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Common shoulder and elbow injuries guide
1. Common shoulder and elbow injuries Nicholas Costiff Chartered Physiotherapist
2. 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?
3. 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
4. Rotator cuff Four smaller muscles Stability of the joint Rotational movements at the shoulder
11. How to prevent this… Rotator cuff strengthening Scapular stability training
12. Physiotherapy Stretch tight muscles and tissue Strengthen specific weak muscles (eccentric strengthening) Soft tissue massage Upper limb proprioception Mobilize stiff joints Core stability training
13. The Elbow Hinge joint Also joints of the forearm Flexion – Extension Pronation – Supination Wrist muscles Nerve tissue
14. 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)
15. 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
17. 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
18. Treatment Eliminate the cause of pain Relative rest Electrotherapy Soft tissue techniques Stretching exercises Eccentric exercises. Graded return to previous activity levels
