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Your first step to recovery

Wrist pain: De Quervains tenosynovitis

De Quervains tenosynovitis is a painful condition caused by inflammation of two prominent tendons that are located at the wrist and thumb.

The two tendons called the Extensor pollicus brevis  and Abductor pollicus longus originate from the middle of the forearm travel down towards and over the wrist to insert into the thumb. Collectively they function to extend the thumb, whilst abductor pollicus longus extends and also abducts the thumb (lifting thumb up to the ceiling).

What causes it?

The most common cause of De Quervains tenosynovitis is the repetitive overuse of thumb and wrist whether it is occupational or hobby related. For example, the repetitive thumb movement whilst using scissors by hair dressers, landscapers using shears or whilst gardening). Trauma to the tendons from injuries to the wrist or the thumb can cause inflammation of the tendons.

In some cases, age related degeneration of the tendon sheath or underlying conditions such as rheumatoid arthritis increases the risk of the developing De Quervains tenosynovitis. Hormonal changes resulting in fluid build up in young mothers can commonly result in De Quervains tenosynovitis.

Symptoms

Commonly your symptoms may include:

  • Pain located at base of your thumb
  • Pain elicited by movement of thumb (gripping or making a fist)
  • Grating or snapping feeling
  • Tightness in the wrist
  • Swelling surrounding the base of thumb and wrist

How is De Quervains tenosynovitis diagnosed?

Your doctor or physiotherapist will be able to diagnose the condition based on your symptoms and after doing a thorough movement assessment to rule out any other potential diagnosis.

  • Finkelstein test is used to elicit symptoms to confirm De Quervains tenosynovitis.

How to test:

  1. Wrap your thumb with your fingers.
  2. Slowly bend your wrist down

A positive test would elicit pain at the site of the two tendons.

Radiological investigations in lights of ultrasound and an x-ray might be recommended for further investigations, particularly to confirm clinical diagnosis or to rule out any other possible causes of De Quervains such as osteoarthritis.

What treatment options are available?

Conservative (non-surgical) management

Conservative management measures are generally recommended as the first line of management for mild to moderate symptoms. This is because up to 60-70% of symptoms are likely to improve over a period of 6-8 weeks of regular physiotherapy intervention. In this period, the following strategies are recommended by your therapist to fast-track your recovery

  • Rest and application of heat or cold packs
  • Avoid repetitive use of thumb
  • Pain medications (anti-inflammatory medications) such as diclofenac or ibuprofen
  • Splints or braces
  • Steroid injection

Surgical management

In more severe cases when conservative management has failed, surgery may be recommended by an orthopaedic specialist or surgeon.

Prior to your surgery you will have the opportunity to thoroughly discuss with your surgeon the details of the surgical procedure and about the post operative rehabilitation process.

  • Surgical procedure

Surgery may be performed under general or local anaesthesia. A small incision is made at the wrist and thumb region. The covering of the tendons (sheath) is then separated and expanded to provide the tendon space to allow the tendon to move smoothly within the sheath. After this the, the incision in then sutured with a firm dressing applied over the suture site.

  • While you recover from the surgery, an information sheet with post operative guidelines will be provided to you by your surgical team. It is important that you must follow the guidelines recommended by your surgeon for optimal recovery.
  • In most cases your will have a follow up with your surgeon few weeks after your surgery to check your wound healing and your progress. You are often times referred to physiotherapy for strength and conditioning of your wrist and hand movements to facilitate your recovery.

Repetitive Strain Injury (RSI) Explained

 

RSI is typically defined as an overuse disorder- a gradual build-up of overload to nerves, tendons, and muscles arising from repetitive movements or activities. Repetitive use of the same motions leads to inflammation and damage to these soft tissues. This disorder mostly affects the upper limb- particularly the elbows, hands and wrists.

 

Causes

Possible causes of RSI include but are not limited to:

  • Undertaking the same and repetitive movements and stressing the same muscle groups
  • Working in cold environments
  • Assuming a sustained and/or awkward posture for prolonged periods of time
  • Undertaking a particular activity for prolonged periods of time with no rest-breaks
  • Frequent and prolonged use of vibrating equipment
  • Adopting poor postures from working at inappropriately designed workstations
  • Undertaking a motion which involves carrying and/or lifting heavy items

 

 

Symptoms

RSI leads to a gradual development of a broad variety of symptoms, which range from mild to severe in severity. RSI particularly affects the muscles and joints of your wrists, hands, elbows, forearms, shoulders, neck. Having said this, RSI can affect other areas of the body as well.

Common symptoms may include:

  • Pain
  • Tingling
  • Cramping
  • Increased sensitivity to heat and cold
  • Tenderness
  • Fatigue
  • Loss of strength
  • Throbbing
  • Soreness
  • Achiness
  • Stiffness
  • Struggling with typical activities of daily living, such as gripping and twisting motions, carrying light weights, writing, kitchen prepping, dressing, personal cares etc

You may develop these symptoms when you undertake a task repetitively for a period of time, and can settle when you stop. Symptoms may settle over a few hours or over the course of a few days. However, if left untreated or is poorly managed, a minor RSI may gradually progress to a nasty chronic injury.

