elbow & wrist pain

Common issues Affecting Your Elbows & Wrists:

You may not realize how important your elbow and wrist are to your everyday function until you develop an acute or chronic injury. Developed from overuse, fractures or underlying medical conditions, elbow and wrist pain can impede your ability to perform simple day-to-day tasks like dressing, showering or cutting your food. Furthermore, the nagging discomfort can hinder you from participating in your job requirements, leisurely activities or specific sport.   

Tennis Elbow & Golfer's Elbow

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. Likewise, medial epicondylitis, commonly known as golfer’s elbow, does not mean that only golfers have this condition.  

The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow and the golf swing is a common cause of medial epicondylitis.

But many other types of repetitive activities can also lead to tennis elbow and golfer’s elbow: painting with a brush or roller, throwing, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.

Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach on the lateral epicondyle and are connected by a single tendonthat connect the muscles to bone.

Golfer’s elbow causes pain that starts on the inside bump of the elbow, the medial epicondyle. Wrist flexors are the muscles of the forearm that pull the hand forward. The wrist flexors are on the palm side of the forearm. Most of the wrist flexors attach to one main tendon on the medial epicondyle. This tendon is called the common flexor tendon.

Numerous studies have shown that both tennis and golfer’s elbow are not due to inflammation. Rather, the problem is within the cells of the tendon. Wear and tear is thought to lead to tissue degeneration, and a degenerated tendon usually has an abnormal arrangement of collagen fibers.

Instead of inflammatory cells, the body produces a type of cells called fibroblasts. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.

No one really knows exactly what causes this. Some researchers believe that the forearm tendon develops small tears with too much activity. The tears try to heal, but constant strain and overuse keep re-injuring the tendon. After a while, the tendons stop trying to heal. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.

Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.

The key to nonsurgical treatment is to keep the collagen in your tendon from breaking down further and to stimulate new collagen formation that is stronger and lines up in the correct direction of force. Our goal is to help the tendon heal, and we do that using Astym therapy. Astym therapy is incredibly effective at treating tendonitis by stimulating the body to produce new collagen. We then use very specific exercises to gradually promote that collagen to grow stronger and is a good alignment.

Because tendonosis is often linked to overuse, we will work with you to reduce repeated strains on your elbow. When symptoms come from a particular sport or work activity, Dr. Trinh will observe your style and motion with the activity. We will provide tips about how to perform the movement so your elbow is protected. We can also check your sports equipment and work tools and suggest how to alter them to keep your elbow safe.


Carpal Tunnel Syndrome:

Carpal tunnel syndrome (CTS) is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS.

This syndrome has received a lot of attention in recent years because of suggestions that it may be linked with occupations that require repeated use of the hands, such as typing on a computer keyboard or doing assembly work. Actually, many people develop this condition regardless of the type of work they do.

Any condition that makes the area inside the carpal tunnel smaller or increases the size of the tissues within the tunnel can lead to symptoms of CTS. For example, a traumatic wrist injury may cause swelling and extra pressure within the carpal tunnel. The area inside the tunnel can also be reduced after a wrist fracture or dislocation if the bone pushes into the tunnel.

Any condition that causes abnormal pressure in the tunnel can produce symptoms of CTS. Various types of arthritis can cause swelling and pressure in the carpal tunnel. Fractured wrist bones may later cause CTS if the healed fragments result in abnormal irritation on the flexor tendons.

Other conditions in the body can produce symptoms of CTS. Pregnancy can cause fluid to be retained, leading to extra pressure in the carpal tunnel. Diabetics may report symptoms of CTS, which may be from a problem in the nerve (called neuropathy) or from actual pressure on the median nerve. People with low thyroid function (called hypothyroidism) are more prone to problems of CTS.

The way people do their tasks can put them at more risk for problems of CTS. Some of these risks include:

  • force
  • posture
  • wrist alignment
  • repetition
  • temperature
  • vibration

One of the first symptoms of CTS is gradual tingling and numbness in the areas supplied by the median nerve. This is typically followed by dull, vague pain where the nerve gives sensation in the hand. The hand may begin to feel like it’s asleep, especially in the early morning hours after a night’s rest.

Sometimes pain may even spread up the arm to the shoulder. If the condition progresses, the thenar muscles of the thumb can weaken, causing the hand to be clumsy when picking up a glass or cup. If the pressure keeps building in the carpal tunnel, the thenar muscles may begin to shrink (atrophy).

