Upper limb injuries

The two main areas in the upper limbs which are more susceptible to injury; the elbow and the hand.

Below is a list of some of the most common injuries which we face on a daily basis. We have compiled information to help assess and manage your injury but if you find you need a personal review or diagnostic please contact your GP for a referral to the PhysioHey Service.

Elbow pain

There are 2 common conditions that affect the elbow Tennis Elbow and Golfer’s Elbow

Tennis elbow causes the outside of the elbow joint to feel painful and tender

Tennis Elbow or lateral Epicondylitis causes pain / tenderness on the outer aspects of the elbow and often affects people who play racquet sports and manual workers but it can affect anyone.

What causes Tennis Elbow

This is an overuse condition affecting the common extensor tendon which attaches the extensor muscles of the wrist to the outside of the elbow.  The movement generated by this muscle is when the palm of the hand is facing down and it contracts causing the muscles to pull the wrist up to 90 degrees.

Due to over use microscopic tears develop causing the tendon to degenerate resulting in the symptoms of Tennis elbow, when the condition becomes chronic or long lasting calcification can occur where the tendon attaches the bone (the tendon insertion). In rare cases larger tears can develop, but the vast majority of cases are not serious and can be self managed.

The Symptoms

Pain and tenderness on the outside of the elbow is most common and is triggered when lifting with palm facing downwards or action similar to wringing out a cloth or pouring a heavy kettle.  Often a precise tender spot can be pin pointed over the bone just in front tendon itself.

How is it Diagnosed

The symptoms are usually classic in their presentation so no special investigations are usually required, if there is uncertainty about the diagnosis an ultrasound or MRI may be required.

Can I prevent it?

  • If you are new to sport or activity seek expert advice, as poor or incorrect technique increases the risks of injury.
  • Build up any new activity slowly, it takes time for the body to adjust to new sports and activities
  • DIY is another common cause of tennis elbow especially if you are not used to doing it. Avoid repetitive actions or excessive lifting, break up large jobs into more manageable chunks
  • Before starting strenuous activity warm up (see our sports injury information)
  • Good posture and correctly set up workstations is important

How do I manage my Tennis elbow?

Most cases can be self-managed with modification of activities, simple exercises and pain killers if required, and a small number of cases may require a steroid injection or in very rare cases surgery may be considered.

Advice

  • If the elbow feels sore after physical activity apply an ice pack for 15 minutes every few hours
  • Massaging the elbow may help and try using topical non-steroidal anti-inflammatory gels available from pharmacists
  • Racquet sports, increase the size of the grip by adding more tape
  • Sports shops or online often stock specially designed braces for tennis elbow symptoms. They work by applying pressure to the tendons and muscles during activity and help reduce symptoms
  • Special exercises from your Physiotherapist called eccentric exercises can be beneficial to tennis elbow sufferers

Further Treatment

Anatomically guided Corticosteroid injections can be done for tennis elbow, this involves steroid being injected around the tendon and its insertion into the bone.  However with any invasive procedure there are risks and possible side effects for you to consider, these will be discussed with you in full by the Injection Therapist should an injection be considered necessary.

A small number of cases may require surgery; the surgery aims to release the strain on the tendon, removing degenerated tissue and promote healing.

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Golfers elbow

Golfer’s elbow (Medial Epicondylitis) causes the inner side of the elbow joint to feel painful and tender, it often affects those who play golf (hence the name) and sports which involve throwing.  Manual occupations and those which involve climbing may also be affected.

What causes Golfers elbow?

Again this is an over use condition.  The affected tendon is the common flexor tendon which attaches the flexor muscles of the forearm and attaches to the inner side of the elbow, these are the muscle that cause the fingers to curl up.

Due to over use microscopic tears develop causing the tendon to degenerate resulting in the symptoms of golfers elbow. Where the condition becomes chronic or long lasting calcification can occur where the tendon attaches the bone (the tendon insertion). In rare cases larger tears can develop, but the vast majority of cases are not serious and can be self managed.

The Symptoms

Pain and tenderness on the inner side of the elbow are the most common symptoms over the bony prominence called the medial epicondyle.  Pain is usually triggered by gripping (lifting with your palm facing up, squeezing or pulling) a spot can usually be felt over the bone just in front of the tendon itself.

How is it Diagnosed

The symptoms are usually classic in their presentation so no special investigations are usually required, if there is uncertainty about the diagnosis an ultrasound or MRI may be required.

Can I prevent it?

  • If you are new to sport or activity seek expert advice as poor or incorrect technique increases the risks of injury.
  • Build up any new activity slowly, it takes time for the body to adjust to new sports and activities
  • DIY is another common cause of golfers elbow especially if you are not used to doing it. Avoid repetitive actions or excessive lifting, break up large jobs into more manageable chunks
  • Before starting strenuous activity warm up (see our sports injury information)
  • Good posture and correctly set up workstations is important

How do I manage my Golfers elbow?

