Physio Penrith Upper Limb Treatments

Upper Limb Injuries Treated at Sydney Muscle & Joint Clinic Physio Penrith

Upper limb injuries cover rotator cuff related shoulder pain, shoulder instability, shoulder osteoarthritis, lateral and medial elbow pain and weakness and a number of overuse injuries at the wrist. Commonly these include subacromial pain syndrome, rotator cuff related shoulder pain, frozen shoulder, multi-directional instability, shoulder impingement, shoulder bursitis, tennis and golfers elbow and de Quervain's syndrome at the wrist. Generally we call these mechanical painful conditions and these respond to both passive and active interventions. The physiotherapists and exercise physiologists at Sydney Muscle & Joint Clinic Penrith use techniques such as joint mobilisations, muscle release techniques, dynamic mobility movements and cutting edge loading principles to reduce pain, improve stiffness and encourage pain free motion.​

Shoulder bursitis

Shoulder bursitis is frequently associated with shoulder pain often independent from the underlying pathology. Typically, shoulder bursitis is often accompanied by other conditions that cause shoulder pain and bursal effusion and these should be managed with specific interventions. Other conditions include acromioclavicular joint arthritis, supraspinatus calcific tendinopathy, full-thickness, partial, superficial and deep tear of supraspinatus. Read more.

Rotator cuff related shoulder pain

Rotator cuff related shoulder pain is an over-arching term that encompasses a spectrum of shoulder conditions that include; subacromial pain (impingement) syndrome, bursitis, rotator cuff tendinopathy, and symptomatic partial and full thickness rotator cuff tears. At Sydney Muscle & Joint Physio Penrith common symptoms include pain and impairment of shoulder movement and function usually experienced during shoulder elevation and external rotation. Rotator cuff related shoulder pain will most often have some excessive and mal-adaptive load imposed on the tissues has a major contributor to the injury.

Physical assessment may include certain loaded movements that are called symptom provocation procedures and really all these tests tell has is that the individual has mechanical shoulder pain and the tissues in lesion could be from rotator cuff tendons, bursa ligaments, labrum or capsule. Further, the reliance on imaging may be problematic, with investigations reporting substantial numbers of people without symptoms demonstrating rotator cuff structural failure. Read more.

Sub acromial pain syndrome

Sub acromial pain syndrome is defined as any non-traumatic shoulder problem, usually unilateral, with localised pain around the acromion, which usually worsens during or after lifting of the arm. The following terms are commonly linked to sub acromial pain syndrome: bursitis, tendinosis calcarea, supraspinatus tendinopathy, partial tear of the rotator cuff, biceps tendinitis and rotator cuff tendon degeneration. Level 1 (the best) evdience suggests that exercise-based treatments are more effective than no treatment in reducing pain and improving function of the shoulder and exercises specifically focused on rotator cuff and scapular muscles appear to be more effective than general exercise therapy. Read more.

Frozen shoulder (adhesive capsulitis)

Frozen shoulder, also known as adhesive capsulitis, is a condition characterised by shoulder pain and significant loss of both active and passive range of motion of the shoulder. The clinical course is over 4 stages that include a period of differential diagnosis that mainly presents as subacromial pain syndrome (up to 3 months), then freezing (3 to 9 months), frozen (9 to 15 months) and thawing (15-24 months) stages that will typically last 12-24 months, although stiffness and restricted ranges of motion can persist for years. Treatments may include corticosteriod injections, physical therapy and some studies report of the use of “supervised neglect” (compared to aggressive therapy), whereby patients are educated on the natural course of the disease, instruction in pendulum exercises, and active stretching techniques within the pain-free range of motion. Read more.

The painful and weak shoulder

Shoulder pain and weakness is typically caused by an irritated tendon and/or bursa, which lead to compromised firing of the shoulder muscles that include the rotator cuff and biceps muscles. Some of the conditions that can cause a painful and weak shoulder include rotator cuff tendinopathy (tendinitis, tendinous), sub-acromial pain syndrome (SAPS), or shoulder bursitis.

Generally a patient will present complaining of pain, weakness, aggravation when lying on the shoulder in bed, difficulty lifting and reaching for things and general pain during activities of daily living. Treatment of a painful and weak shoulder must concentrate on these exact symptoms with techniques used to settle the shoulder down and then build the shoulder back up with isometric and heavy slow resistance exercises, Further education and advice from an experienced physiotherapist about why the rotator cuff related painful shoulder does not like stretching, massage and direct pressure can also help with recovery. Common conditions that are more likely to present as a painful and weak shoulder include: rotator cuff related shoulder pain, sub acromial pain syndrome.