 

Diagnosis

 

If you experience mild discomfort whilst completing particular activities at home or at your job, it is a good idea to see your GP or physiotherapist to talk about RSI. But an RSI is not always simple to diagnose as there is no particular clinical test for it. Your GP will enquire about your medical history, occupation and work environment, and other activities to attempt to identify any repetitive motions you undertake that may be the cause of your symptoms. A physical examination will be undertaken, where they will assess your movement, check for pain, inflammation, sensation, tenderness, strength and reflexes in the impacted body part. RSI may be triggered by specific health disorders like bursitis, carpal tunnel, tigger finger, ganglion cyst, or tendonitis (inflammation in your tendons). Your GP can refer you on further diagnostic tests such as X-rays, Ultrasounds, blood tests, MRIs, nerve conduction tests etc, to determine if these underlying disorders may be the cause of your symptoms. You may be also be referred onto a physiotherapist and acupuncturist for conservative treatment and management for mild-moderate issues. If symptoms persist, you will then be referred onto a specialist.

 

Management

Initial treatment options for the management of RSI symptoms is conservative. This includes:

  • Rest, Ice, Compression, and Elevation (RICE principles)
  • Taking regular breaks between tasks and looking after your posture
  • Undertaking your activities and movements with appropriate form and posture
  • Intake of Nonsteroidal anti-inflammatory drugs (NSAIDs), both oral and topical as prescribed by the GP
  • Use of cold and heat to the impacted area
  • Administration of steroid injections into inflamed joints and tendons
  • Tailored exercise prescription from physiotherapists to correct posture and strengthen and stretch affected muscles
  • Acupuncture
  • Stress reduction and relaxation training
  • Use of splints and braces to help protect and rest the affected muscles and tendons

Ergonomically appropriate adjustments to your workstation and work environment may be recommended by your physio and GP- for example resetting your desk and chair if you’re working at computer, and alterations to your equipment and activities/motions to lessen the strain and stress on your muscles and joints. Surgery may be necessary in some cases.

 

Prevention

Minimizing repetitive actions particularly if they involve the use of heavy machinery or vibration. Improving your working posture and work-environment as well a taking regular breaks. Employers often undertake risk-assessments when you join a company to determine that the work area is ergonomically fit, comfortable and appropriate for you. You may be able to request for an assessment if you have not had one or are having issues with your work environment

Osteoporosis

 

Osteoporosis is a condition which results in weak and brittle bones- to such degree that a fall or even mild stresses like coughing or bending over may result in a fracture. Bones are living tissues which are continually being broken down and replaced. However, your bones become osteoporotic when the formation of new bone does not keep up with the loss of old bone. This condition typically develops over time without any pain or other major symptoms, and is generally not diagnosed until you have sustained a fracture. The hip, pelvis, upper arm, spine and wrists are the most common structures affected by osteoporosis- related fractures.

 

 

How do you know if you have Osteoporosis?

 

Because there are no obvious early warning signs and symptoms, it is difficult to pre-diagnose osteoporosis. You may be unaware that you have this condition perhaps till you have one of the following:

  • Sustained a fracture from an incident more easily than you should have- like a simple fall or a bump
  • A decrease in the height of your spinal vertebrae over time
  • Change in posture – stooping or bending forwards
  • Back pain, due to a fractured or collapsed vertebra

Please see your doctor if you experience the following:

  • If you are over the age of 50 and have sustained a fracture
  • Sustained a spine, wrist, or hip for the first time
  • Sustained a fracture more easily than you should have (a simple fall or after a slight bump)

 

Risk factors

Key factors which may increase your risk of developing osteoporosis include:

  • Females- particularly post-menopausal Caucasian and Asian women
  • Over the age of 50
  • Excessive consumption of caffeine or alcohol
  • Smoking
  • Having a smaller or petite body frame
  • Poor physical activity levels and leading a very sedentary lifestyle
  • Family history of osteoporosis
  • Having low levels of vitamin D and poor dietary calcium intake
  • Decreasing levels of testosterone with ageing in men
  • Estrogen deficiency in women (irregular periods, early (before turning 40) or post-menopausal, surgical removal of the ovaries)
  • Use of long-term medication such as thyroid and epilepsy medications, corticosteroids
  • Having medical conditions such as gastrointestinal diseases; endocrine diseases; rheumatoid arthritis; cancer; and blood disorders

 

 

How will you be diagnosed?

Your doctor will review your signs and symptoms, family and medical history. You may be referred on for a specialized X-ray or CT scan to evaluate the bone density to help diagnose osteoporosis. Your bone density will be classified by comparing it to the typical bone density for a person of equivalent gender, size, and age.

 

 

How is Osteoporosis treated?

