Upper Limb Pain
Inc Shoulder, Elbow, Wrist and Hand Pain
Shoulder Pain:
A complex joint by virtue of its multi direction of movement/function. A very common source of pain either by trauma or sudden or slow onset. Symptoms can be attributable to a number of different causes.
Tendonitis/impingement is an issue primarily caused by a subtly incorrect position of the shoulder bone in the socket which can then irritate surrounding soft tissues. Treatment will be initially targeted at calming the irritated soft tissues with techniques such as manual therapy, taping, acupuncture or injection therapy. This is then complemented by strengthening the surrounding muscles to restore function.
Instability of the shoulder is whereby the shoulder bone demonstrates laxity within the socket (too much movement). This can lead eventually to regular sub-luxing (feelings of the shoulder ‘slipping out’) and possible dislocation. Instability can be trauma related whereby the supporting soft tissues of the joint are damaged and become lax or from a person’s innate tendency to have lax joints (it then tends to be the dominant side). Treatment is by way of strengthening to stabilise the joint. In more problematic cases surgery is sometimes required.
Frozen shoulder (or adhesive capsulitis) is another common complaint characterised by more prominent night pain and onset of gradual stiffening of and then pain within the shoulder. If diagnosed correctly in the early stages local pain relief (often by way of cortico-steroidal injection) can help significantly and reduce the length of dysfunction. Movement encouragement in the form of manual and exercise therapy will assist improvement at all stages.
Post trauma ie fractured (break) shoulder: physiotherapy is vital in the rehabilitation of any joint where a fracture is involved. Manual therapy together with exercise therapy for strength and mobility will aid recovery.
Neck and upper back related shoulder pain: symptoms in the shoulder can often originate from neural (nerve root) irritation from in between tight/stiff neck joints. Appropriate assessment of the neck/spinal alignment and the specific nerve(s) involved is crucial for correct diagnosis and treatment. Manual and exercise therapy to address these issues can resolve the problem.
Osteo-arthritis (wear and tear) of the shoulder: a rare, individual cause of the primary shoulder joint dysfunction. Often misdiagnosed in the more ageing population without reference to x-ray. In severe cases however it can cause shoulder movement restriction and pain. A more common area of wear and tear (and also trauma in origin) in the shoulder is the secondary shoulder joint the acromio-clavicular joint (ACJ), the small bony prominence on top of the shoulder when you look front on in the mirror. In a lot of cases this joint can be calmed with a local cortico-steroidal injection if severe and appropriate strengthening. In more severe cases of the primary shoulder joint wear and tear a joint replacement can be performed and then rehabilitated by physiotherapy.
Elbow Pain
Overuse tendonitis (muscle attachment inflammation or long term irritation/trauma:tendinopathy) at the elbow occurs on either side of the joint. These problems are commonly termed as golfer’s elbow and tennis elbow although most people who present with these do not play either sport. Pain is characterised by pain on loading the elbow. Local treatment at the source of pain by way of taping, manual therapy, acupuncture and injection therapy is needed. Then long term strengthening is the way forward and modification of activities in the meantime.
Post trauma ie fractured (broken) elbow: physiotherapy is vital in the rehabilitation of any joint where a fracture is involved. Manual therapy together with exercise therapy for strength and mobility return will aid recovery.
Neck and upper back related elbow pain: often neural (nerve) pain in the elbow is misdiagnosed as tennis or golfer’s elbow because of two of the major three nerves in the arm passing either side of the joint near the two main muscular attachments. Appropriate assessment of the neck/upper back/spinal alignment to locate any pressure on a nerve is vital together with manual and exercise therapy to resolve.
Osteo-arthritis: (wear and tear) is rarely the main cause of symptoms in the elbow except in the more elderly population and can only truly be clinically diagnosed with reference to an x-ray. Mobilisation by way of manual therapy and strengthening of the joint may assist with symptoms in these cases.
Wrist / Hand Pain:
A common area of tendon (muscular) problems in the body. Diagnosis such as De Qeurvain’s Tenosynovitis of the thumb, trigger finger and Mallett finger are regular presentations to physiotherapy. Most hand/wrist tendon problems are overuse related and can also be linked to both degenerative tendons (muscle attachments) and to degeneration of bony surfaces across which these tendons pass.
They can either be resolved with local cortico-steroidal injections to calm inflammation if necessary, taping to off-load tension, manual therapy and strengthening. Some tendon conditions (ie Mallett finger) do require surgical procedures and then physiotherapy intervention to rehabilitate to normal function. If after assessment, a surgical review is deemed necessary, you will be referred to the appropriate specialist or back to your GP.
Neural (nerve) pain in the wrist and hand can occur when radiating from the neck and upper spine. Usually a common sign is paraesthesia (pins and needles) in the hand if there is enough irritation of the nerve at its origin between the spinal joints. Appropriate assessment of the neck/spinal alignment and the specific nerve(s) involved is crucial for correct diagnosis and treatment. Manual and exercise therapy to address these issues can resolve.
Neural (nerve) pain in the wrist (including pins and needles) can also occur as a result of the nerve being irritated locally at the wrist ie as in conditions such as Carpal Tunnel (compression of one of the main nerves of the arm as it crosses the wrist). Symptoms can sometimes be resolved by local administration of a cortico-steroidal injection to the area to calm inflammation if severe, manual therapy and exercises to get the nerve moving. Surgical review may be required in severe cases that do not respond to physiotherapy.
Post trauma ie fractured (broken) wrist: physiotherapy is vital in the rehabilitation of any joint whereby a fracture is involved. Manual therapy together with exercise therapy for strength and mobility will aid recovery.