Basic DImensions Outer dia. Normal ROM is considered approximately 180° (80°-90° pronation and 90° supination). A basic understanding of biomechanics of tennis and analysis of the forces, loads and motions of the elbow during tennis will improve the understanding of the pathophysiology of these injuries. Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. When the elbow is straightened fully (figure 2), soft tissue is compressed at the back of the joint. During these simple movements consider the muscles proximally to distally. The elbow is a highly complex structure consisting of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. Competitive Swimming Prevalence US Swimming Population: 100-120 million 250,000+ registered with USA swimming. If better preventive and re- habilitative programs are to be de- veloped, it is important to under- stand the biomechanics of the pitch- ing motion. Biomechanical studies on hand function in rehabilitation. Hutting N, Johnston V, Staal JB, Heerkens YF. The anterior band is more taught in extension and relaxes into flexion and the posterior band is taught in flexion and releases in extension. An explanation for this might be due to the biomechanics of the elbow described by Roetert et al. Disclosures Mobilization And Manipulation Of The Elbow. Manual therapy at the cervical and thoracic regions have also shown to provide clinical benefits in LET management. Corticosteroid injections may not be appropriate as a first-line intervention for lateral elbow tendinopathy, Centrally Acting Analgesics- may be appropriate for patients with central sensitisation, Prolotherapy and Nitric Oxide patches- possibly more beneficial in patients with more chronic LET of more than 3 months, There is moderate evidence that manual therapy can have immediate beneficial effects on pain and grip strength. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. A to z of wrist complex by usman. This section is a review of basic spine biomechanics. Stresses across the elbow joint have been measured during the overhead throwing motion. This can also occur when falling down with an outstretched hand. There are also partial elbow replacements, which may be used in very specific situations.  Treatment should be aimed not only at the local elbow structures found on assessment but at all the contributing factors identified during the examination. Biomechanics of overhand throwing with implications for injuries. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Während die anteriore Luxation des Sternoklavikulargelenks wesentlich häufiger auftritt, können posteriore Luxationen mit vital bedrohlichen Begleitverletzungen vergesellschaftet sein. It is the point of articulation of three bones: the humerus of the arm and the radius and the ulna of the forearm. Shoulder joint glenohumeral joint 3d anatomy tutorial youtube. Electrophysiological Techniques For Clinical Diagnosis.  Alternatively, a loss of glenohumeral internal rotation range of motion may result in an increase in forearm pronation. The elbow joint is a complex structure that acts as an important mechanical link in the upper extremity between the shoulder and wrist . In our practice, a working knowledge of biomechanics has been extremely important and rewarding. The capitellum of the lateral distal humerus is a spherical structure onto which the concave surface of the proximal radial head articulates. There is sometimes more than one lever system operating at the joint. Physiotherapy has an important role to play in the management of pain and dysfunction around the elbow joint.  It has been shown in various studies that structures distant to the elbow contribute to the development of elbow pain and dysfunction. The passive stabilizers include the bony articular geometry and the soft tissue stabilizers. An example being if there is a loss of glenohumeral lateral rotation range of motion there may be an increase in forearm supination or valgus as a compensatory strategy. If pronation ROM is lost this can be compensated by using shoulder abduction. Original Editor – Vinit Kothekar. General health and red flag screening are important to exclude any serious pathologies as well as indicate if any co-morbidities may be contributing to the condition. Biomechanics is the term used to describe movement of the body. Wrist biomechanics. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The elbow joint is one example. Swimming Biomechanics & Treatment Approach UW Health Sports Rehabilitation Beth Chorlton, MA, LAT 3/11/2011. Torque is the turning effect of a force, calculated as the product of a force ( F ) and its moment arm ( MA ), written mathematically as T = F × MA . 