not all pain means surgery
Not all conditions need surgery; sometimes the best approach is not to try to 'fix it', but to understand its limitations and work to manage the pain and function by looking to best guide everyday movements and identify the best range of movement and strengthening activities.
You may know of someone that has had surgery for a condition for the same condition you have, however you have been advised to try a less invasive approach - depending on the stage of your condition, what has been trialed and what activities you are aiming to return to you, the advice from your health team for you may be different to those you know with the same condition and that's ok.
Let's together explore some of the most common upper limb conditions that we see in the practice and help explain what they are what can help!
Subacromial Impingement
What is it?
Firstly, we need to introduce the subacromial space. The subacromial space is the space between the humeral head (upper arm bone) and the acromion (part of the shoulder blade). Inside the subacromial space there are a number of structures which are important to shoulder function and general shoulder health. The most common sites of irritation with subacromial impingement are the bursa (gliding surface that reduces friction between tissues), supraspinatus muscle/tendon (helps position the humeral head & initiate arm movements), and the biceps tendon (assists with movements of the arm). Impingement syndrome, as it is commonly called, involves narrowing of the subacromial space and impingement of one or more of the aforementioned structures.
What can help?
When it comes to making improvements in shoulder disability and pain, rehabilitation programs should include a combination of scapular mobilisations, stretching and most importantly a progressive exercise program. The incorporation of each modality will assist in an individual's journey towards being able to performing meaningful activities in a pain free manner. Essentially, a graded exercise program can help to restore and then improve the integrity and efficiency of the shoulder joint and its surrounding structures.
Adhesive Capsulitis
What is it?
Adhesive capsulitis is a soft tissue disorder that results in restriction of shoulder movement and is often accompanied by disabling pain. The progressive decline in shoulder range of motion and inability to perform daily activities such as dressing, grooming and overhead activities is the reason for its moniker “Frozen Shoulder”. There are three distinct stages of frozen shoulder:
- Freezing
- Frozen
- Thawing
Each requires a slightly different treatment approach.
What can help?
The good news is that rehabilitation protocols involving exercise have been shown to improve physical health outcomes for people with frozen shoulder when compared to alternative treatment methods. Specifically, exercise interventions involving stretching and strengthening protocols used in supervised gym sessions and at home have achieved the best outcomes when it comes to pain and disability.
Lateral Epicondylitis
What is it?
If you have heard of “tennis elbow” before then you may already know a little bit about lateral epicondylitis. Tennis Elbow presents as pain during activity on the lateral aspect of the elbow; the pain itself is often distinctly localised to the lateral epicondyle of the elbow. The injury itself is often the result of overuse and is commonly seen in throwing athletes or people in occupations that involve repetitive arm movements heavily reliant on the forearm.
What can help?
For some people, recovery can be spontaneous given that pain is the main symptom that is limiting function. However, for most others recovery requires a rehabilitation program involving a combination of static stretching, eccentric strength training, and the use of forearm band and wrist support. This rehabilitation protocol should be relatively inexpensive given that many of the stretches and exercises, once learnt, can be performed at home with little supervision.