The treatment pathway chosen for the management of this condition is dependent on results of your bone density scan, gender, age, medical history and severity of the condition. Potential treatments for osteoporosis may include exercise, making positive lifestyle changes, vitamin and mineral supplements, and medications. Please consult your doctor for appropriate advice and treatment options.

 

 

How can Physiotherapy help?

 

Your physiotherapist will help you strengthen your bones and your muscles through a personalized and graduated rehabilitation program. Components of this rehabilitation program may include weightbearing aerobic exercises, resistance training using free weights/resistance bands/bodyweight resistance, and exercises to enhance posture, balance and body strength. Your physiotherapist will work with you to find activities that suit your needs and as per your physical activity level.

 

 

Managing your Medial Knee Pain: MCL injuries

What is it?

Although your knee has free movement going forwards and backwards, its’ sideward movements are restricted by the robust collateral ligaments on either sides of your knee. The medial collateral ligament (MCL) is situated on the inner part of your knee, but on the outside of your joint. The MCL connects the top of your shinbone (tibia) to the bottom of your femur (thighbone). It helps hold your bones together, provides stability and prevents your knee from bending sideways away from your body.

Injuries to the MCL are from the result of a direct blow to the outer part of your knee- and is most commonly seen in contact sports such as football and soccer. These injures may either over-stretch or cause a tear in the ligament. Whilst surgery may be needed in some severe cases, it is not always the go-to form of management.

Read on to know how physiotherapy can help manage your MCL related-knee pain.

 

 

Mechanism of Injury

Injury to the MCL typically occurs when a force drives the lower leg in a sideward direction away from your upper leg and body. Awkwardly landing from a height, twisting of your knee with your foot fixated to the ground, or from a direct blow to the outer part of your knee- most commonly seen in contact sports, are frequent causes of injury to the MCL.

 

 

Grading of MCL Injuries

MCL injuries are often graded using the system below:

Grade 1: Regarded as a minor injury- means that the MCL has been overstretched but not torn

Grade 2: Regarded as a moderate injury- means that there is a partial tear in MCL, and presents with some degree of instability in the knee

Grade 3: Regarded as a severe injury- means that the MCL has completely ruptured/torn, and presents with noticeable joint instability

 

Often 3 MCL injuries are associated with concurrent medial meniscus and ACL ligament damage, which may need surgical intervention. But, the good news is that most MCL injuries may be treated well with conservative physiotherapy management. It usually takes between 2-8 weeks for Grade 1 and 2 MCL injuries to heal, and a graduated rehabilitation programme is highly commended for prevention of future injury.

 

 

Signs and Symptoms

Because injury to the MCL may present with similar symptoms as with other knee injuries such as ACL damage, it is vital to have a medical professional such as your physiotherapist evaluate your injury.

Common symptoms of an MCL injury may include:

  • Tenderness and pain along in the inner part of your knee
  • Swelling in the knee
  • Experience catching and locking sensations in the knee joint
  • A ‘pop’ sound at the time of injury
  • Actual or feeling of giving way of the knee (often indicate grade 2 or 3 injury)

 

 

Diagnosis

Your physiotherapist will discuss your injury and its presenting symptoms, past medical history (including a history of any prior knee injuries) and will also undertake a thorough physical examination. During the physical examination, your physiotherapist will assess the structures of your injured knee and compare them to the non-injured side. The range of motion, strength and stability of your knee will be assessed. You may be referred on for imaging such as X-rays and Ultrasounds to help aid the diagnosis. For more severe MCL injuries, and if your symptoms do not resolve with conservative physiotherapy management, you may be referred onto a specialist who may consider referring you for an MRI to get a deeper look at your knee.

 

Management

The management options for MCL injuries will be dependent on the severity of the injury. In the initial stages of injury, management is focused on controlling swelling and pain, whilst allowing your body to initiate healing processes via inflammation. This is typically achieved through the P.O.L.I.C.E. principles (Protect, Optimal Loading, Ice, Compression and Elevation).

Over the counter medication such as ibuprofen and paracetamol may be taken to reduce pain. Other stronger painkillers and NSAIDs may be prescribed by your doctor to help reduce swelling and inflammation as well.

After assessing your knee, your physiotherapist will frame a rehabilitation programme with exercises tailored to your needs. The purpose of physiotherapy is to help restore your knee’s range of motion, stability and strength, which in turn will then allow you to safely return to your usual day-to-day and sporting activities as soon as possible.

Management of most MCL injuries usually only involves knee bracing and physiotherapy treatment. However, in some cases, surgery may be recommended. Particularly if there is damage to more than one ligament or structure in your knee or if you continue to experience instability in spite of physiotherapy.

Dealing with Rheumatoid Arthritis

Rheumatoid arthritis (RA), a chronic inflammatory condition associated with swelling, pain, fatigue, and joint deformity. Although there are no known cures for this condition at present, a combination of treatments are available to help manage your symptoms. RA is the 2nd most common form of arthritis after osteoarthritis and is known to affect 1–2% of New Zealand’s population.