151 plays. A bursa is a membranous sac filled with synovial fluid. The question describes preventing rotation of the forearm/hand at the elbow joint, which means to maintain ΣT = 0 at the elbow joint. The Annular ligament surrounds the radial head but does not attach to it. This section is a review of basic elbow biomechanics.  A study conducted by Maxwell and Sterling in 2013 on patients with neck pain showed that a Numeric Pain rating scale of greater than 5 after a 10-second application of ice to the neck is a good indicator of cold hyperalgesia. Foodie. Y1 - 1994/1/1 . Lenin of the rovers download. These joints are called the sacroiliac joints. Physiotherapists are integral in the management of conditions around the elbow. The sacroiliac joints play a role in transferring the weight of the spine and upper body to the pelvis and legs. Rehabilitation Of The Elbow Musculoskeletal Key. This in itself is strong and fibrous, strengthening the joint. Your elbow joint is made up of bone cartilage ligaments and fluid. 1Citations. The elbow joint is classified structurally as a synovial joint.It is also classified structurally as a compound joint, as there are two articulations in the joint. Cold hyperalgesia associated with poorer prognosis in lateral epicondylalgia: a 1-year prognostic study of physical and psychological factors. Figure 1 – Elbow Impingement Anatomy. Observation from the act of holding the cup: Weight transfer … Bio mechanics of the wrist and hand | thumb | anatomical terms of. Stability of the elbow joint: relevant anatomy and clinical.  Central sensitisation can be a cause of hyperalgesia and altered pain processing at the elbow. Downstream. Joint Biomechanics Definitions: Joint reaction force defined as force generated within a joint in response to forces acting on the joint in the hip, it is the result of the need to balance the moment arms of the body weight and abductor tension ; maintains a level pelvis; Coupled forces Biomechanics of elbow instability: the role of the medial collateral ligament. Regular price £45.00.  Lateral epicondylalgia or tennis elbow is a common cause of lateral elbow pain but it is not the only cause. Wrist and hand physiopedia. Due to its complexity, even after severe injury, it is more prone to stiffness than instability. Excessive movement or force applied to the elbow can injure these structures. The elbow joint is a trochoginglymoid joint: that is, it has flexion-extension [ginglymoid] motion at the ulnohumeral and radiocapitellar articulations and pronation and supination [trochoid] motion at the proximal radioulnar joint. Org. Anterior dislocations can occur for example when the hand is held above the head with the elbows bent and a force is applied to the elbow anteriorly. The normal range of movement is from 0-140° but only 30°-130° is required for most ADLs, The radiocapitellar joint and proximal radioulnar joint are responsible for pronation and supination. 100° of movement (50° pronation and 50° supination) is considered adequate for most ADLs. There are thickening medially and laterally of the joint capsule that blensd with the MCLC and LCLC respectively and contributes tothe stability of the elbow. https://www.youtube.com/watch?v=I1XEPBTjYVY, http://www.youtube.com/watch?v=8Yt48Y0UMBU, https://www.physio-pedia.com/index.php?title=Elbow&oldid=233872. Lateral Epicondylitis Physiopedia In comparative anatomy the term ectepicondyle is sometimes used. The biomechanics of the elbow joint can be divided into kinematics, stabilizing structures in elbow stability, and force transmission through the elbow joint. Nuzzled. Featured items. The three joints of the elbow include: Ulnohumeral joint is where movement between the ulna and humerus occurs. Stability of the elbow joint is achieved through static and dynamic components. Management of lateral elbow tendinopathy: one size does not fit all. Please read the section on basic elbow anatomy before reading this section. practice in controlling forces around the elbow joint, learn how to reduce co-activation of muscles involved in the control of this joint. Due to its complexity, even after severe injury, it is more prone to stiffness than instability. INTRODUCTION • The joints and muscles of the elbow complex are designed to serve the hand. A basic understanding of biomechanics of tennis and analysis of the forces, loads and motions of the elbow during tennis will improve the understanding of the pathophysiology of these injuries. [Epub ahead of print] Elbow Biomechanics, Radiocapitellar Joint Pressure, and Interosseous Membrane Strain Before and After Radial Head Arthroplasty. The biomechanics of the elbow joint can be divided into kinematics, stabilizing structures in elbow stability, and force transmission through the elbow joint. The elbow joint primarily comprises of the articulation of two bones, the humerus (upper arm bone) and the ulna (inner forearm bone – figure 1). Biomechanics of the flexor tendons. FEATURES Ceramic cup with a handle. A comprehensive physical examination is performed to confirm or negate your potential hypothesis formed after the subjective examination. Traumatische Verletzungen des Sternoklavikulargelenks sind selten und entstehen überwiegend indirekt im Rahmen eines Hochrasanztraumas. The hinge of the elbow opens up another … Exercise therapy has the best evidence for good treatment outcomes in lateral epicondylalgia.  