Peck D, Buxton DF, Nitz A. A comparison of spindle concentrations in large and small muscles acting in parallel combinations. J Morphol. 1984;180(3):243–52. https://doi.org/10.1002/jmor.1051800307.

    Article  CAS  PubMed  Google Scholar 

  23. Kulkarni V, Chandy M, Babu K. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India. 2001;49(4):355.

    CAS  PubMed  Google Scholar 

  24. Banks RW. An allometric analysis of the number of muscle spindles in mammalian skeletal muscles. J Anat. 2006;208(6):753–68. https://doi.org/10.1111/j.1469-7580.2006.00558.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gordon J, Ghez C. Muscle receptors and spinal reflexes: the stretch reflex. Princ Neural Sci. 1991;3:565–80.

    Google Scholar 

  26. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev. 2012;92(4):1651–97. https://doi.org/10.1152/physrev.00048.2011.

    Article  CAS  PubMed  Google Scholar 

  27. Petrie S, Collins JG, Solomonow M, Wink C, Chuinard R, D'Ambrosia R. Mechanoreceptors in the human elbow ligaments. J Hand Surg Am. 1998;23(3):512–8. https://doi.org/10.1016/s0363-5023(05)80470-8.

    Article  CAS  PubMed  Google Scholar 

  28. Burgess PR, Clark FJ. Characteristics of knee joint receptors in the cat. J Physiol. 1969;203(2):317–35. https://doi.org/10.1113/jphysiol.1969.sp008866.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sojka P, Johansson H, Sjölander P, Lorentzon R, Djupsjöbacka M. Fusimotor neurones can be reflexy influenced by activity in receptor afferents from the posterior cruciate ligament. Brain Res. 1989;483(1):177–83. https://doi.org/10.1016/0006-8993(89)90051-6.

    Article  CAS  PubMed  Google Scholar 

  30. Johansson H. The anterior cruciate ligament: a sensor action on the γ-muscle-spindle systems muscles around the knee joints. Neuro-Orthopedics. 1990;9:1–23.

    Google Scholar 

  31. Needle AR, Swanik CB, Farquhar WB, Thomas SJ, Rose WC, Kaminski TW. Muscle spindle traffic in functionally unstable ankles during ligamentous stress. J Athl Train. 2013;48(2):192–202. https://doi.org/10.4085/1062-6050-48.1.09.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cohen MS, Bruno RJ. The collateral ligaments of the elbow: anatomy and clinical correlation. Clin Orthop Relat Res. 2001;383:123–30.

    Article  Google Scholar 

  33. Sabick MB, Torry MR, Lawton RL, Hawkins RJ. Valgus torque in youth baseball pitchers: a biomechanical study. J Shoulder Elb Surg. 2004;13(3):349–55. https://doi.org/10.1016/s1058274604000308.

    Article  Google Scholar 

  34. Williams RJ 3rd, Urquhart ER, Altchek DW. Medial collateral ligament tears in the throwing athlete. Instr Course Lect. 2004;53:579–86.

    PubMed  Google Scholar 

  35. Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ. Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 2001;83-a(12):1823–8.

    Article  CAS  PubMed  Google Scholar 

  36. O'Driscoll SW, Jupiter JB, King GJW, Hotchkiss RN, Morrey BF. The unstable elbow. JBJS. 2000;82(5):724.

    Article  Google Scholar 

  37. Freivalds A. Biomechanics of the upper limbs: mechanics, modeling and musculoskeletal injuries. London: CRC press; 2011.

    Google Scholar 

  38. Snijders CJ, Volkers A, Mechelse K, Vleeming A. Provocation of epicondylalgia lateralis (tennis elbow) by power grip or pinching. Med Sci Sports Exerc. 1987;19(5):518–23.

    Article  CAS  PubMed  Google Scholar 

  39. Hong Y, Bartlett R. Routledge handbook of biomechanics and human movement science. Londres: Routledge; 2008.

    Google Scholar 

  40. Dhillon MS, Bali K, Vasistha RK. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). Int Orthop. 2010;34(5):737–41. https://doi.org/10.1007/s00264-009-0948-1.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bali K, Dhillon MS, Vasistha RK, Kakkar N, Chana R, Prabhakar S. Efficacy of immunohistological methods in detecting functionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):75–80. https://doi.org/10.1007/s00167-011-1526-9.

    Article  PubMed  Google Scholar 

  42. Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. Phys Ther. 1989;69(2):106–12. https://doi.org/10.1093/ptj/69.2.106.

    Article  CAS  PubMed  Google Scholar 

  43. Borsa PA, Lephart SM, Irrgang JJ, Safran MR, Fu FH. The effects of joint position and direction of joint motion on proprioceptive sensibility in anterior cruciate ligament-deficient athletes. Am J Sports Med. 1997;25(3):336–40. https://doi.org/10.1177/036354659702500311.