The painful and stiff shoulder

Shoulder pain and stiffness is commonly associated with articular problems, namely shoulder arthritis and frozen shoulder (adhesive capsulitis). Patients will often present with shoulder pain, stiffness, and an insidious reduction in shoulder range of motion- movements like doing your hair or drying the back of the head will become difficult and painful.

Sydney Muscle & Joint Physio in Penrith that uses techniques proven to work for shoulder pain and stiffness. Treatment of the painful and stiff shoulder will include application of heat and gentle stretches, joint mobilisations, dynamic movements to improve range of motion, muscle release techniques and strengthening exercises. Common conditions that are more likely to present as a painful and stiff shoulder include: shoulder osteoarthritis, frozen shoulder.

The painful and unstable shoulder

A painful and unstable shoulder is described as shoulder pain caused by irritation of shoulder joint structures such as the joint, capsule lining, tendons, ligaments, bursa and muscles and is due to the elaborate system of both static and dynamic stabilisers being compromised. The terminology often used is glenohumeral instability or multi-directional instability of the shoulder and can be a major problem for repetitive throwing or overhead athletes and active individuals. 

Symptoms of a painful and unstable shoulder can be generalised shoulder pain or anterior shoulder pain that is deep and persistent, feelings of instability or laxity and apprehension to move the shoulder in overhead or behind the head actions. Treatment of the painful and unstable shoulder needs to first focus on settling the shoulder down with passive techniques to reduce pain and irritation. Then next phase needs to combine active interventions such as isometric, concentric and eccentric movements directed at the glenohumeral joint, the scapula and the back muscles. Common conditions that are more likely to present as a painful and unstable shoulder include: recurrent dislocations, labral tear (SLAP lesion).

Tennis elbow (lateral epicondylitis)

Tennis elbow is also known as lateral epicondylitis or lateral epicondylalgia and is a condition that affects the tendons of the forearm wrist extensors where they attach on the outside of the elbow joint. This is primarily an overuse injury that is common in people who do alot of gripping and then shoulder or arm movements, these may include using screwdrivers, a hammer, playing sports such as tennis.

Tennis elbow needs to be treated as a tendinopathy and the treatment principles need to be two fold- settle the tendon down and then build back the strength of the associated muscles. Removing compression in the form of deep massage to the tendon attachment at the elbow, foam rolling and compression through vigorous stretching needs to stop immediately. A progressive physiotherapy led loading program of isometric, concentric and eccentric movements then needs to be prescribed. Read more.

Golfers elbow (medial epicondylitis)

Golfers elbow is also known as medial epicondylitis or medial epicondylalgia and is an injury caused by overuse to the forearm flexor muscles and presents with pain on the inside of the elbow joint. It is a similar injury to tennis elbow, whereby it is an overuse injury of gripping and moving the shoulder and elbow. Treatment also follows the same tendinopathy guidelines as tennis elbow, where pain reduction and irritation is the first phase, followed by a rigorous loading program to help stimulate tendon regeneration. Sydney Muscle & Joint Physio in Penrith uses research supported interventions for all tendinopathy injuries, tennis elbow and golfers elbow.

Ulnar nerve instability

The term “ulnar nerve instability” describes the chronic conditions of subluxation and relocation of the ulnar nerve at the elbow with flexion and extension of the elbow, respectively. Recurrent subluxation of the nerve at the elbow results in a tractional and frictional neuritis and is not to be confused with common compression neuropathy. Read more.

Cubital tunnel syndrome

Cubital tunnel syndrome is a peripheral neuropathy at the elbow in which the ulnar nerve is compressed, pinched and irritated in the cubital tunnel. Cubital tunnel syndrome can also be known as ulnar nerve entrapment at the elbow. When the ulnar nerve is compressed, it doesn’t get enough blood flow to work properly and over time, compression causes nerve damage that leads to pain and numbness in the forearm or hand. In cubital tunnel syndrome compression is worse in full elbow flexion (bending) and non-surgical treatment should be attempted for 6-12 weeks. Read more.

Carpal tunnel syndrome

Carpal tunnel syndrome

De quervain's tenosynovitis

De Quervains tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, with repetitive hand or wrist movements making the condition worse.