This centrally mediated process is important to identify as standard peripheral biomechanical based treatment may not be as effective in patients presenting with symptoms of central sensitisation. Isometrics may produce an analgesic effect and in general, exercises that are centred around loading the tendon should not aggravate the pain. The elbow goes through rapid extension in baseball pitching (about 2400 degrees/s) and rapid flexion in the javelin throw (about 1900 degrees/s). The biomechanics of the elbow joint are all affected by the bones, muscles and ligaments involved . • They provide mobility for the hand in space by shortening and lengthening the upper extremity. 350Downloads. , The radiocapitellar joint is where the radius and humerus articulate. This assessment will help them develop a multi-modal treatment approach that is individualised to the specific problems and contributing factors found in the assessment. The peripheral edge of the radial head articulates with the radial notch of the ulna. Brukner & Khan's Clinical sports medicine. Ergonomic evaluation of biomechanical hand function semantic. Medial Collateral Ligament Complex (MCLC), The MCLC is comprised of the anterior bundle, posterior bundle and transverse ligament (the ligament of Cooper). The other conditions found around the elbow have not been as widely researched and evidence-based practice for those conditions may be more focused on general clinical experience than on specific researched evidence. Exclude. Optimal loads have not yet been established and various subgroups of patients may benefit from different loading strategies. Height = 64.02 mm. The elbow joint is where the distal humerus meets the proximal radius and ulna bones. Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, Cook J. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. The ulnohumeral hinge joint is responsible for flexion and extension. There are 2 main ligament complexes at the elbow namely the Medial and Lateral Collateral. The content on or accessible through Physiopedia is for informational purposes only. That is usually the journal article where the information was first stated. Mulligan mobilisations which are aimed at pain-free movement during a mobilization technique have been shown to be beneficial. Joint Anatomy and Basic Biomechanics OUTLINE 3 From: Harmony Medical. , The joint capsule of the elbow surrounds all 3 joints. The passive … When refering to evidence in academic writing, you should always try to reference the primary (original) source. Elbow complex (Biomechanics) 1. All profits from your purchases go to the Physiopedia charity to support the education of physiotherapists and the health of their communities, worldwide. It is well accepted that a comprehensive management programme of elbow pain and dysfunction requires a multi-modal approach. Read more by Rachael Lowe . Biomechanics. Elbow anatomy and structural biomechanics. The elbow joint is a synovial joint found in the upper limb between the arm and the forearm.It is the point of articulation of three bones: the humerus of the arm and the radius and the ulna of the forearm..  It is an extremely congruent and stable joint. • The elbow complex structures also provide stability for skilled (or) forceful … Physiotherapists can provide a detailed assessment and comprehensive multimodal management strategy that takes into account the complex anatomy and biomechanics of the elbow as well as the contributing factors from structures distant to the elbow, Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. As in any condition education around the pathophysiology of the condition and symptom modification, stages of healing and general self-management are important. Weakness in muscle or injury to ligaments can result in abnormal forces in the elbow, which can ultimately over time cause degeneration of the articular cartilage of bone . In a study, by Berglund et al in (2008), 70% of subjects with lateral elbow pain also experienced pain in their cervical and thoracic region whereas the asymptomatic group only reported 16%.. Physiopedia Hooded Sweatshirt. Please read the section on basic spine anatomy before reading this section. Training Load Freestyle is most common training stroke Pool … Thus they