In this article, Physio Logic Physical Therapist, Dr. Sarah Whiteside, DPT, discusses the importance of addressing lingering pain in the upper extremities (shoulder, arm, or hand) after a fall or sports impact injury.
Summertime can come with acute injuries or repetitive stress from sports such as tennis, squash, basketball, baseball, surfing, biking, golf or a fall on the hand-also known as a FOOSH injury (fall on outstretched hand injury).
It’s a good idea to get checked out after any kind of fall on your hand, if you have lingering pain. It may be confusing to decide should I stretch or immobilize it?
Swelling can dissipate after an impact, and a fracture of a carpal bone in the wrist may not be apparent.
Get In To See A Physical Therapist
By differential diagnosis, a Physical Therapist can perform special tests to determine the origin of pain. Structures in the hand are very close together and pain caused by fracture, osteoarthritis, tendonitis or ligamentous instability can seemingly come from the same place with similar pain intensity.
Many people don’t realize that you can initially see a Physical Therapist without a script from an Medical Doctor. A Physical Therapist will evaluate your condition for red flags that would require medical intervention or further evaluation from an Orthopedic Specialist.
An injury may require a brace which a Physical Therapist or Occupational Therapist can prescribe. A painful trigger point in a muscle or nerve entrapment may require the opposite: movement, massage and mobilization.
Your PT may suspect that an injection is indicated to break the cycle of inflammation, and can recommend confirmation by an Orthopedic Specialist. Fractures and ligamentous instability can lead to severe complications if untreated, and require close observation.
It is important for kids with elbow pain from a fall or repetitive racket sports and baseball to be assessed by a PT or MD for ligamentous laxity.
Pain from Repetitive Stress Injuries
Pain from repetitive stress injuries, can be caused by tendinitis, tenosynovitis, bursitis, trigger finger, and carpal tunnel. The problem can be caused by or exacerbated by keyboard and mouse use, texting “texting thumb” (DeQuervain’s disease) which can also caused by too tight grip on the mouse or repetitively hitting the space bar, or lifting.
The muscles that control the wrist and hand have long tendons designed so there is no ‘muscle bulk’ in the hand. This is advantageous for dexterity and fine motor skills. The disadvantage is they can quickly get tight or enflamed if there is repetitive strain or restriction along their path.
Stretching and Strengthening
The wrong type of stretching or strengthening can exacerbate your condition. A Physical Therapist can determine which type of strengthening exercises are safe or most appropriate for your condition. Strengthening exercises can be concentric (shortening contraction of a muscle) or eccentric (lengthening contraction); an example being biceps curl vs. controlled lowering of the forearm.
While hand, wrist or elbow pain may be caused by a repetitive task, the underlying problem may stem from weakness in the scapula muscles that control and provide a stable base for the entire upper extremity to function normally. Weakness and poor posture can lead to strain, impaired motor control and make you vulnerable to acute injury.
The Importance of Proper Posture
A Physical Therapist will help you not only to decrease pain, and teach you exercises to stretch and strengthen, but also to improve posture to decrease the likelihood of a re-occurrence. Correct posture, positions your entire upper extremity, for optimal strength and efficiency, and decreases strain on your wrist and hands.
How you hold your head, neck and even upper back contribute to the health of your hands and efficiency of fine motor skills. Slumping forward from your upper or lower back can cause strain on your arms while typing, holding the steering wheel, or lifting a baby. This type of poor posture can also contribute to a weak grip swinging a tennis racket.
Healing and Injury Prevention
3 important types of exercises for healing and injury prevention are:
- scapula strengthening
- Stretching of myofascial and neural tissues
- Postural re-education in desk ergonomics or sport specific training
Good posture, strong shoulders and scapula provide a stable base for using your arm efficiently and with least amount of effort.
Wrist Tendon Glides Exercise for Efficient Arm Movement
Exercise 1: Wrist tendon glides – Extend arm with palm forward “stop”, slowly curl fingers bring fist toward shoulder “come hither” and then extend arm straight “punch.”
This exercise stretches and glides tendons, fascia and nerves from the shoulder to the hand to create integrated, efficient motion. See video demonstration of wrist tendon glides below.
Prone Scapula T Exercise for Creating A Stable Base for the Arm
Exercise 2: Prone Scapula T – Lying on stomach, raise arms drawing shoulder blades down your back, then extend the arms in line with shoulders into a “T” shape. Be sure to keep the shoulder blades engaged, so they stay in place and don’t creep up to your neck. Hold this position 5-10 sec then lower the arms back to the sides. See video demonstration of Prone Scapula T exercises below.
Strong coordinated scapula muscles create a stable base for the arm. When scapula muscles are a weak, the shoulder, wrist and hand are vulnerable to repetitive strain injury.
All exercises should be pain free, and it is recommended to consult a health professional before starting any exercise program.
If you’re interested in learning more about rehabilitating an upper extremity injury that has caused lingering pain, schedule an appointment today with one of our Physical Therapists at Physio Logic. Fill out the form below to get started.