Injuries to the upper limb (arm and hand) may be due to ergonomic stresses and strains typically through sport or in the workplace, or more gradually through repetitive trauma creating irritation or micro injury to soft tissues, muscles, joints and nerves.
Trauma from falls can result in soft tissue or bony injuries to the upper limb and hand. Finger injuries are common during sport (eg through miscatching a cricket ball). Conditions such as tennis and golfers elbow are often down to overuse, overstrain or poor technique.
When assessing upper limb injury, we take a history of the injury, and consider implications of work station ergonomics or regular activities such as sport. At times the spine may be implicated, and pain may be referred from the neck or thoracic area.
We will ascertain the source of the problem, provide a diagnosis and formulate a suitable and effective treatment plan. This may include manual therapy, postural advice and progressive mobilising and strengthening exercises. The main aims are to advise regarding sport or activity, and provide exercise to prevent injury recurrence.
When appropriate, onward referral for specialist consultant opinion or MRI referral can be arranged.
This is provided as general information only and is not intended to be relied upon as medical advice.
Shoulder Conditions
Shoulder Impingement
Shoulder impingement is a common problem where the rotator cuff tendons are irritated and inflamed at the sub-acromial space. The irritation causes pain, weakness and loss of movement at the shoulder. Repeated overhead movement at the shoulder can cause this to worsen, and may be bothersome at night particularly when lying on the affected side.
Conservative management is usually successful. This includes rest and avoidance of painful activity alongside physiotherapy. Physiotherapy would typically focus on maintaining movement, improving posture, muscle strengthening and reducing pain, using techniques such as joint mobilisation, acupuncture, soft tissue massage, therapeutic taping and relevant muscle strengthening. Education regarding the cause and mechanism of the condition, and identifying aggravating factors is key. Ice and anti-inflammatory medication (or gel) may also help with pain.
Frozen shoulder is a painful condition potentially causing severe movement restriction the shoulder. Typical symptoms are pain and stiffness in the shoulder, affecting movements such as dressing and reaching. Pain can also be problematic at night.
Frozen shoulder occurs when the normally flexible joint capsule becomes inflamed and thickened. It is unclear why this happens, although there are factors thought to be associated with developing a frozen shoulder including previous shoulder injury or surgery, diabetes and health conditions such as heart disease and stroke
Frozen shoulder may last as long as 18-36 months. Appropriate treatment may help to shorten the period of disability.
Physiotherapy will help to keep the joint as mobile and pain free as possible, while healing takes place. Treatment will depend on the severity of the frozen shoulder. Treatment may include acupuncture for pain relief, soft tissue massage, joint manipulation and exercises. Heat may help ease the pain.
Shoulder dislocation is often the result of trauma to the shoulder. The ball at the top of the arm becomes detached from the socket, becoming out of alignment. This usually requires management in A&E. If the joint subluxes or partially dislocates, it may relocate by itself.
The joint may then be ‘unstable’ , and with repeated episodes of dislocation surgery may be needed to tighten the shoulder capsule.Physiotherapy is important following dislocation to strengthen the shoulder and stabilise the joint. Physiotherapy will include progressive strengthening to improve the functioning of the surrounding muscles (rotator cuff, deltoid and scapular muscles)
The shoulder may dislocate without trauma, possibly due to having hypermobile joints. This is known as multidirectional instability. There may be pain in the shoulder and arm, with clicking and a sense of slipping in the joint. Progressive exercises and controlled shoulder strengthening can lead to a successful outcome for pain and instability.
This is provided as general information only and is not intended to be relied upon as medical advice.
ELBOW, WRIST AND HAND Conditions
Injury to the elbow, hand and wrist can be due to stresses and strains in the workplace, at or during sport. Repetitive trauma can affect ligaments, connective tissue, muscles, joints or nerves. This is sometimes known as work related upper limb disorder or RSI.
Sporting activities involving sustained grip and repeated movement at the wrist can lead to tennis elbow or golfers elbow, resulting in pain at the outside or inside of the elbow. This is due to = overuse of the muscles and tendons of the forearm, which attach to bone near the elbow joint.
Nerve irritation at the neck can cause referred pain in the arm and hand. There may be accompanying symptoms such as numbness, tingling or burning in the elbow, forearm or fingers. Nerves can also be irritated in the arm following stretch or direct pressure. Carpal tunnel syndrome is when the median nerve becomes irritated - typically at the wrist - causing burning or tingling in hand and fingers.
Falls onto the hand can cause soft tissue or bony injuries, and finger injuries are common from contact during sport.
Your physiotherapist will ascertain the history of the injury and symptoms, whether there was trauma, and consider factors such as work station ergonomics or daily/ sporting activities. With diagnosis and identification of contributing factors, an effective treatment plan can be made. This may involve manual therapy, the use of sport tape and appropriate postural advice and progressive strengthening exercises. Poor work ergonomics or movement patterns related to sporting activities will be addressed. Sport or activity specific advice and exercise will help to prevent injury recurrence.
If necessary onward specialist consultant or MRI referral can be organized.