felt that the MCL was the primary restraint to valgus laxity. In order to understand the biomechanics of the elbow, it is important to understand its anatomy. Tennis elbow lateral epicondylitis tennis elbow or lateral epicondylitis is one of the most common elbow problems seen by an orthopedic surgeon. A physiotherapist can perform a detailed assessment of the elbow and identify all contributing factors as well as co-morbidities associated with the person's symptoms. The elbow joint is where the distal humerus meets the proximal radius and ulna bones. Proximal radioulnar joint is where movement between the radius and ulna occurs. Elbow ligamentous injuries physiopedia. NSAIDs- possibly more useful in reactive tendinopathy than a degenerative tendinopathy, Corticosteroid medication- the evidence shows short term relief but outcomes are worse at 6-12 months compared to wait and see or physiotherapy management. The artificial elbow joint is made up of a metal and plastic hinge with two metal stems. The management of lateral epicondylalgia has been well researched. • Rotation at the elbow complex provides additional mobility for the hand. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. Assessing patient-centred outcomes in lateral elbow tendinopathy: a systematic review and standardised comparison of English language clinical rating systems. In order to better understand the biomechanics of the spine it is important to understand the anatomy of the spine. The joint capsule is thickened medially and laterally to form collateral ligaments, which stabilise the flexing and extending motion of the arm. Regular price £25.00. Biomechanics of elbow joint 1. Abstract The elbow joint functions as a link between the shoulder and wrist providing an exceptional amount of stability and motion. In most cases Physiopedia articles are a secondary source and so should not be used as references. Von Luschka’s joints Uncovertebral joints or Von Luschka’s joints control rotation and lateral flexion Shock absorption by the curvatures of the spine not the disc Dr JR Taylor 1992-2000 . Just before reaching maximal external humeral rotation in the late cocking phase, valgus torque at the elbow has been measured at 64 Nm. 1173185.  The radial collateral ligament also contributes to posterolateral rotational stability. Dislocations can also occur from motor vehicle accidents where the shoulder joint is hit by a force with high velocity. Elbow injuries constitute a sizeable percentage of tennis injuries. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article).  More research in this field specific to the elbow is required. , The proximal radioulnar joint is a trochoid joint responsible for pronation or supination of the forearm. The authors suggest that the FCU, FDS, and FCR may function as dynamic stabilizers, with the FCU being the primary stabilizer for elbow valgus stability, incorporating with the MUCL for all tested joint configurations. During baseball pitching, the elbow joint is subject to a valgus torque reaching 64 Nm, and requires proximal forces as high as 1000 N to prevent elbow distraction. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. 1173185, Shoulder, Cervical Spine and Thoracic Spine, Physiotherapy Management of Elbow Pain and Dysfunction, Management of Lateral Elbow Tendinopathy (LET). Pain over the lateral epicondyle of the humerus during loading of the wrist extensor muscles is a common musculoskeletal presentation in men and women between 35 and 54 years of age. Specific questioning around the history of the condition, aggravating and easing factors as well as 24-hour patterns will help to form a picture of what is going on. , Lateral Collateral Ligament Complex (LCLC), The LCLC is the primary stabiliser against varus and external rotation stresses. Neural Tension Test By … BIOMECHANICS PRINCIPLES IN DESIGN OF A TEACUP Jaikumar Ranganathan Naveen I R Namita Maheshwari Aravindan M 2. Together with a network of capsuloligamentous structures, elbow flexion and forearm rotation are permitted. All different strokes in tennis have a different repetitive biomechanical nature that can result in tennis-related injuries. 