Upper Limb Disorders

Shoulder Pain

Shoulder pain is one of the most common musculoskeletal complaints and there are a number of different conditions which can give rise to pain and disability in this region. Shoulder problems can be basically categorised into one of the following groups:

  • 1) Impingement:
  • Structures are “pinched” in the shoulder with certain movements, activities and positions.
  • 2) Capsulitis:
  • Commonly referred to as “frozen shoulder”, varying degrees of stiffness are associated with pain or discomfort.
  • 3) Instability:
  • Shoulder movement is either excessive or poorly controlled by muscles and this may develop gradually or follow a traumatic episode such as a dislocation.
  • 4) Torn/Damaged Structures:
  • Tendons, ligaments or joint cartilage (labrum) may become compromised either by overuse or trauma.
  • 5) Inflammatory Disorders
  • 6) Referred Pain from another source:
  • This means that whilst pain is felt in the shoulder, its source is actually elsewhere (eg the neck).

Successful treatment requires correct diagnosis of the disorder, addressing causative factors, pain relieving techniques & restoration of normal movement, strength & co-ordination to perform normal daily tasks which could range from a tennis serve to hanging out the washing. Surgery and injection techniques also have a significant role to play in the treatment of some shoulder pain. A thorough history and clinical examination is vital in this region, as scans do not always actually reflect what is going on in a particular presentation and thus should always be interpreted in light of how the patient presents as false positive and negative results do occur.

Elbow Pain

Whilst there are a number of different elbow conditions, without doubt the most commonly seen in practice are tendon disorders. These are frequently referred to as tennis and golfer’s elbow, despite the fact that the majority do not arise from either of these sports.

Tendons attaching to the elbow form the origin of forearm muscles which act to stabilise and move the wrist and fingers. Different types of overuse, for example a sudden increase in activity or performing the same type of task repeatedly over a prolonged period of time, can lead to these tendons becoming painful. Primarily this will manifest itself with gripping activity, such as lifting a saucepan or shaking hands.

Treatment involves activity modification to reduce the load placed upon the affected tendon, pain relieving techniques and critically, a graduated strengthening program to recondition the arm for return to normal daily activities. It is also very important to identify and address any lifestyle or work/sport technique issues which have lead to the disorder arising in the first place.