 

 

Signs and Symptoms

RA may develop very quickly or gradually over time, with its signs and symptoms, as well as the severity varying from one person to another. This condition is associated with episodes of remission and flare ups, with or without apparent triggers.

Other symptoms may include

 

  • Swollen, tender joints- (often accompanied by warmth and redness)
  • Joint pain
  • Joint stiffness which worsens in the mornings and after a period of inactivity
  • Fever, loss of appetite weakness, and fatigue
  • Muscle pain
  • Changes to the skin and nails

In the early stages of RA, you may notice its impact on your smaller joints- especially in your toes and fingers. And as this condition develops, your symptoms typically branch out to the bigger joints- your shoulders, ankles, knees, wrists, hips and elbows. Symptoms are likely to affect your joints bilaterally. Over time, RA also causes joints to deform and shift out of place.

Because RA is a systemic condition, it is estimated that approximately 40% of the RA population may experience symptoms and signs other body systems than the joints. These may include:

  • Kidneys, lungs, heart
  • Skin, eyes, mouth
  • Bone marrow
  • Nerves and blood vessels

 

 

Causes and Risk Factors

Your immune system is designed to help protect your body from infection and disease. However, in RA, changes occur in your immune system that (for poorly understood reasons), causes it to mistakenly attack the healthy soft-tissues of joints resulting in pain, swelling and inflammation. Because of this ongoing process, over time damages to the lining of your joints and other soft-tissues may lead to bone erosion and joint deformity. It can also have an impact on your heart, lungs, nerves, eyes and skin.

One can get RA at any age, although it is more probable to develop in those in the age bracket of 25-50 years old. Though rare, under 16s may also develop Juvenile RA or Still’s disease.

Risk factors for the development of RA include:

  • Family history of RA
  • Age bracket of 25-50 years old
  • Smoking
  • Women are more likely to develop RA than men
  • Obesity

 

 

 

Diagnosis

 

At present there is no single test to confirm a clinical RA diagnosis. It is often difficult to differentiate this condition in its initial stages from other forms of connective tissue inflammation (fibromyalgia, lupus, gout etc.).

Your doctor will get your full medical history (as well as any familial history of RA), discuss your signs and symptoms, undertake a physical assessment- particularly of your joints, and refer you on for imaging and blood tests. X-rays may help evaluate RA progression in your joints over time, whilst MRI and ultrasound imaging may help evaluate the severity of RA in your body. The blood test will evaluate your level of anti-bodies and proteins (including the rheumatoid factor protein that is present in approximately eighty percent of the RA population), and markers of inflammation.

 

 

Management

At present, though there is no cure for RA, a range of treatments are available which may help slow its’ progression and reduce pain and inflammation, minimise and/or prevent joint damage and maximise joint movement.

A combination of prescribed medication as advised by your doctor and other treatment options as noted below are recommended:

  • Cease smoking if you are smoker
  • Physiotherapy will help improve and maintain your joint range of motion, increase your muscle strength, and decrease your pain. Additionally, your physiotherapist or occupational therapist will be able to teach you ways of using your body efficiently to reduce stress on your joints
  • Finding a balance between rest and activity
  • Use of heat and cold packs to help ease pain and inflammation
  • The use of splints or braces for joint support as needed
  • Hydrotherapy- exercising in water reduces the pressure on your joints, whilst the warmth of the water will relax your muscles and help lessen your pain.
  • Seeking regular medical advice and check-ups to monitor your RA symptoms and the progression of the condition
  • Adopting a healthy and active lifestyle

Dealing with De Quervain’s

De Quervain’s tenosynovitis is categorised as an overuse disorder which affects the tendons in your wrist that you use to straighten your thumb. It is associated with swelling in the two tendons around the base of your thumb, which then causes the sheaths encompassing these tendons to become inflamed. This results in increased pressure on surrounding nerves as well, resulting in symptoms such as numbness, tenderness and pain. You are likely to have these symptoms when making a fist, gripping or grasping something, pinching, twisting your wrist, and/or laterally bending your thumb.

Symptoms

The key distinguishing symptom of De Quervain’s tenosynovitis is tenderness and/or pain at the base of your thumb. You can experience pain referring up or down your forearm. You may notice the pain gradually develop or appear suddenly, and worsen when using your wrist, thumb and hand. Painful movements include making a fist, gripping or grasping something, twisting your wrist, pinching, and/or laterally bending your thumb.

Other key symptoms include:

  • Swelling at the base of your thumb
  • Experience numbness along the back of your index finger and thumb
  • ‘Snapping’ or ‘catching’ sensation experienced when you move your thumb

Causes

De Quervain’s tenosynovitis is typically associated with the chronic overuse of your thumb, hand and wrist. When undertaking movements like gripping, grasping, clenching, pinching, or wringing items in your hand, the two tendons in your lower thumb and wrist usually glide in a smooth manner via the small tunnel which attaches them to the base of your thumb. However, when you repeat a certain movement day in day out, it irritates the sheath around these two tendons, resulting in swelling and thickening which restrict their movements.