    Article  CAS  PubMed  Google Scholar 

  44. Willems T, Witvrouw E, Verstuyft J, Vaes P, De Clercq D. Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability. J Athl Train. 2002;37(4):487–93.

    PubMed  PubMed Central  Google Scholar 

  45. Fusaro I, Orsini S, Kantar SS, Sforza T, Benedetti M, Bettelli G, et al. Elbow rehabilitation in traumatic pathology. Musculoskelet Surg. 2014;98(1):95–102.

    Article  PubMed  Google Scholar 

  46. James RY, Throckmorton TW, Bauer RM, Watson JT, Weikert DR. Management of acute complex instability of the elbow with hinged external fixation. J Shoulder Elb Surg. 2007;16(1):60–7.

    Article  Google Scholar 

  47. Ettinger LR, Shapiro M, Karduna A. Subacromial Anesthetics increase proprioceptive deficit in the shoulder and elbow in patients with subacromial impingement syndrome. Clin Med Insights Arthritis Musculoskelet Disord. 2017;10:1179544117713196.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Safran MR, Caldwell GL Jr, Fu FH. Proprioception considerations in surgery. J Sport Rehabil. 1994;3(1):105–15.

    Article  Google Scholar 

  49. Riemann BL, Myers JB, Lephart SM. Sensorimotor system measurement techniques. J Athl Train. 2002;37(1):85–98.

    PubMed  PubMed Central  Google Scholar 

  50. Clark NC, Röijezon U, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 2: clinical assessment and intervention. Man Ther. 2015;20(3):378–87. https://doi.org/10.1016/j.math.2015.01.009.

    Article  PubMed  Google Scholar 

  51. Lephart SM, Warner JJP, Borsa PA, Fu FH. Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders. J Shoulder Elb Surg. 1994;3(6):371–80. https://doi.org/10.1016/S1058-2746(09)80022-0.

    Article  CAS  Google Scholar 

  52. Benjaminse A, Sell TC, Abt JP, House AJ, Lephart SM. Reliability and precision of hip proprioception methods in healthy individuals. Clin J Sport Med. 2009;19(6):457–63. https://doi.org/10.1097/JSM.0b013e3181bcb155.

    Article  PubMed  Google Scholar 

  53. Waddington G, Adams R, Jones A. Wobble board (ankle disc) training effects on the discrimination of inversion movements. Aust J Physiother. 1999;45(2):95–101. https://doi.org/10.1016/S0004-9514(14)60341-X.

    Article  PubMed  Google Scholar 

  54. Waddington G, Seward H, Wrigley T, Lacey N, Adams R. Comparing wobble board and jump-landing training effects on knee and ankle movement discrimination. J Sci Med Sport. 2000;3(4):449–59. https://doi.org/10.1016/S1440-2440(00)80010-9.

    Article  CAS  PubMed  Google Scholar 

  55. Kristjansson E, Oddsdottir GL. “The fly”: a new clinical assessment and treatment method for deficits of movement control in the cervical spine: reliability and validity. Spine. 2010;35(23):E1298–E305. https://doi.org/10.1097/BRS.0b013e3181e7fc0a.

    Article  PubMed  Google Scholar 

  56. Dover G, Powers ME. Reliability of joint position sense and force-reproduction measures during internal and external rotation of the shoulder. J Athl Train. 2003;38(4):304–10.

    PubMed  PubMed Central  Google Scholar 

  57. O'Leary SP, Vicenzino BT, Jull GA. A new method of isometric dynamometry for the craniocervical flexor muscles. Phys Ther. 2005;85(6):556–64.

    PubMed  Google Scholar 

  58. Schmidt RA, Lee TD. Motor control and learning: a behavioral emphasis. Champaign, IL: Human Kinetics; 2005.

    Google Scholar 

  59. Nagai T, Sell TC, Abt JP, Lephart SM. Reliability, precision, and gender differences in knee internal/external rotation proprioception measurements. Phys Ther Sport. 2012;13(4):233–7. https://doi.org/10.1016/j.ptsp.2011.11.004.

    Article  PubMed  Google Scholar 

  60. Preuss R, Grenier S, McGill S. The effect of test position on lumbar spine position sense. J Orthop Sports Phys Ther. 2003;33(2):73–8. https://doi.org/10.2519/jospt.2003.33.2.73.

    Article  PubMed  Google Scholar 

  61. Suprak DN, Osternig LR, van Donkelaar P, Karduna AR. Shoulder joint position sense improves with external load. J Mot Behav. 2007;39(6):517–25. https://doi.org/10.3200/JMBR.39.6.517-525.

    Article  PubMed  Google Scholar 

  62. Goble DJ. Proprioceptive acuity assessment via joint position matching: from basic science to general practice. Phys Ther. 2010;90(8):1176–84. https://doi.org/10.2522/ptj.20090399.

