Category Archives: Elbow

PT News PTandMe

PT News September 2019

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PT News PTandMe

This time in PT News we recap what our clinics have been posting throughout September 2019. We are excited to begin a new year of new posts featuring published articles from PTandMe partnering clinics!

1. Carpal Tunnel Syndrome

Written by Spectrum Physical Therapy with three locations in New London County, CT.

Carpal Tunnel Syndrome (CTS) is a type of injury called a peripheral nerve entrapment. What this means is that it is a condition in which the median nerve gets compressed and irritated as it passes through a structure called the carpal tunnel, located on the palm side of your wrist. The carpal tunnel is formed by the carpal (wrist) bones and connective tissue and protects the median nerve and finger flexor tendons as they pass through the wrist.  Read more

 

2. Tommy John Elbow Ligament Injuries in Football Quarterbacks: Why are there significantly fewer injuries than in baseball pitchers?

Written by Mishock Physical Therapy, an outpatient physical therapy practice with locations throughout PA’s Montgomery, Berks, and Chester Counties. 

Recently Ben Roethlisberger, quarterback for the Pittsburgh Steelers, sustained an ulnar collateral ligament tear and subsequent surgery, ending his football season. Elbow injuries in football players are uncommon with 92% of the injuries being traumatic (contusions and dislocations), (Ortho J Sports Med 2019). Ulnar collateral ligament injuries in football quarterbacks are even more uncommon. Read more

 

Fire fighter workers compensation

3. Firefighter and Active Dad Gets Back to Work and Life 

Written by ARC Physical Therapy+ an outpatient physical therapy practice with locations across Kansas, Missouri, and Iowa

Marcus Winstead is a firefighter, husband, and father who enjoys leading an active lifestyle with his wife and three children.  “I’ve been a firefighter for 13 years”, Marcus explained. “Throughout that time, I’ve been on numerous calls and in very unique and challenging situations. As luck would have it, I was injured during a training exercise. I had two-disc injuries (protrusion and extrusion between L4-L5/L5-S1).” Read more

Find these locations and others to start feeling better today!

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FOOSH

FOOSH – Silly Name, Serious Injury

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FOOSH

One of the most common mechanism of injury from falls is called a FOOSH (Fall on an Out Stretched Hand) injury. Don’t let the funny name fool you. A FOOSH injury is one of the most debilitating ways to injure your upper extremity and cause a significant loss of function. A Foosh occurs when a person is on their way down during a fall and tries to brace for impact using their hands. This is a natural response to falling and is difficult to try and prevent. The resulting impact of the hand and wrist on the ground can cause varying types of injuries from strains and sprains to fractures of the hand, wrist, elbow or shoulder.

What to look for if you experience a FOOSH Injury

1. Fractures: Typically, the fractures of the forearm from a FOOSH are the easiest to spot. They become swollen and bruised very rapidly and are associated with a lot of pain. Often times they produce a visible bulging of the skin of the forearm which can even protrude outside of the body. Fractures of the wrist and forearm will need to be evaluated and often times re-set and casted. Following casting the person must regain strength and range of motion through a guided exercise program before normal function can return. These injuries may take as long as 12 weeks to heal, but as many as 20 weeks for return to normalcy. This process can be expedited significantly by a referral to a well-trained physical therapist.

2. Sprains: Sprains from a FOOSH are much more difficult to spot. A sprain is a common injury to a ligament that normally holds one bone to another as a part of a joint. It most likely causes moderate to severe swelling, bruising, and pain. The pain may occur both by moving the joint yourself or having someone else move the joint while you are relaxed. During a sprain, a non-contractile piece of tissue becomes torn partially or completely. The result is a joint that is too lax to allow proper joint stability. This can cause problems for years following the initial injury. Think of the brake system on your bicycle. If the brake cable becomes elongated the brake does not function correctly until it is repaired. An evaluation by a physical therapist is necessary to diagnose and treat a sprain correctly and to prevent further injury to the injury site as well as allow for speedy recovery.

3. Strains: Strains are also difficult to spot following a FOOSH. A strain differs from a sprain in that it occurs as a tearing of the tendon instead of a ligament. This can present like a sprain with swelling and bruising, but will have a few different characteristics. Tendons attach to bone on one side and a muscle on the other. Tendons therefore hurt with both passive motion, but also with active motion. Strains of the wrist and hand can cause a significant loss in function with things like writing, typing, or even just holding an object in your hand. Without intervention, this can lead to progressively worsening problems like tendonitis and carpal tunnel syndrome which may need surgical intervention if not attended to quickly.