Factors which may increase your risk of developing this condition are:

  • Being in the age bracket of 30 to 50 years old
  • Pregnancy
  • Found more commonly in women.
  • Baby care: Lifting, carrying and/or holding your child repetitively with using your thumbs as leverage.
  • Hobbies or occupations which involve repetitive wrist and hand movements

Diagnosis

Your doctor or physiotherapist will discuss your medical and occupational history, and carry out a physical assessment of your wrist and hand.

The physical examination will include palpation for pain when pressure is applied to the thumb side of the wrist, as well as clinical test called the Finkelstein test. This test requires you to bend your thumb across the palm of your hand and bend your fingers down over your thumb. You will then bend your wrist towards your little finger. If this causes pain on the thumb side of your wrist, you are likely to have this condition.

Whilst X-rays are usually not needed for the diagnosis, however, you may be referred on for ultrasound imaging.

Management

The aim of the management for this condition is to reduce pain caused by the irritation and inflammation of the tendons, preserve movement in the wrist and thumb, and prevent its reoccurrence. If treatment is commenced early, the symptoms should subside in 4-6 weeks. If your symptoms arise during pregnancy, they may settle around the end of the pregnancy or post the breast-feeding stage.

  • Splints may be utilised to immobilise and rest your wrist and thumb
  • Ice application to the affected area
  • Your doctor may recommend the use of anti-inflammatory medication to ease swelling and decrease pain
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Avoidance of aggravating repetitive movements and activities
  • Administration of corticosteroid injection into the tendon sheath can ease pain and decrease swelling if recommended by your GP
  • Physiotherapy: Your physiotherapist will examine how you use your wrist and provide suggestions on how to make technique modifications to relieve stress on your wrists. They will teach you strengthening exercises for your wrist, hand and arm to help decrease pain and limit tendon irritation
  • Surgery may be recommended by your specialist in more severe cases and if conservative management fails

Tennis Elbow Explained

What is Tennis Elbow?

Tennis elbow, or also known as lateral epicondylitis, is a painful disorder of the elbow triggered by overuse. This disorder is characterised by inflammation or, in some cases, micro-tearing of the extensor tendons which link the forearm muscles on the outer part of the elbow. This leads to pain and tenderness on the outside of the elbow, spreading through to the forearm and wrist.

Elbow Pain - Do I have Tennis Elbow? - Oh My Arthritis

Causes

Tennis elbow is characterized as an overuse and muscle strain injury. It is caused by repetitive and/or vigorous contractions of the forearm muscles which is used to straighten, extend, and lift the wrist and hand. The repetitive motions and stress to the tissues can result in a string of tiny, microscopic tears in the tendons which attach your forearm muscles to the bony prominence on the outside of the elbow.

Tennis elbow may result from number of activities including but not limited to:

  • Typing and repetitive computer mouse use
  • Cutting/chopping motions
  • Manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying.
  • Gardening
  • Using hand tools such as scissors, clippers, screwdrivers, plumbing and carpentry tools
  • Playing racquet sports, such as tennis, badminton, or squash
  • Throwing sports, such as the javelin or discus
  • Painting
  • Sewing/knitting

Tennis elbow may also occur after a sudden knock or bang to the elbow, if you undertake activities that you are not used to excessively and aggressively, and sometimes there is no apparent cause for it.

Risk Factors

Factors which may increase your risk of tennis elbow include:

Your age: Whilst this disorder impacts people of all ages, it is mostly prevalent in adults in the age group of 30-50 years old.

Your occupation: Those who have jobs which entail repetitive movements of the wrist and arm are more likely to develop this disorder. Examples include but are not limited to painters, computer users, plumbers, butchers, carpenters, and chefs.

Sports: Partaking in racket sports increases the risk of tennis elbow, particularly if you use poor form and technique.

Common Signs and Symptoms

Tennis Elbow - Symptoms, Causes, Treatment & Exercises

Pain noted around the bony knob on the outside of your elbow is the most common characterising symptom of tennis elbow. This knob is where the injured tendons connect to the bone. The pain is often depicted as “burning” in nature. Your elbow may be tender and sore to touch, and the pain can refer down to the forearm. The pain often increases with gripping, grasping, or rotating motions of the wrist and forearm. Bending and straightening your elbow may also be painful.

The severity of your pain may vary from a mild discomfort to severe pain that can interfere with your sleep and day to day activities. The pain typically starts gradually and then worsens over weeks or months.

Diagnosis

During your physical examination your physiotherapist will attempt to produce your pain in your elbow via specific tests and movements. They will assess your range of motion in your elbow, wrist, and shoulder joints. Referrals for X-rays and ultrasound scanning may be indicated to further support your diagnosis and to rule out other potential sources of your pain

Management

A mix of non-surgical treatment options are effective for the majority of tennis elbow cases, and self-resolves over time. You should rest your elbow and painful activities should be avoided. But it is very vital to maintain gentle movements of the forearm, elbow, and wrist through its range of motion.

