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Common shoulder and elbow injuries
Nicholas Costiff Chartered Physiotherapist
Aims
• Brief education on the anatomy of the shoulder and elbow
• How the rotator cuff muscles work during overhead activities
• What happens when tissues are injured?• How to recognize and prevent injury• What can physio do?
Anatomy of the shoulder
• Ball and socket joint• Increased mobility at the expense of stability• Ligaments & capsule• Deep muscles – Rotator Cuff• Superficial muscles• Also consider the Thoracic spine
Rotator cuff
• Four smaller muscles• Stability of the joint• Rotational movements at the shoulder
Scapular (Shoulder blade)movements
Winging scapulae Tilted Scapulae
Rotator cuff & overhead activities
• Concentric – standing up / lifting weight up Muscles getting shorter
• Eccentric – sitting down / lowering weight Muscles lengthening under tension
ShoulderPain
Vicious Cycle
Rotator cuff tendinopathy
Impingement with Exercise
Narrowing of Sub Acromial
Space
Swelling of Rotator Cuff
tendon
How to prevent this…
• Rotator cuff strengthening• Scapular stability training
Physiotherapy
• Stretch tight muscles and tissue• Strengthen specific weak muscles (eccentric
strengthening)• Soft tissue massage• Upper limb proprioception• Mobilize stiff joints• Core stability training
The Elbow
• Hinge joint• Also joints of the forearm• Flexion – Extension• Pronation – Supination• Wrist muscles• Nerve tissue
Lateral Epicondylalgia“Tennis Elbow”
• Very common injury• Over use of the wrist extensor mechanism• Leading to collagen disarray (NOT inflammation).• 1 – 2 cms from the epicondyle (bony bit at the elbow)
Physio for Lateral Epicondylalgia
• History of onset – gradual or sudden?
• Changes in activity or increased activity
• Is pain related to activity? or is it constant –
• mechanical or nerve entrapment
Mechanical or Nerve entrapmentMechanical Nerve Entrapment
Resisted wrist extension (Mill’s test)With wrist pronated and radially deviated
Prolonged posture
Specific test for ECRB ( Middle finger extension)
Sensory disturbance such as pins and needles
Decreased grip strength and pain on making a fist
Neck, upper thoracic or shoulder pain may also be present
What is happening microscopically?
• Excess of fibroblasts and blood vessels (Angiogenesis)
• This abnormal tissue has a large number of nociceptors (Pain receptors)
• Wrist extension causes a shearing stress compromising blood flow
• With continued use – may develop into microscopic tears
=PAIN
Treatment
• Eliminate the cause of pain• Relative rest• Electrotherapy• Soft tissue techniques• Stretching exercises• Eccentric exercises.• Graded return to previous activity levels
Epiclasp
Any Questions?