No matter your age or fitness level please use caution to avoid these types of debilitating injuries. If you do fall, it is important to consult your health care provider. During rehabilitation we can help you reduce pain, increase strength and regain function. Please feel free to call us for more information or to schedule an appointment.

throwing injuries PTandMe

Guidelines to Prevent Throwing Injuries

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In this monthly series, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


WRIST EXTENSION
Start with the arm supported on a table and your wrist facing toward the ground. Hold the weight off the edge of the table and bring the back of your hand toward the ceiling.


WRIST FLEXION
Start with the arm supported on a table and your wrist facing toward the ceiling. Hold the weight off the edge of the table and bring your palm toward the ceiling.

ASMI GUIDELINES TO HELP PROTECT PITCHERS FROM SHOULDER & ELBOW THROWING INJURIES:

Don’t throw too much:
Daily, weekly and annual overuse is the greatest risk to a pitcher’s arm health. Numerous studies have shown that pitchers who throw more pitches per game and those who do not adequately rest between appearances are at an elevated risk of injury. While medical research does not identify optimal pitch counts, pitch count programs have been shown to reduce the risk of shoulder and elbow injury in Little League Baseball by as much as 50% (Little League, 2011). The most important thing is to set limits for a pitcher and stick with them throughout the season.

Don’t pitch through arm fatigue:
Individuals are 36 times more likely to develop shoulder and elbow injuries when routinely pitching with arm fatigue.

Don’t pitch more than 100 innings per year:
If an athlete throws over 100 innings they are 3.5 times more likely to be injured than those who did not exceed 100 innings pitched.

Don’t throw more than 8 months per year:
Athletes who throw > 8 months per year are 5 times as likely to suffer an injury requiring surgery of the elbow or shoulder. Pitchers should refrain from throwing for at least 2-3 months per year and avoid competitive pitching for at least 4 months per year.

Don’t pitch on consecutive days:
Pitchers who pitch on consecutive days have more than 2.5 times greater risk of experiencing arm pain.

Don’t play catcher following pitching:
If the player catches following pitching they are 2.7 times more likely to suffer a major arm injury.

Don’t play on multiple teams at the same time:
There is increased risk of injury due to the difficulty in monitoring pitch limits and rest time. If the player is on multiple teams, make meticulous efforts to keep track of the amount of pitches thrown to allow adequate rest.

Don’t forget the shoulder in strength and conditioning programs:
Numerous studies have shown that deficits in upper extremity strength and mobility are strongly correlated to serious arm injuries. Shoulder and forearm strengthening exercises can build strength, endurance and motor control which can prevent injury.

Be cautious with throwing curve balls and sliders:
While existing research has not consistently shown a strong connection between the curveball and injuries, Yang et al., found that amateur pitchers who threw curveballs were 1.6 times more likely to experience arm pain while pitching and Lyman et al, found that youth pitchers who throw sliders are 86% more likely to experience elbow pain.

Be cautious with the radar gun:
Radar guns do not directly cause harm to a pitcher, however, the gun may cause the pitcher to over throw beyond their normal comfort level. This could possibly create arm strain.

Following these guidelines may keep the throwing athlete safe from the debilitating shoulder and elbow throwing injuries seen on a regular basis in physical therapy clinics.

Pitching Guidelines Chart

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. They specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Their staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

Guidelines to Prevent Throwing Injuries

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GuidelinesPreventThrowingInjuries#3_FBsize

In this third intallment of our series to prevent throwing injuries, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


INTERNAL ROTATION WITH SHOULDER AT 90 DEGREES OF ABDUCTION
Attach band high up on a doorway and face away from door. Hold band and move your arm out sideways away from your body until your arm is parallel with the ground. Bend your elbow to 90 degrees and point your fist toward the ceiling. Rotate from your shoulder bringing your hand forward while keeping your arm parallel to the floor and your elbow bent to 90 degrees.


EXTERNAL ROTATION WITH SHOULDER AT 90 DEGREES OF ABDUCTION
Attach band high on a doorway and face toward the door. Hold band and move your arm out sideways away from your body until your arm is parallel with the ground. Bend your elbow to 90 degrees and point your fist toward the door. Rotate from your shoulder bringing your hand away from the door while keeping your arm parallel to the floor and your elbow bent to 90 degrees.