The main focus of our treatment is to reduce or eliminate the cause of pressure in the carpal tunnel. We may check your workstation and the way you do your work tasks. We may provide suggestions about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems.

Following a full evaluation, Dr. Trinh will begin treatments to reduce inflammation and to encourage normal gliding of the tendons and median nerve within the carpal tunnel.

Although time required for recovery is different for every patient, as a general rule, you may see improvement in four to six weeks. 

It generally takes longer to recover after open carpal tunnel release. Pain and symptoms usually begin to improve, but you may have tenderness in the area of the incision for several months after surgery.

Patients who wait too long to seek medical advice sometimes have difficulty adjusting after surgery. Recovery may take longer than expected when nerve damage is severe. In some cases, symptoms are not entirely alleviated.

When the stitches are removed, you may begin to come see us. Our treatments are used at first to ease pain and inflammation. Dr. Trinh will perform gentle manual therapy to the incision to help reduce sensitivity in and around the incision and limit scar tissue from building up. We will show you some special exercises that you can do to encourage normal gliding of the tendons and median nerve within the carpal tunnel.

As you progress, Dr. Trinh will give you exercises to help strengthen and stabilize the muscles and joints in the hand, wrist, and arm. We use other exercises to improve fine motor control and dexterity of the hand. We will also work with you to help you do your daily and work activities safely and with the least amount of strain on your wrist and hand.

Forearm Fractures:

Forearm fractures are those that occur in the middle section (shaft) of the forearm bones. The forearm has a complex anatomy to serve its functions of supporting and positioning the hand in space and providing anchorage for muscles that serve hand function. To fully restore these functions after a forearm fracture, the bones must heal in the normal anatomical position.

All fractures occur when the limb is subjected to stress outside the normal range. The most common cause of forearm fractures include – a blow to the forearm, a bending force such as falling on the outstretched hand, or a twisting forcewhere the forearm is over-rotated. Most often, these forces cause both bones to break, but a fracture of the ulna alone can occur if you put your arm up to ward off an attack. This isolated fracture of the ulna used to be called the nightstick fracture!

Twisting and bending fractures occur with falls, sports accidents, and MVAs. As with all fractures, the damage done to the muscles and tendons is a significant feature of the injury. Open fractures, where the bone comes out through the skin are quite common in the forearm.

If your forearm has been immobilized in a cast from the fracture, then treatment at Physioflow Physical Therapy can begin once the cast is removed. While you are in the cast, simple finger movements as well as exercises to maintain your shoulder range of motion, such as lifting your arm overhead, will be your only exercises.

If you have had surgery to fixate your forearm fracture, then rehabilitation at Physioflow Physical Therapy will begin as soon as your surgeon recommends it. Each surgeon will set his or her own specific restrictions based on the type of fracture, surgical procedure used, personal experience, and whether the fracture is healing as expected. Generally, however, early non-weight bearing hand, wrist, and elbow movements will be allowed. Dr. Trinh at Physioflow Physical Therapy will prescribe these exercises for you and liaise with your surgeon regarding the optimal time to begin more advanced exercises such as putting weight through the healed forearm bone via the hand.

The next part of your treatment will focus on regaining the range of motion, strength, and dexterity in your wrist, hand, elbow, and shoulder. If you have been immobilized, your arm will look and feel quite weak and atrophied after the period of immobilization.

Dr. Trinh will perform hands-on mobilization techniques and manual therapy to encourage the stiff joints of your wrist and elbow to move gradually into their normal range of motion. Fortunately, gaining range of motion and strength after a forearm fracture occurs quickly. You will notice improvements in the functioning of your limb even after just a few treatments. As your range of motion and strength improve, we will advance your exercises to ensure your rehabilitation is progressing as quickly as your body allows.

Generally, the strength and stiffness one experiences after a forearm fracture responds very well to the Physical Therapy we provide at Physioflow Physical Therapy. With our initial one-on-one Physical Therapy treatment along with the exercises of your home program, the strength, range of motion, and proprioception gradually improve towards near full recovery/function over a period of 3-6 months even though the actual final stages of bone healing won’t occur for another 6-12 months after that.

Are you experiencing elbow or wrist pain? Physical Therapy can help! Dr. Trinh will perform a comprehensive evaluation and produce a specifically designed plan of care targeting your specific condition and your individual needs.