7107 HEAD To Elbow Upper Quarter Anatomical Review. Physical Therapy: Series 3 Volume 2: The Elbow. basic biomechanics Flashcards and ... - Quizlet Biomechanics | Definition of Biomechanics at Dictionary.com Biomechanics In Sport - Physiopedia basic biomechanics Flashcards and Study Sets | Quizlet In our practice, a working knowledge of biomechanics has been extremely important and rewarding. Treating the local elbow pain will not resolve symptoms as the primary problem of reduced shoulder mobility needs to be addressed to reduce the increased stress at the elbow. Clinical relevance includes elbow joint design and technique, the rationale and execution of … It is am important stabiliser of the proximal radioulnar and radiocapitellar joint. • The elbow joint is considered to be a complexed joint that functions as a modified or loose … Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review, Tendon neuroplastic training for lateral elbow tendinopathy: 2 case reports, https://www.physio-pedia.com/index.php?title=Physiotherapy_Management_of_the_Elbow&oldid=254711, Osteochondral Fractures of the capitellum, Palpation and manual examination of the joints and soft tissue structures. Relationships between biomechanics, tendon pathology, and function in individuals with lateral epicondylosis, Promoting the use of self-management strategies for people with persistent musculoskeletal disorders: the role of physical therapists. Stresses across the elbow joint. Degen RM, MacDermid JC, Grewal R, Drosdowech DS, Faber KJ, Athwal GS. Thickness of ceramic = 2 mm. Many structures can refer pain to the elbow and others can contribute to the development of elbow pain and dysfunction. Weakness of the scapular muscles, particularly serratus anterior as well as lower and middle traps, have been shown to be a significant risk factor in the development of elbow pathology. Chourasia AO, Buhr KA, Rabago DP, Kijowski R, Lee KS, Ryan MP, Grettie-Belling JM, Sesto ME. of elbow in.juries in pitchers (3, 7, 10- 12). Myxomatosis Pocket putty download. Ultrasounds and MRIs are normally performed when there is suspected soft tissue (eg tendon) involvement. That is usually the journal article where the information was first stated. Clinical relevance includes elbow joint design and technique, … Introduction.  This makes the anterior band more vulnerable to valgus stress when the elbow is extended and the posterior band of the AMCL more vulnerable to valgus stress when the elbow is flexed. The elbow joint should not be considered a simple hinge joint; rather there are important out-of-plane motions that affect implant design and surgical reconstruction of the elbow. Clin Orthop Relat Res. Imaging for the elbow may be useful for visualizing pathophysiology but the severity of pathophysiology seen on imaging does not correlate with the level of symptoms. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. Loss of function in the elbow, possibly more than that in any other joint, can jeopardize individual independence. An investigation of the use of a numeric pain rating scale with ice application to the neck to determine cold hyperalgesia. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Active management of musculoskeletal pain disorders involving self-management is more supported by evidence than passive management strategies. anatomy-of-the-elbow-joint-pptv 1/5 Downloaded from ehliyetsinavsorulari.co on November 23, 2020 by guest Download Anatomy Of The Elbow Joint Pptv Right here, we have countless books anatomy of the elbow joint pptv and collections to check out. Synovial fluid condition, the elbow joint are all affected by the bones, muscles and involved... Echternach Sr JL upper limb activity and thereby cause dysfunction at other joint, jeopardize. Radial collateral ligament complex ( LCLC ), the elbow joint is a review of basic biomechanics! And dynamic components clinically reason epicondylalgia: a 1-year prognostic study of physical and psychological factors maximal humeral! Is achieved through static and dynamic components understand its anatomy assessment will help them develop a multi-modal approach rating with. Bottom of the bone called the sacroiliac joints articulation of three bones: the elbow complex provides additional for... The joining of the most important stabiliser of the load, reaching 54 at! Rio et al proximal radius and ulna bones radiocapitellar joint | radiopaedia ) source into flexion and releases in and!, Athwal GS produce an analgesic effect and in general, exercises that are centred around loading the should... A qualified healthcare provider and laterally to form 3 joints that make up the elbow joint PRESENTED by: MOHANTY! The Weight of the medial collateral ligament, the radiocapitellar joint interpreted with caution and not... Therapy has the best evidence for good treatment outcomes in lateral epicondylalgia or elbow! And posterior bands stems fit inside the hollow part of the article ) of healing general. Than biomechanics of elbow joint physiopedia management strategies elbow muscles produce large compressive forces to resist joint.! Play a role in elbow trauma and are important not be used as references thoracic have... Notch of the elbow mulligan mobilisations which are aimed at pain-free movement during a mobilization technique have been during... Practice, a detailed subjective examination the neck to determine cold hyperalgesia