SHOULDER INTERNAL ROTATION AT SIDE
Attach band to the doorway at chest height. Stand perpendicular to the doorway with the arm you are exercising closest to the door. Keep your arm at your side with a towel roll under the arm and bend the elbow to 90 degrees. Bring your hand toward your stomach while keeping the elbow bent to 90 degrees.


SHOULDER EXTERNAL ROTATION AT SIDE
Attach band to the doorway at chest height. Stand perpendicular to the doorway with the arm you are exercising furthest from the door. Keep your arm at your side with a towel roll under the arm and bend the elbow to 90 degrees. Bring your hand away from your stomach while keeping the elbow bent to 90 degrees.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. We specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Our staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

Medial epicondylitis golfer's elbow

Golfer’s Elbow (Medial Epicondylitis)

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Medial epicondylitis is most commonly referred to as Golfer’s Elbow and is a painful condition where the tendons that attach to the inside of the elbow become inflamed due to repetitive use of the hand, wrist, forearm and elbow. It often occurs with repetitive activities such as, swinging a golf club or tennis racket, work or leisure activities requiring twisting and gripping such as shoveling, gardening and swinging a hammer. It can also appear in other sports-related activities such as throwing and swimming. Medial epicondylitis is most commonly seen in men over the age of 35, but can be seen in any population.

Medial epicondylitis affects the group of muscles that are responsible for bending the wrist, fingers and thumb and that rotate the wrist and forearm. The tendons that connect those muscles to the medial epicondyle (bump on inside of elbow). Tendons are made up of collagen fibers that are lined up next to each other. The repetitive forces pull on those tendons creating pain and tenderness. Without treatment those tendons can eventually pull away from the bone. Acute injuries to your elbow can create an inflammatory response which can cause redness, warmth and stiffness in your elbow.

Medial epicondylitis is most often caused by an abnormal arrangement of collagen fibers. This condition is called tendinosis. During tendinosis the body doesn’t create inflammatory cells as it does during an acute injury. Instead, fibroblasts are created which help make up scar tissue to fill in the spaces between the collagen fibers. This increase in scar tissue can lead to increased pain and weakness in the tissues. Physical therapy is the most common non surgical treatment for medial epicondylitis. Your therapist will perform an evaluation where he/she will ask you several questions about your condition, pain level and other symptoms you may be experiencing. He/she will perform motion and strength testingon your entire upper extremity. Your physical therapist will also palpate your arm to determine which tendon(s) may be inflamed. He/she will use special tests designed to differentially diagnose your condition from others that may have similar presentations, such as Cubital Tunnel Syndrome.

golf ball on tee

After you have been evaluated by your physical therapist, he/she will formulate an individualized treatment plan that can include any of the following:

1. Pain Management: this can include Mechanical Diagnosis & Therapy, ice, ice massage, moist heat, electrical stimulation and ultrasound.
2. Range-of-Motion Exercises: stretches and mobility exercises to help maintain proper movement in your elbow, forearm, wrist and hand.
3. Strengthening Exercises: progressive resistive exercises to help build strength in your arm, elbow, forearm, wrist and hand. These can include weights, medicine balls and/or resistance bands. This will also include your Home Exercise Program.
4. Manual Therapy: used to ensure full, pain-free movement is achieved and can include joint mobilizations, manual muscle stretches and soft tissue massage.
5. Neuromuscular Re-education (Functional Training): used to help you return to your prior level of function for both home and work activities. Will include retraining proper movement patterns with necessary modifications based on current level of function and patient limitations.
6. Patient Education: used to help retrain patient on proper postural control during everyday activities including dressing, self-care, work and sports activities. This can include helping return a patient to their specific sport, such as making adjustments to their golf swing or throwing technique.

Once you’ve completed your care under the direct supervision of a physical therapist you’ll want to do everything you can to prevent this from reoccurring. This can occur by maintaining proper awareness of your risk for injury during your daily movements. Key things to keep in mind:

1. Maintain proper form during all repetitive movements both at work and home.
2. Continue your Home Exercise Program in order to maintain proper strength in your shoulder, elbow, forearm, wrist and hand.
3. Use proper posture and body mechanics with lifting or carrying to avoid any undue stress on your joints and tendons.

This information was written by Plymouth Physical Therapy Specialists, an outpatient physical therapy group with fourteen locations in the surrounding Plymouth, Michigan area. At Plymouth Physical Therapy Specialists, they are committed to using evidence-based treatments in their practice. This means that their therapists utilize the most current and clinically relevant treatments in their approach to rehabilitation. For more information click here.