Shoulder and elbows

Spire Portsmouth Physiotherapy offer a wide range of services to treat shoulder and elbow conditions. Our team works closely with the specialist orthopaedic consultants at Spire Portsmouth Hospital to ensure an excellent level of care.

Find more information below about

Rotator Cuff injury
The rotator cuff is a group of four muscles that surround the shoulder joint. These muscles are responsible for stabilising and maximising movement efficiency within the shoulder joint. Sometimes one or several of these muscles can become injured either through an injury or through general 'wear and tear'.

In some instances the tendon, bursa or muscle is not damaged but is irritated due to being impinged or squashed between two bony structures. Interestingly many of us will develop signs of rotator cuff degeneration as we grow older, but be completely asymptomatic. It is those who develop symptoms who may need further intervention either from a physiotherapist or a shoulder specialist.

Signs and symptoms
People who have rotator cuff injuries will often have pain around the shoulder joint, extending down the upper arm. They may also have a decreased range of movement especially in lifting the arm out to the side and forwards. Depending on the severity of the injury to the muscle complex the patient may also have a reduction in strength. on having an ultrasound scan this may show signs of tendon injury or tear and/or bursa inflammation. In some cases an X-ray will show a bone spur with may have developed due to mechanical wear or compression. 

How physiotherapy can help
If you have sustained a rotator cuff injury it is essential you do the correct strengthening exercises to improve the strength of the affected muscles and just as importantly the muscles around the whole shoulder girdle. This can dramatically improve pain and function. Usually small tears respond very well with physiotherapy, however larger or more degenerative tears take longer to respond and may require surgical repair.

As part of your treatment process your physiotherapist may also use a combination of other modalities including joint mobilisations, massage, acupuncture, ultrasound and taping, as well as exercise rehabilitation. Your physiotherapist can also advise you on activities to avoid and appropriate pain relief options, should this be necessary.

Frozen Shoulder

The medical name for this condition is adhesive capsulitis. It is caused by severe inflammation of the capsule (connective tissue) that surrounds the shoulder joint. When the shoulder is looked at through key-hole surgery we will often see a very red inflamed and tight joint capsule. Frozen shoulder is more common in women than men. It occurs mostly in patients over 40 years of age and more frequently in those with diabetes. It can happen following a trauma or surgery, but this is often not the case appearing in those who have sustained no previous injuries.

Signs and symptoms
There are no scans or X-rays to diagnose a frozen shoulder, just symptoms and movement tests. Patients will, however, often find the symptoms will follow a fairly distinctive pattern:

  • The first stage, often called the ‘freezing’ stage, the patient will have a painful shoulder with increasing stiffness. 
  • The second ‘frozen’ stage will mean the patient’s shoulder will become very stiff, but not necessarily painful.
  • The final ‘thawing’ stage is often characterised by an increase in shoulder movement.

Typical daily activities that become difficult for those suffering with a frozen shoulder are:

  • Putting the affected hand behind your back for example, to fasten your bra, or to reach inside your back pocket
  • Sleeping on the affected side
  • Stretching the arm out to the side, to do activites such as closing the car door

It is fairly well acknowledged that physiotherapy can be the most helpful in the frozen and thawing stage, that is, once the initial pain has subsided. Treatment would usually include soft tissue massage, joint mobilisations and stretches, acupuncture, and electrotherapies. Once movement has begun to increase strengthening rehab plays a vital role in restoring lost shoulder power which is often becomes impaired during a frozen shoulder.

How physiotherapy can help
In most cases a frozen shoulder will eventually get better, but this may take up to two years to resolve. Some patients are happy to manage their symptoms with pain killers and activity modification. Other options that may aid in speeding up the recovery from this condition include; an injection usually by an orthopaedic surgeon, which can help with pain relief but won’t restore motion; a manipulation of the shoulder joint under anaesthetic or capsular release, followed by physiotherapy. These are options to consider if the movement impairment is significant or too painful to manage.

Tennis and Golfer's Elbow

Tennis elbow, also known as lateral epicondylitis, and golfer's elbow, also known as medial epicondylitis, are both conditions that come from a degeneration of the tendon that attaches the muscles of the forearm to the elbow. This can often follow a change in activity or a period of increased repetitive strain on the arms. It does not only affect tennis players or golfers! It can take several months for this problem to resolve and it will often need some form of treatment.

People suffering from golfer's elbow often suffer with pain on the inside the elbow which can also spread down the forearm.

Those suffering from tennis elbow present with pain on the outside of the elbow which spreads down to the forearm.

Pain is often provoked by gripping activities, carrying, typing and some sports. This pain will often build up over a period of time and can become so severe that it can be unbearable to even have clothes resting against the painful area.

How physiotherapy can help
Physiotherapy can help to improve the flexibility and strength of the muscle in the forearm. Your therapist will advise you on activities to avoid and exercises that will help to improve the symptoms. Treatment could also involve massage, joint and soft tissue mobilisations, electrotherapies and acupuncture. If appropriate your physiotherapist may fit you with a brace to help ‘off-load’ the tendons in your elbow alleviating the discomfort.

Top tips to follow after sustaining an injury
If you can identify which activities aggravate your pain then it is advisable to try and avoid these initially. You will need to rest your arm and may feel that icing the painful area can be helpful. Some people find anti-inflammatory medication can help with the pain, but this may not be the case. If you feel these are beneficial then make sure you follow advice from your pharmacist. You can also buy braces that can often help with the pain; these are available at most chemists or online.

 All physiotherapists at Spire Portsmouth Hospital are registered with the Health Professions Council (HPC) and the Chartered Society of Physiotherapy (CSP). Find out more about our Spire Physiotherapy team.

The physiotherapy team at Spire Portsmouth Hospital

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