Most cases can be self-managed with modification of activities, simple exercises and pain killers if required, a small number of cases may require a steroid injection or in very rare cases surgery may be considered.

Advice

  • If the elbow feels sore after physical activity apply an ice pack for 15 minutes every few hours
  • Massaging the elbow may help and try using topical non-steroidal anti-inflammatory gels available from pharmacists
  • Racquet sports, increase the size of the grip by adding more tape
  • Sports shops or online often stock specially designed braces for golfers elbow symptoms. They work by applying pressure to the tendons and muscles during activity and help reduce symptoms
  • Special exercises from your Physiotherapist called eccentric exercises can be beneficial to golfers elbow suffers

Further Treatment

Anatomically guided Corticosteroid injections can be done for tennis elbow, this involves steroid being injected around the tendon and its insertion into the bone.  However with any invasive procedure there are risks and possible side effects for you to consider, these will be discussed with you in full by the Injection Therapist should an injection be considered necessary.

A small number of cases may require surgery; the surgery aims to release the strain on the tendon, removing degenerated tissue and promote healing.

Both cases can be easily be self-managed yourself by modifying activities to avoid further symptoms and performing some simple exercises and painkillers if required

Hand pain

Hand pain is very common with many causes ranging from osteoarthritis to trapped nerves.

The common cause of hand pain is Carpal Tunnel Syndrome (CTS). Approximately 1 in 1,000 people develop CTS each year with excellent information relating to diagnosis and surgery by following the below links;

Carpal Tunnel Syndrome: Your Diagnosis and Treatment Options

Carpal Tunnel Decompression: What to Expect Following Surgery

The carpal tunnel is a canal formed between the small bones of the wrist called carpal bones and a ligament that lies across the front of the wrist.  A large nerve, called the median, along with the tendons that attach the forearm muscles to the fingers, pass through this canal.  In CTS the nerve becomes compressed and in most cases it is not clear why, although increased pressure is believed to compress and restrict blood flow to the median nerve.

Symptoms include pins and needles, pain and/or numbness in the index and middle fingers and weakness of some muscles in the fingers and/or thumb which may cause poor grip.

What causes CTS?

Often the cause is not clear as to what increases the pressure in the carpal tunnel resulting in restricted blood supply to the median nerve.  However it is more common in manual workers with jobs using lots of wrist movement such as scrubbing or wringing.  Therefore overuse may be contributing factor to CTS

Bone or arthritic conditions - such as osteoarthritis and rheumatoid arthritis or wrist fractures may lead to CTS

Genetics – hereditary factors have been identified and 1 in 4 people with CTS also have a close familiar member (father, mother, brother or sister) with CTS

Other conditions – CTS is associated with pregnancy, obesity, diabetes, hypothyroidism and the menopause.

What are the symptoms?

Pins and needles – tingling or burning in parts of the hands supplied by the median nerve.

Pain – in the same fingers as the pins and needles and may travel to the forearm

Numbness – in the same fingers, or in part of the palm may develop if the condition becomes worse

Dryness of the skin – in the same fingers

Weakness – in the muscles of the fingers and/or thumb in severe cases, you may experience poor grip and may eventually lead to wasting of the muscles at the base of the thumb.

Morning symptoms – people often wake in the night or find the symptoms are worse in the morning

How do you diagnose CTS?

No special tests are usually required to diagnose CTS as the symptoms are classic in their presentation.  If a diagnosis is clear then a nerve conduction study may be required which is a test measure of how well the nerve is transmitting its impulses.

How is CTS treated?

If a specific trigger is identified such as a work, hobby or sport related cause then modification of activities should be considered to help settle the symptoms.  Over use of the wrists should be avoided such as excessive squeezing, gripping, wringing etc.  If you are over weight then consider losing weight to improve your symptoms and PhysioHey may be able to advise you on services and support available locally to help you do this.  Please our other services section.
Simple painkillers available from your pharmacist such as paracetamol or co-codamol are beneficial to reduce pain.   There is no evidence that anti-inflammatories are of any benefit to reducing CTS symptoms

Not treating – this may be an option as 1 in 4 cases resolve without treatment after a year or so and 2 out of 3 cases of pregnancy related CTS resolve after the baby is born.  Often only mild symptoms are suitable to leave to spontaneously resolve. 

Splinting – wrist splints aim to keep the wrist in a neutral position and is a first step intervention.  Once worn for 2 – 3 months, especially overnight, results in patients symptoms significantly improving or full resolution of symptoms if used in the first 2 – 3 weeks

Surgery – only severe symptoms or moderate symptoms that have not improved with treatment are usually considered for surgery.  It is a small operation that cuts the ligament over the front of the wrist to ease the pressure in the carpal tunnel, this is done most times under local anaesthetic and usually cures the problem.  Post surgery you will not be able to use your hand at work for 2 – 3 weeks.

Clinical decision making tool

To you make a clear informed decision about how to move forward in the management of your CTS please click here for more information and to weigh up which what is right for you.

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