Shoulder and elbow areas are complex and therefore require attention. Most people avoid going to a doctor unless it is absolutely necessary and when it comes to athletes it gets worse. “Surgery”, “rest”, “physical therapy” or “you need to take a break from your sport” are the words that you need to avoid.
Explain to your patient that there’s a lot of injuries involving shoulder and elbow that can heal without any type of surgery and there’s actually some tips and tricks that can help you avoid them.
Keep in their minds that in a perfect world, people would be able to do everything they wanted to without any measures and training sessions would be all performed in freestyle.
Most of the problems around shoulder involve muscles, ligaments and tendons, rather than the bone itself, but surgery will be required if the injury gets into instability or impingement stages. These two categories need to be explained to your patient, while you’re studying the injury’s situation.
Instability occurs when the joint of the shoulder moves or is forced out from its natural position and it’s common to feel pain when the patient raises the arm. Impingement happens by too much rubbing of the shoulder muscles against the top part of the shoulder blade.
There’s also an important component in the shoulder called the rotator cuff.It is contained for a group of muscles and tendons that holds the bones of the shoulder together. When this component gets injured, people may never get fully recovered. When a rotator cuff tears, it’s a common cause of pain among adults. A tear will weaken the shoulder and make daily activities painful and difficult to do.
In case of injury, you should advise your patient that there’s some exercises that will help them to get more strength out the shoulder. If they wish to have a well-rounded rotator cuff, they need to include more than just the basic internal-external workouts.
Flexibility is an important part of the training, so it’s important to keep in mind to maintain the flexibility in the entire upper quarter of the body. A good tip for this kind of work is to start with some flexibility exercises, progress to isolated strength work and then finally implement the functional strength exercises. The exercises need to accentuate proper scapular position of the arm when performed, but also they need to be careful not to exceed the natural range of motion when stretching or tightening the shoulder.
There’s a training program that can get you closer to your patient’s situation and it’s based around 3 stages from recovery: acute phase; recovery phase and functional phase.
- Acute Phase, happens right after the injury occurs and will continue until pain free range of motion has been achieved and normal daily activities can be performed. It aims to allow tissue healing, reduces pain and inflammation, prevent muscles wasting, maintain the normal movement in the shoulder blade and maintain fitness.
- Recovery Phase, happens when the initial phase and inflammation has gone and most of the normal activities are pain free and the injury has at least 75% of movement when compared to the uninjured one. It aims to regain full pain free motion, normal upper body strength, and normal shoulder joint movement patterns.
- Functional Phase, last but not least, is more sports oriented. For athletes who want to join the training as soon as possible. It aims to increase power and endurance in the upper body muscles, improve the strength of the shoulder joint in all directions and introducing sports specific shoulder exercises.
The elbow is a joint made up of three bones (humerus, radius and ulna) and there are several types of elbow fractures, including: supracondylar, condylar, epicondylar, physis, forearm, fracture dislocation and open fracture.
Orthopedics know that no matter where the break happens, most elbow fractures result in sudden, intense pain in the elbow and forearm. It can decrease mobility in the arm, shoulder or wrist. The worst on an elbow injury is stiffness, which limits range of motion, something that may persist even when the elbow seems healed.
You may need to send your patient to a physical therapist to restore the normal range of motion to the elbow. Patients may be required to use a sling, limiting the use of the arm, wrist and hand. Your patient’s fracture may be fully healed about two months after injury and should have total control of the arm about three months after the injury. Remember that surgery is only required when the fracture is displaced or open.
Be sure to discuss with your patient what the outcomes in their specific situation are. Working close with your patient, and a physical therapist, can help them quickly return to the normal activity of the elbow.
Physical therapy helps them regain range of motion, strength and function in the arm and shoulder. Some of the exercises required to restore the strength on the elbow require working on the biceps, as it will strengthen the muscles on the front of the upper arm that flex the elbow; tighten the triceps, as the back of the upper arm becomes weak post fracture, so they need to stimulate them again; strengthen the shoulders, should only happen 10 to 12 weeks after the injury. A shoulder front raise exercise improves forward flexion range of motion and strengthens the deltoids for lifting activities.
In most of the cases, the range of motion returns to normal, or has just mild limitation.
On the weekend of September 24th and 25th 2016, there’s a closed-meeting organized by the European Society for Surgery of the Shoulder and Elbow (SECEC/ESSSE), taking place in Antwerp, Belgium.
A range of topics for all professionals that aims to improve their knowledge on shoulder and elbow fields, with themes such as anatomical shoulder arthroplasty, fractures, instability, reverse shoulder arthroplasty, rotator cuff and prosthesis, will be discussed. It’s a must-go, if you as an orthopedic surgeon feel like learning more about this field.