Reviewing National Physical Therapy Month: Shoulder, Elbow, And Wrist
October is National Physical Therapy Month, an annual campaign that’s intended to increase public awareness about physical therapy and highlight the multitude of ways that patients’ lives can improve from treatment. To do our part in spreading the word and working towards these goals, we’re providing a detailed review of the wide range of conditions that physical therapists can treat in each region of the body.
In this post, we’re focusing on the shoulder, elbow, and wrist with brief summaries of the most prevalent injuries and conditions that occur in these regions.
The shoulder is the third most common site for musculoskeletal pain in the body, with up to 67% of the population bound to experience it at some point. The primary reason pain occurs so frequently in this region is that the shoulder is the most flexible and mobile of all the joints, as it can rotate a full 360°. This extreme flexibility, however, makes the shoulder more vulnerable to a variety of sudden and overuse injuries. Among the most common shoulder–related conditions are the following:
- Note: about 85% of shoulder issues involve the rotator cuff, a group of four muscles and tendons that form a “cuff” and support the head of the upper arm bone
- Rotator cuff tendinitis (shoulder tendinitis): results from irritation or inflammation of a rotator cuff tendon, leading to pain and swelling in the front of the shoulder and side of the arm; most common cause of shoulder pain
- Shoulder impingement syndrome: involves any of the rotator tendons or other structures being trapped (or impinged) by two bones, which leads to shoulder pain, weakness, and difficulty reaching up behind the back
- Rotator cuff tear: results when a rotator cuff tendon detaches from the bone, either partially or completely; can occur either traumatically or gradually, which is usually the case in older patients
- Shoulder bursitis: inflammation of a fluid–filled sac in the shoulder called the bursa, which occurs from regularly performing too many overhead activities; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
- Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, which causes the shoulder capsule to thicken and tighten around the shoulder joint; symptoms include pain and stiffness that makes it difficult to move the shoulder
The elbow is the link between the upper and lower arm, and it can be subjected to repeated stress from many daily activities. As a result, most elbow–related injuries that physical therapists treat result from repetitive stress, either from one’s occupation or from certain sports. Below are a few of the most common:
- Golfer’s elbow (medical epicondylitis): this condition results from repeated bending of the wrist, which damages the muscles and tendons in the elbow and eventually leads to inflammation; it’s most common in golfers, but can occur from other sports and activities that strain the elbow, and the clearest indication is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities
- Tennis elbow (lateral epicondylitis): a repetitive strain injury caused by repeatedly performing the same movements—in tennis, other racquet sports, or one’s profession—over and over; common symptoms are pain and a burning sensation on the outside of the forearm and elbow that gets worse with activity, as well as weakened grip strength
- Ulnar collateral ligament injury: the ulnar collateral ligament, which connects the inside of the upper arm bone to the inside of your forearm, is frequently damaged or torn in youth baseball from young pitchers throwing too often without rest; a tear will sideline a player for an extended period
The wrist is comprised of 15 bones, which are connected by three primary joints and several other smaller joints, plus numerous muscles, ligaments, and tendons that reinforce these connections. Any of the structures of the wrist can be damaged by extreme movements—like twisting, bending, or a direct impact—that force it beyond its normal range of motion, or from repetitive use. Below is a selection of the most common wrist–related injuries physical therapists manage:
- Carpal tunnel syndrome: a repetitive strain injury that affects about 5% of the population; results from regularly performing tasks that require repetitive hand motion, awkward hand positions, strong gripping, mechanical stress, or vibration; starts with a burning/tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then up the arm
- Wrist arthritis: a general term for the wearing away of protective cartilage on the ends of bones in the wrist, usually either from osteoarthritis or rheumatoid arthritis; leads to pain and impaired wrist range of motion
- Ulnar tunnel syndrome (Guyon’s canal syndrome): similarly to carpal tunnel syndrome, this condition involves compression of the ulnar nerve and leads to a tingling sensation in the ring and little fingers; it’s particularly common in weightlifters and cyclists
- Wrist tendinitis: a condition in which one or more tendons in the wrist becomes inflamed and irritated, which leads to pain and disability; tendinitis can occur at any age but is more common in adults, especially those over the age of 40
- Dupuytren’s contracture: an abnormal thickening of tissue between the skin and tendons in the palm, which may limit the use of the fingers or eventually cause them to be pulled in towards the palm in a bent position
The use of physical therapy for these conditions is backed by research
Physical therapists can effectively treat these and many other painful conditions that affect the shoulder, elbow, and wrist. Most treatment programs will involve some combination of education, pain–relieving interventions, flexibility and strengthening exercises, manual (hands–on) techniques, and activity modification recommendations—particularly for repetitive strain injuries—but the specific contents of each plan will vary depending on the type and severity of the condition, and the patient’s abilities and goals.
There is an abundance of research that supports physical therapy as effective solution for many of these conditions. For example, a recent review of studies called a systematic review found that stretching exercises, strengthening exercises, and other physical therapy techniques reduced pain and improved range of motion in patients with frozen shoulder, while a 2018 systematic review identified moderately strong evidence to support exercise therapy for rotator cuff tears. Research has also shown that exercise therapy is effective for both tennis elbow and golfer’s elbow, and that manual therapy can lead to significant benefits in patients with carpal tunnel syndrome.
In our next post, we’ll review conditions affecting the knee, ankle, and foot.