    Article  PubMed  Google Scholar 

  63. Lakie M, Walsh EG, Wright GW. Resonance at the wrist demonstrated by the use of a torque motor: an instrumental analysis of muscle tone in man. J Physiol. 1984;353(1):265–85. https://doi.org/10.1113/jphysiol.1984.sp015335.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Boyer MI. Green's operative hand surgery. J Hand Surg. 1999;24(3):649.

    Article  Google Scholar 

  65. Kaltenborn FM, Evjenth O. Manual mobilisation of the extremity joints: basic examination and treatment techniques. Oslo Norway: O.N. Bokenhandel; 1989.

    Google Scholar 

  66. Chinchalkar SJ, Szekeres M. Rehabilitation of elbow trauma. Hand Clin. 2004;20(4):363–74. https://doi.org/10.1016/j.hcl.2004.06.004.

    Article  PubMed  Google Scholar 

  67. Ramachandran VS, Altschuler EL. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009;132(7):1693–710.

    Article  CAS  PubMed  Google Scholar 

  68. Wilk KE, Arrigo C, Andrews JR. Rehabilitation of the elbow in the throwing athlete. J Orthop Sports Phys Ther. 1993;17(6):305–17.

    Article  CAS  PubMed  Google Scholar 

  69. Wilk KE, Arrigo CA, Andrews JR, Azar FM. Rehabilitation following elbow surgery in the throwing athlete. Oper Tech Sports Med. 1996;4(2):114–32.

    Article  Google Scholar 

  70. Wilk KE, Voight ML, Keirns MA, Gambetta V, Andrews JR, Dillman CJ. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993;17(5):225–39. https://doi.org/10.2519/jospt.1993.17.5.225.

    Article  CAS  PubMed  Google Scholar 

  71. Huang Q, Li D, Yokotsuka N, Zhang Y, Ubukata H, Huo M, et al. The intervention effects of different treatment for chronic low back pain as assessed by the cross-sectional area of the multifidus muscle. J Phys Ther Sci. 2013;25(7):811–3.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Huo M, Maruyama H, Kaneko T, Naito D, Koiso Y. The immediate effect of lumbar spine patterns of neuromuscular joint facilitation in young amateur baseball players. J Phys Ther Sci. 2013;25(12):1523–4.

    Article  PubMed  Google Scholar 

  73. Huang Q, Wang K-Y, Yu L, Zhou Y, Gu R, Cui Y, et al. Evaluation of the effects of different treatments for the elbow joint using joint proprioception and surface electromyography. J Phys Ther Sci. 2015;27(12):3907–9.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Khabie V, Schwartz MC, Rokito AS, Gallagher MA, Cuomo F, Zuckerman JD. The effect of intraarticular anesthesia and elastic bandage on elbow proprioception. J Shoulder Elb Surg. 1998;7(5):501–4.

    Article  CAS  Google Scholar 

  75. Bae Y-S. Effects of spiral taping on proprioception in subjects with unilateral functional ankle instability. J Phys Ther Sci. 2017;29(1):106–8. https://doi.org/10.1589/jpts.29.106.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Long Z, Wang R, Han J, Waddington G, Adams R, Anson J. Optimizing ankle performance when taped: effects of kinesiology and athletic taping on proprioception in full weight-bearing stance. J Sci Med Sport. 2017;20(3):236–40.

    Article  PubMed  Google Scholar 

  77. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol. 2012;22(5):768–76. https://doi.org/10.1016/j.jelekin.2012.02.012.

    Article  PubMed  Google Scholar 

  78. Barrett D, Cobb A, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br. 1991;73(1):53–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey

    Tüzün Firat Ph.D., M.Sc., P.T. & Özgün Uysal P.T.

Authors
  1. Tüzün Firat Ph.D., M.Sc., P.T.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Özgün Uysal P.T.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tüzün Firat Ph.D., M.Sc., P.T. .

Editor information

Editors and Affiliations

  1. Department of Physiotherapy and Rehabilitation, Uskudar University, Faculty of Health Sciences, Istanbul, Turkey

    Defne Kaya

  2. Department of Physiotherapy and Rehabilitation, Baskent University, Faculty of Health Sciences, Baglıca/Ankara, Turkey

    Baran Yosmaoglu

  3. Faculty of Medicine, Department of Orthopedics and Traumatology, Ufuk University, Ankara, Turkey

    Mahmut Nedim Doral

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Firat, T., Uysal, Ö. (2018). Proprioception After Elbow Injury, Surgery, and Rehabilitation. In: Kaya, D., Yosmaoglu, B., Doral, M. (eds) Proprioception in Orthopaedics, Sports Medicine and Rehabilitation. Springer, Cham. https://doi.org/10.1007/978-3-319-66640-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-66640-2_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66639-6

  • Online ISBN: 978-3-319-66640-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation