Upper Limb Injuries

This contains information about upper limb injuries

Management of the Injured Tendon: Difficulties in Diagnosis and Treatment

Abstract

Background: Tendon injury is a painful and often debilitating affliction, which commonly presents to the sports medicine professional. Researchers have often struggled to determine the most appropriate way to manage this condition. Despite the plethora of literature on management strategies, there appears to be little stemming from sound scientific evidence. Objective: The aim of this is to identify studies that demonstrate a greater understanding of the pathophysiology of tendon injury and evaluate the most effective management strategies for this difficult condition. Methods: A systematic review of the literature was conducted. Results: The current review found support for the early use of corticosteroid injections, despite long term detrimental effects. The review also demonstrated exercise therapy designed to stretch and strengthen will be more effective in the long term. Conclusion: Individuals with tendinopathy should perform a regular strengthening and flexibility regime as early as possible. Patients with pain limiting daily activities may benefit from corticosteroids injections, to allow them to perform activities with reduced pain.

Management of the injured Tendon

Rotator Cuff Strain

What is It?

A rotator cuff strain is a sudden traumatic injury to one or a combination of the supraspinatus, infraspinatus, teres minor and subscapularis muscles and or tendons. prior history of impingement syndrome may be present, and can often be difficult to diagnose. injury to the rotator cuff musculature, typically follows a traumatic incident, which is usually a good way to differentiate between tendinopathy.

to determine the extent of muscle injury a grading system exists to assist in guiding the rehabilitation process:

  • Grade 1: Minimal fibre damage, slight strength loss, minimal pain and a reduction in the range of motion
  • Grade 2: Partial tear with moderate fibre damage, increased strength loss, the tear is often palpable.
  • Grade 3: Complete rupture, possibility of surgical management, individuals may have a complete loss of strength with marked dysfunction including the arm drop sign.

Causes

  • Unaccustomed overuse of the muscle/tendon unit following extended periods of home improvements (gardening, painting), sporting activity (Tournaments with multiple rounds), weight training.
  • A single violent blow to the shoulder, particularly in the mechanisms of abduction, external rotation and extension (pulling the arm back to throw) and or adduction, internal rotation or flexion (Empty can).
  • lifting or pulling something with significant weight.
  • Falling onto and outstretched hand
  • If you have suffered a previous impingement syndrome without adequate recovery.

Signs and Symptoms

An individual may experience immediate pain at the time of the injury, depending on the severity of the injury the individual may be able to continue the activity only for the pain to come back once activity has ceased. A popping or tearing sensation may be felt at the time of the injury. There will be associated pain and weakness felt in the shoulder with possible swelling and bruising.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the shoulder joint and rotator cuff musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain and inflamation is present you may benefit from ice application and some non-steroidal anti-inflammatory medication (NSAIDS). initial immobilization of the shoulder joint may be necessary in grades 2 and 3.
  • Initiation of flexibility and strengthening programs for the shoulder muscles with particular focus on the rotator cuff muscles, focusing on building stability in the joint before looking at strength.
  • Evaluating any training errors, correct technique and checking use of appropriate equipment. posture education for desk based workers limit the risk of further weakness through faulty head and neck alignment.

*** Assessment of muscle damage by a qualified professional is essential to determine the extent of the injury and evaluate the best course of treatment, therapists at sports injury scotland will be able to evaluate your injury and guide you as to the best method of progression ***

What can Sports Injury Scotland do??

Correct diagnosis of a muscle injury will ensure the individual gains the most appropriate treatment strategy for their injury. management of a muscle injury will vary depending on the amount of tissue damage and also the individuals daily activities. Sports massage and mobilizations have been found to be an effective method of reducing the pain associated with rotator cuff tears, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Lateral Elbow Tendinopathy (Tennis Elbow)

What is it?

Lateral elbow tendinopathy is the most common cause of elbow pain, 7 times more than medial. Pain on the lateral aspect of the elbow, typically known as tennis elbow, has an insidious onset with early presentations of pain only posing a problem with aggravating activity. despite the term tennis elbow, research has suggested that 95% of individuals presenting with lateral elbow pain have never actually played tennis. The condition typically affects the extensor muscle group at the elbow (Extensor carpi radialis brevis, extensor digitorum and extensor carpi ulnaris), commonly due to repeated overload of the tendons without adequate recovery.

Causes

  • Overuse: a sudden change in training levels and/or loads can have a detrimental impact on the muscle. as well as training overuse, occupational stresses can place additional loads on the flexor musculature.
  • Change in training technique or equipment: in tennis a change or racquet, grip size, playing with a wet ball all has implications on the elbow joint.
  • Changes in work duties: additional typing or writing can increase the stress applied to the lateral tendon group.
  • Neck and thoracic dysfunction: previous or current neck and/or thoracic pain can refer pain into the elbow region.
  • Poor grip strength: poor strength and flexibility in the arm can predispose an individual to lateral elbow pain.

Signs and Symptoms

Individuals usually experience pain on the outside of the elbow, which in the early stages is only symptomatic following aggravating activity, which subsides following cessation of activity. When the issue is ignored the pain is felt in other times of daily life, and in severe cases the pain may keep the individual awake, have difficulty picking up normal items such as a mug, carrying shopping bags and certain movements may be an issue. performing daily activities i.e. work tasks, especially if there is a lot of computer work can become difficult. There may be associated neck and upper back pain, which may cause neural distribution symptoms.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the elbow joint and wrist extensor musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain and inflammation is present you may benefit from ice application and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programs for the elbow muscular with particular focus on the extensor muscles, while incorporating flexor, supinator and pronator strength, training not only isometric strength but also looking at the control of movement under load. Focus on building stability in the joint before looking at strength.
  • In patients with associated neck and thoracic pain, mobilizations have been found to be an effective treatment strategy.
  • Evaluating any training errors, correct technique and checking use of appropriate equipment. posture education for desk based workers limit the risk of further weakness through faulty head and neck alignment.

*** Assessment of tendinopathies by a qualified professional is essential to determine the extent of the injury and evaluate the best course of treatment, therapists at sports injury scotland will be able to evaluate your injury and guide you as to the best method of progression ***

What can Sports Injury Scotland do??

Correct diagnosis of a tendinopathy will ensure the individual gains the most appropriate treatment strategy for their injury. management of tendinopathies will vary depending on the level of pain and dysfunction and also the individuals daily activities. Sports massage and mobilizations have been found to be an effective method of reducing the pain associated with lateral elbow tendinopathies, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education and technique evaluation is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Upper body Stretches

Sports Injury Scotland

 

 

 

 

 

Stretching should form an integral part of any training regime. Research suggests the best time to stretch is after exercise, making sure the muscles are warm. stretching a cold muscle can lead to potential muscle damage.

Attached is some stretches focusing on the main muscles of the upper body.

Upper Body Stretching Program

Stretching programs for the lower body and core can also be found on the website.

Initial Management of an Acute Injury

Once an injury occurs, whether to muscle, bone or ligament, it is imperative that you seek the most appropriate treatment for this. Injury often varies in severity, and therefore symptoms will differ. The most common signs of inflammation are heat, redness, swelling, pain and loss of function, not all of these symptoms may be present and some may even appear at a later date.

When you suspect you have sustained an injury to soft tissue (Muscle or Ligament) you must first minimize the symptoms of inflammation. The first 24 hours following the initial injury are critical in management. The following acronym is designed to control the bleeding and thus reduce inflammation and scar formation.

R: Relative Rest

I: Ice

C: Compression

E: Elevation

Relative Rest

Following any musculoskeletal injury, depending upon the severity, may require some immobilization, generally research suggests that a short period of reduction in motion can result in a stronger scar, which will be able to withstand more force, thus improving tissue regeneration and promotion of parallel alignment (Brukner and Khan 2012).

It is important however not to rest the injured area for too long, extended periods of immobilisation can weaken not only the injured tissue but also the surrounding areas, making return to activity a slow process.

Ice

One of the most important components of inflammation recovery, is the application of ice, Ice has been thought to reduce tissue metabolism, thus reducing blood flow and accumulating fluid, which results in reduction of swelling. Application of ice should happen as soon after injury as possible and should continue for the first 48 hours.

Two application procedures have been suggested, continuous and intermittent.

Continuous: 20 mins every 2 hours

Intermittent: 10 mins, with 10 mins rest then another 10 mins ice every 2 hours.

There are a number of ways to apply ice, with the most common being reusable packs (which can be kept in the freezer and used when required), Chemical ice packs (these are one use, disposable packs which are good for travelling, can be an expensive long term option tho), and frozen veg (frozen peas** have been found to be a good alternative to ice, as they conform to the body easily and can be re frozen for further uses).

** Mark bag with do not eat.

Prolonged exposure to ice can cause burning or nerve damage.

Compression

To reduce bleeding and swelling compression should be applied to the injury site, this should be used during and after ice application. The pressure should be firm but not to tight that it causes pain.

When using a bandage pressure should be initially applied distal to the injury and with slight overlap move proximal to one handbreadth above the injured area.

Elevation

The injured limb should be, where appropriate be raised above the heart, to reduce the pressure within the injured structure. This will also help in reducing the accumulation of fluid into the area, which will therefore reduce swelling.

Precautions in the Acute Stages

During the initial 72 hours there are a number of things that the injured person should avoid

Heat: Which will increase blood flow to the injured site, therefore increasing swelling,

NO hot baths, showers, saunas etc

Alcohol: this can mask the level of pain and severity of the injury

Aggravating Activity: Can result in worsening of the injury or re-injury

Massage and aggressive manual therapy: can increase blood flow, thus increasing swelling and risking further injury.

Relieving Neck Pain

The neck region is a highly complex series of joints, which offers great mobility; this increased mobility increases the vulnerability of the structure (Prentice 2011). Neck pain is extremely common with research finding the prevalence of non specific neck pain to be as high as 66.7% in a 1 year period (Sarig-Bahat 2003). Non specific neck pain has typically no known cause (Brukner and Khan 2012). A well known reason for neck pain, is the number of hours an individual sits at a desk, increases in flexion when reading, and lateral flexion when on the phone can place additional stress on the intervertebral disks, joints and muscles (Prentice 2011).

Many Treatment strategies have been evaluated for the management of non specific neck pain, the most common forms of treatment are exercise therapy, postural education, mobilisations and massage. success has been demonstrated when a combination of therapies are adopted. It is important when suffering from neck pain that you do not ignore it, the quicker you seek treatment the shorter the recovery. A number of stretching exercises which can be done at the end of a stressfull day or on the onset of neck stiffness, if these exercises do not help to relieve your pain, a course of treatment can be provided at the clinic.

References

Brukner, P. and Khan, K. (2012). Clinical Sports Medicine. 4th Edition, McGraw Hill, Austrailia

Prentice, W. E. (2011). Principles of Athletic Training: A Competency Approach. 14th Edition, McGraw Hill, New York.

Sarig-Bahat, H. (2003). Evidence for exercise therapy in mechanical neck disorders. Manual Therapy, 8(1), 10-20

Exercises