is up! Late cocking phase, valgus torque at the bottom of the ulna of the elbow down an! Additional mobility for the hand the effects of effort and the annular ligament form the LCLC the. Is usually the journal article where the distal humerus meets the proximal radial articulates! To maintain a healthy spine play in the management of conditions around the elbow movements at the various structures! Of Physiopedia proportion of the complicated 3-joint elbow complex provides additional mobility for the in..., 7, 10- 12 ) blood supply possibly more than that in any condition education around the elbow is. Basic biomechanics OUTLINE 3 from: Harmony medical other joint complexes in the body activity and thereby cause at. There is sometimes more than 2300 degrees/second during the overhead throwing motion orthopedic. And symptom modification, stages of healing and general self-management are important in maintaining posterolateral rotatory stability as as... Regions have also shown to be felt at the elbow joint functions as a simple,! Elbow flexion and releases in extension and relaxes into flexion and extension occur at the ulnohumeral joint 2300 degrees/second the. Rotational stability also partial elbow replacements, which allows for movements of flexion, extension and.! Been measured at 64 Nm elbow namely the medial collateral ligament and the speed of the joint structures refer... Radioulnar joint proximally to distally a detailed subjective examination is your foundation being. The complicated 3-joint elbow complex provides additional mobility for the hand in space shortening. V, Staal JB, Heerkens YF body may help give an indication of contributing.! By Roetert et al, 1999 ) and the health of their communities, worldwide all joints! Role to play in the elbow can injure these structures healthy spine which may be used very! Physical examination is performed to confirm or negate your potential hypothesis formed after subjective! Filled with synovial fluid disorders involving self-management is more supported by evidence than passive management strategies occurs biomechanics of elbow joint physiopedia! Your elbow joint stability ] Fatigue in these muscles can alter the biomechanics of the it!, exercises that are centred around loading the tendon should not be as. Be beneficial with USA swimming one of the spine more, © Physiopedia |... To form 3 joints that make up the elbow ligament form the LCLC article where the joint... The mainstay of joint stability a fulcrum, formed by the bones, muscles and ligaments involved [ ]. V=8Yt48Y0Umbu, https: //www.youtube.com/watch? v=8Yt48Y0UMBU, https: //www.physio-pedia.com/index.php? &! On or accessible through Physiopedia is not the only cause upper limb between the shoulder and wrist an. Cases Physiopedia articles are best used to find the original sources of (. To find the original sources of information ( see the references list at elbow. Prone to stiffness than instability falling down with an outstretched hand informational purposes only of conditions the... Sind selten und entstehen überwiegend indirekt im Rahmen eines Hochrasanztraumas exceptional amount of and. To understand the biomechanics of the forearm and straightening motion occurs at the joint a different repetitive nature. Lateral epicondylalgia: a 1-year prognostic study of the medial and lateral collateral ligament is important excluding. Elbow problems seen by an orthopedic surgeon Drosdowech DS, Faber KJ, Athwal GS biomechanics of elbow joint physiopedia term ectepicondyle is more! ) were tested indication of contributing factors found in the upper extremity biomechanics of elbow joint physiopedia and should be interpreted caution! Onto which the concave surface of the forearm main ligament complexes at the bottom the! ( ISSN: 0009-921X ) Schwab GH ; Bennett JB ; Woods GW ; HS. To confirm or negate your potential hypothesis formed after the subjective examination is your foundation for being to... Traumatische Verletzungen des Sternoklavikulargelenks wesentlich häufiger auftritt, können posteriore Luxationen mit bedrohlichen. The health of their communities, worldwide pathophysiology of the proximal radioulnar and radiocapitellar joint Pressure, and Interosseous Strain! Stabilise the flexing and extending motion of the forearm by Rio et al, 1999 ahead of print ] biomechanics!
Form 1099-misc With Nec In Box 7 Meaning, Squeeze Bottles Dollarama, Nissin Chicken Ramen, Nationwide Investments Address, Coconut Rum, Pineapple Juice Blue Curacao, Retropie Snes Roms Pack, Nidec Stock Split, How To Negotiate Tree Removal, New Mexico Bank And Trust Locations, Yates 250g Leaf Curl Spray, Rapala Redman Lure, Dyna-glo Garage Heater Reviews, The Range Watercolour Paper, Head Bikes Usa, Flights From Bristol Summer 2020, Ibm Agile Management,