Potential treatment options include:

  • Ice
  • Rest
  • Physiotherapy and acupuncture
  • Anti-inflammatory medications as recommended by your doctor or pharmacist
  • The use of a wrist and forearm brace or splint to support and rest your forearm

As your initial elbow pain lessens, your muscles around the elbow, forearm and wrist should be safely strengthened and stretched under guidance of a physiotherapist. Your physiotherapist will advise you on particular exercises, give you appropriate symptom management advice and take you through a personalised graduated rehabilitation program. If you continue to experience pain after 6-8 weeks of treatment, your physiotherapist can refer you back to your doctors, to consider administration of a cortisone injection into the elbow to help reduce pain and inflammation, and further referral onto see a specialist to seek guidance on other treatment options.

Helpful Exercises

Rotator cuff injury

Rotator cuff injuries are the most common source of shoulder problems. They can range from minor sprains causing impingement type symptoms, to massive tears resulting in severe loss of function and pain. They commonly occur as a result of acute injuries (sports, falls), chronic overuse (repetitive loading) or due to gradual aging.

Anatomy of shoulder

The shoulder joint (glenohumeral joint) is the most mobile joint in the human body. It comprises of the humeral head (top portion of upper arm bone) which fits in the glenoid cavity of the scapula (shoulder blade) to create a ball and socket configuration. This anatomical configuration results in limited bony contact between the humeral head and the glenoid fossa, which reduces the stability of the joint.

Several passive and active structures stabilize and maintain proper biomechanics of the shoulder joint.

  • Passive stabilizers include the ligaments, joint capsule, cartilage and the bony concavity of glenoid fossa. Thick cartilage known as labrum lines the glenoid fossa to further deepen the groove by about 50% which is advantageous in stabilizing the shoulder joint during the articulation.

  • Dynamic stabilizers of the glenohumeral joint is gained from the coordination of rotator cuff muscles that compress the passive structures providing stability and mobility as whole.

The rotator cuff muscles include:

  • supraspinatus

  • infraspinatus

  • subscapularis

  • teres minor

Rotator Cuff Disorders: The Facts | OrthoBethesda

 

 

Injury to any or all these four muscles, including the tendons that attach the muscles to bone can result movement dysfunction and severe pain.

Other important joints of the shoulder complex include:

  • sternoclavicular joint

  • arcomioclavicular joint

  • scapulothoracic joints

Types of rotator cuff pathology

Tendinitis and Tendinosis

More often than not the term tendinitis and tendinosis are interchangeably used to describe a similar tendon pathology. However, the factor that differentiates the two is the time of injury (acute or chronic).

Tendinitis results from acute injury to the tendon which sets off an inflammatory process characterized by pain, swelling, and redness. On the other hand, tendinosis is a chronic pathology that does not involve an inflammatory process. It is characterized by degeneration of collagen fibers in response to persistent micro-trauma, vascular compromise and aging.

Acute rotator cuff tear

  • Acute tears result from sudden forceful lifting of the arm against resistance or in an attempt to cushion a fall (for example, heavy lifting or a fall on the shoulder).

Chronic injuries

  • Most commonly resulting from occupational or sports requiring excessive repetitive overhead activity.

Signs and symptoms

Symptoms of a rotator cuff injury are due to the inflammation that accompanies the strain. Swelling that forms within the small space of the joint prevents the normal mechanics of the shoulder, resulting in the clinical picture of pain and decreased range of motion.

  • Acute rotator cuff tears
    Tearing sensation
    Immediate severe localised pain
    Reduced strength
    Symptomatic clicking
    Reduced and worsening pain with movements
    Affects daily activities (personal care, lifting, reaching etc)

  • Chronic rotator cuff tears
    Generalized deep dull ache, sharp onset of pain with movements
    Global shoulder weakness
    Reduced movements and daily activities (especially moving to the side, reaching behind back)

When to seek medical treatment

See your doctor or a physiotherapist if you experience any of the following symptoms in the shoulder:

  • Pain, especially pain that does not improve with rest

  • Swelling, redness or tenderness around the joint

  • Shoulder weakness

  • Reduced shoulder movement

For more severe rotator cuff injuries, you may require immediate medical attention.

Seek immediate medical attention if you experience the following symptoms:

  • Sudden, severe pain

  • Visible joint deformity

  • Inability to move or use your shoulder joint

  • Sudden swelling, discoloration

Diagnosis

To diagnoses an injured rotator cuff, your physiotherapist will begin with a thorough subjective and physical examination of your shoulder.

  • Subjective assessment

Your physiotherapist will begin with a thorough subjective assessment inquiring about your signs and symptoms of an acute injury as well as any symptoms that may suggest a more long-term problem.

  • Physical assessment

The physical examination often involves observation to look for muscle wasting, deformities, and/or changes in appearance of the injured shoulder to the unaffected side. Your physiotherapist will also palpate different areas of the shoulder complex to find the area of pain or tenderness. Further examination will involve assessment of movement and strength to establish injury to muscles or tendons.

