Shoulder and Elbow

What is it?

A Frozen Shoulder, also called ‘Adhesive Capsulitis’ occurs when the capsule that surrounds the shoulder becomes too tight, and limits your movement of the shoulder, and commonly disturbs sleep. This can manifest with lots of restriction (often when moving the hand behind the back) but can have varying levels of pain.

The causes are somewhat unknown, but can follow on from injuries, and can commonly occur in those with Diabetes. It usually presents in women more than men, and in those in their 40s to 60s.

Will a scan help?

In age groups or individuals that could be at risk to both Osteoarthritis (OA) and Frozen Shoulder – an X-Ray would be helpful to differentiate between the two. In the absence of any OA, Frozen Shoulder is confirmed.

What are the options?

The management options are generally:

1. Wait – left untreated, there can be a ‘thawing’ process that can take up to two/three years
2. Injection Therapy – corticosteroid, or a high volume injection (distension procedure) including around 20-30ml saline plus corticosteroid
3. Physiotherapy – for stretching exercises and manual therapy
4. Orthopaedic management – ‘manipulation under anaesthetic’ or ‘capsular release’

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What is it?

Medial Epicondylitis could be referred to as the lesser known sibling to Tennis Elbow. Affecting the inside of the elbow, where the wrist flexor tendons attach on to the bone. The principles of management are still the same, but focus on the forearm flexors this time.

Will a scan help?

See related section on Tennis Elbow.

What are the options?

The principles of management are still the same as for Tennis Elbow, but focus on the forearm flexors this time.

What is it?

Rotator cuff-related shoulder pain (or sometimes referred to as subacromial pain), is what we see mostly when it comes to shoulders. Accounting for up to 85% of diagnoses, it is broad term that includes several soft tissue problems in the shoulder. In the majority of cases it’s not always necessary to know which structure related to the cuff that is causing your pain, in order to put a treatment plan in place.

This injury can come on either gradually, after a trauma, from repeated use, or perhaps after an awkward movement or lift.

The principle method of treatment is exercise therapy and activity modification – which often initially involves doing less of the things that hurt.

Will a scan help?

Not routinely, but for more stubborn cases – an Ultrasound Scan can help identify if there are any calcific deposits in the tendons. An MRI would be indicated for suspected large, traumatic rotator cuff tears. An X-Ray offers minimal information here.

What are the options?

1. We have an exercise programme tailored to this injury, available online – called the REACH programme (also available in printed form from your therapist)
2. A corticosteroid injection might be indicated if this programme (plus adjusting some daily activities) does not help
3. In some cases, a ‘key-hole surgery’ known as an ASAD might be the final option

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What is it?

The cause of these will be obvious to most – a direct trauma due to a fall usually. And diagnosis will come from the Emergency Department via an X-Ray. The most common area to fracture is the proximal humerus, which is the top of the upper arm.

Will a scan help?

Yes. X-Ray required in the Emergency Department to confirm or negate the presence of a fracture.

What are the options?

The question that needs answered is whether the fracture needs immobilised in a cast and/or sling, or needs to be fixed in place with a plate and/or screws.

The Physiotherapy team will usually see patients 6 to 12 weeks after their initial injury to start working to restore elbow movement and rebuild strength in the arm.

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What is it?

Osteoarthritis in the shoulder is much less common than it is in the hip or the knee, but can still cause pain and disability. Shoulder OA is more frequent in those over the age of 65, which helps differentiate from those with Frozen Shoulder, alongside the rest of the presentation.

Will a scan help?

An X-ray is the imaging method of choice for suspected OA of any joint, and the shoulder is no different. If OA is present – then this would help the team understand to which degree, and whether best managed through Physiotherapy, or in extreme cases – via the Surgeon (Shoulder Replacement).

What are the options?

1. Although exercises won’t change the OA in the joint, it can help reduce pain and help function
2. Steroid injections can again provide short to medium term benefits
3. Joint replacement is the last resort in order to ease pain, although does not always restore function

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What is it?

Another very common upper limb condition, is tennis elbow – or ‘lateral epicondalgia’. Irritation or inflammation of the wrist extensor tendons (located near the elbow) mean gripping, lifting items even as light as a mug can be very painful. Tendons are susceptible to changes in activity, normally new hobbies, a new job, or performing an unaccustomed task.

Will a scan help?

In short, no. For most cases any scans are neither useful or necessary in the diagnosis or guiding the management of tennis elbow.

What are the options?

Injections are not usually indicated for this problem and even more rarely is any form of surgery.

Treatment primarily revolves around:

1. A resistance (loading) programme for the forearm extensors
2. Reducing or altering the activity that initiated or is maintaining the problem
3. Wearing an elbow brace (Epi-Clasp)

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