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?