  • Radiology

In addition, your physiotherapist may refer you for imaging tests to diagnosis the cause of your symptoms:

  • Ultrasound: examines soft-tissue structures (muscles, tendons, bursa)

  • X-rays: examines bone health, calcification

  • MRI: provides detailed imaging of areas injured (referred by doctors, specialists or surgeons)

Treatment

Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in.

Initial treatment of rotator cuff tendinitis involves managing pain and swelling to promote healing. This can be done by:

  • avoiding activities that cause pain

  • applying cold packs to your shoulder three to four times per day

  • taking anti-inflammatory medications like ibuprofen and naproxen

Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear.

When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. An individualized physiotherapy program is necessary to regain strength and improve function in the shoulder.

Physical therapy

Physiotherapy will initially consist of passive exercises to help restore range of motion and ease pain.

Once the pain is under control, your physiotherapist will prescribe exercises to help regain strength in your arm and shoulder.

Steroid injection

If you have persisting symptoms, your physiotherapist may recommend a steroid injection. This is injected into the tendon to reduce inflammation, which reduces pain.

Surgery

Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. In which case, your physiotherapist will refer you to surgeon for an opinion of surgical intervention.

Exercises

Range of movement exercise

Pendulums

  1. Lean forward with one arm hanging freely. Use your unaffected arm to brace against a chair for support.

  2. With your affected side, gently swing the hanging arm from side to side, forward and back, and in a circular motion for 15-20 seconds each direction.

  3. Slowly return to a standing position.

  4. Repeat 4-5 times a day

 

Shoulder pulley (Flexion)

  1. Put a chair against the door and sit so you are facing away from the door.

  2. Grasp the door pulley handles with both hands.

  3. Pull down on the pulley with your unaffected arm. This will lift your injured arm up over your head. Pull it as high as you can.

  4. DO NOT FORCE THE MOVEMENT. Your affected arm should be relaxed. The unaffected arm does the work.

Hold for 5 seconds. Relax and repeat 10-15 times, 3 sets.
Three times a day.

Shoulder pulley (Abduction)

  1. Put a chair against the door and sit so you are facing away from the door.

  2. Using door pulleys slowly pull down with your unaffected arm so that your affected arm raises up and to the side without effort.

  3. Your affected arm should be relaxed. The unaffected arm does the work.

Hold for 5 seconds. Relax and repeat 10-15 times, 3 sets.
Three times a day.

Wand flexion

  1. Stand upright and hold a stick in both hands

  2. Cup the top end of stick with affected hand

  3. Using your unaffected arm hold the stick midway and drive the affected arm forward and up.

  4. Ensure your elbow is straight throughout

  5. Hold for 5 seconds and return to the starting position.

  6. Repeat 10 times.

Wand Abduction

  1. Stand upright and hold a stick in both hands

  2. Cup the top end of stick with affected hand

  3. Using your unaffected arm hold the stick midway and drive the affected to the side as high as able.

  4. Ensure your elbow is straight throughout.

  5. Hold for 5 seconds and return to the starting position.

  6. Repeat 10 times.

Strengthening exercises with band

Flexion

  1. Stand on one end of the band while holding the other end with your affected side.

  2. Whilst keeping your elbow straight, lift the band up to 90 degrees to shoulder level.

  3. Hold at the top for 1-2 seconds then lower slowly to starting position.

  4. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

Abduction

  1. Stand on the band while holding the band with affected hand.

  2. Keep your elbow straight, lift the band up to 90 degrees to shoulder level.

  3. Hold at the top for 1-2 seconds then lower slowly to starting position.

  4. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

External Rotation

  1. Attach the resistance band to a secure anchor at belly button height.

  2. Stand with unaffected arm perpendicular to the anchor.

  3. Place a towel between your elbow and your torso to stabilize your elbow

  4. Grab the band using your affected side and then slow pull the band away from your body by squeezing your shoulder blade in towards the middle of your back.

  5. Slowly return to starting position.

  6. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

Internal Rotation

  1. Attach the resistance band to a secure anchor at belly button height.

  2. Stand with affected arm perpendicular to the anchor.

  3. Place a towel between your elbow and your torso to stabilize your elbow

  4. Grab the band using your affected side and then slow pull in to your body

  5. Slowly return to starting position.

  6. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

Meet Your Body Parts!

Here are definitions of common terms for body parts you may hear your doctor or physio use!

 

Ligaments

Ligaments are cordlike extensions that serve to connect ends of two bones to form a joint. They are made up of strong, durable, slightly elastic bandlike structures comprised of collagen fibres. The structural make up of ligaments is advantageous providing joint stability by limiting excessive movement.

What are Ligaments? (with pictures)

Tendons

Similar to ligaments, tendons contain densely packed bundles of tough collagen fibres that hold muscles together to the bone. They are located at the ends of every muscle in the human body. Bound together in tight sheaths they are made to withstand tension and transmit forces exerted by the muscle to the bone to cause movement.

 

10 Facts About Tendons | Physio Direct - Rural Physio at Your Doorstep

Muscles

Human body is made up of over 600 muscles categorised into three different types – cardiac, smooth and skeletal muscle.

  • Cardiac muscle – is only found in the walls of the heart. Its contractions help propel blood through the blood vessels to all part of the body.
  • Smooth muscle – is found mainly in the lining of internal organs (except the heart) including digestive and uninary tract organs, blood vessels. Smooth muscle works to transport substances through the organs by alternately contracting and relaxing.
  • Skeletal muscles – Skeletal muscles are the most abundant type of muscles that form the flesh of the body. They are attached to bones of the skeleton by tendons. They are responsible for voluntary movements of body. Facial expression, mobility, postural control and breathing are some of the movements we observe when skeletal muscles are subjected to voluntary control.

 

Muscle types — Science Learning Hub

Bones

Skeletal system of the human body is made up of 206 bones. Bones are most involved in providing an architectural framework by providing body shape, support and protection of vital organs and for locomotion. Besides these functions, bone is a reservoir for mineral and fats as a source of stored energy and formation of blood cells. Bones are classified by their shape as long, short, flat and irregular. They are connected by ligaments to form joints.

Let's learn about bones | Science News for Students

Cartilage

There are three different types of cartilage found in the human body – hyaline, elastic and fibrocartilage. Hyaline cartilage is the most common cartilage in the human body. It covers the ends of most bones at movable joints, connects ribs to the breastbone, forms the voice-box and nasal passages. It  consists of high water content that provides resilience to withstand great compressive forces found predominantly in joints.

 

What Is Cartilage?

Ankle injuries – Your first step to recovery

Common? Oh Yes!

The ankle is the most commonly injured joint in sport. This does not exclude other people such as active hikers, beach goers and even your average Sunday stroller. Good news though – your ankle injury is highly likely to be uncomplicated.

It is still vital that your ankle is examined, evaluated and treated early. This will ensure a swift return to activity and prevent further complications.

 

The road to recovery

Planning for Resiliency and the Road to Recovery

Your clinician will ask you some questions related to how you injured your ankle, pain, instability and any past episodes of injury. The earlier you get your ankle checked, the sooner your recovery will begin.

Keeping a mental note of things like initial pain, swelling, ability to walk and balance will go a long way in assisting your clinician to making an accurate diagnosis.

 

Investigations

Ankle x-rays

In most cases, initial X – rays are done to rule out broken bones.

Ultrasounds can be used to diagnose some ligament and tendon damage.

MRI is the best form of imaging but this does come at a higher cost and higher exposure to radiation. These are usually done after failed conservative treatment or in instances where pain remains high for longer periods.

A CT scan is helpful with complicated foot and ankle fractures. It will normally be ordered by a specialist surgeon who is planning for an operation.

 

What to look out for

Ankle sprains:

This is normally a twisting injury that causes a stretch or tear of ligaments surrounding the ankle. Your health care professional will provide you with all the information and tools you need for recovery.

These heal relatively quickly when the outside border of the foot is affected and a little slower when the inside border of the ankle is affected.

You will normally feel pain on certain ankle movements, stiffness in the ankle and experience some swelling and bruising.

Ankle - Wikipedia

 

Ankle Fractures:

These normally present with swelling, bruising and pain initially – although not always. In some cases, it is too painful to put weight on the ankle.

They are usually best confirmed with X – ray and specialist referral.

Management may be surgical or non-surgical depending on the severity and site of the fracture.

Fractures generally take longer to recover compared to sprains.

 

What treatment to expect

Foot and Ankle Doctor | EmergeOrtho—Triangle Region

Acute phase:

Your healthcare professional will normally initiate techniques to minimise your pain and swelling with rest, ice, compression and elevation.

Analgesia and anti – inflammatory medication may also be used.

Strapping may be used for stability at this stage and can be done by your physiotherapist.

You will also be encouraged to increase movement and begin strengthening.

 

Rehabilitation phase:

Balance and proprioceptive exercises will be given to you by your physiotherapist.

Strengthening will continue and running will start soon.

Once running in a linear motion pain free, you will progress to sport specific exercises.

Finally, you will return to sport or previous function such as trekking with a graded program.

Strapping may continue for up to 12 months after your injury in order to prevent re–injury.

 

What can you do on the day of the injury?

Rest by reducing time spent walking or standing. This will help the ankle to heal.

Ice the ankle for up to 20 minutes every couple of hours.

Compress the ankle with a firm bandage during the day and remove the bandage at night.

Elevate the leg.

Attempt circulatory exercises such as ankle circles and foot pumps (About 10 – 30 repetitions every couple of hours).

Contact your health professional or physiotherapist in order to make appointment for assessment.

If you are unable to stand on your leg or have excruciating pain in the ankle, head on to the local emergency department for immediate investigation.

 

Remember, your injury will heal and you will recover!

 

To find your nearest Physio Fusion clinic and book an appointment call 09 6266186 or visit our website https://physiofusion.co.nz