In our experience upper arm injuries are very common especially in people who have occupations that require heavy lifting (e.g., builders, labourers, etc.) and sportsmen and women (throwing sports such a cricket, athletics, rugby etc.).
At Walker and Hall we have considerable experience in treating upper arm injuries and the most common conditions we treat are
Biceps Tear
Bicipital Tendonitis
Fractured Humerus
Referred Pain
If your condition is not listed above please contact us
To see how Walker and Hall can help you please click on the links below:
Biceps Rupture (also known as Ruptured Biceps, Biceps Tendon Rupture, Rupture of the Long Head of Biceps)
A biceps rupture is when one of the two heads of the biceps muscle “snaps” due to sudden contraction of the muscle. This can happen during sport or at work.
Whilst not a very common injury it responds well to physiotherapy treatment.
Anatomy
The biceps muscle (biceps brachii) is located on the front of the arm between the elbow and the shoulder. It has two tendons that attach to the shoulder and one to the elbow. The tendons at the shoulder are called the long head and short head of biceps. The long head attaches within the shoulder joint and the short head to a process on the shoulder blade (coracoid process).
Causes of Biceps Rupture
Sudden or excessive contraction of the biceps muscle – this may occur with heavy lifting (either lifting above the head or lifting objects over the head) or bending the elbow forcefully against resistance (e.g., performing chin ups or biceps curls).
Repetitive or prolonged activities – this places a sustained strain on the biceps tendon which over a period of time weakens the tendon predisposing it to a complete tear often with minimal trauma.
Age related rupture – biceps ruptures are more common in the older patient with a history of biceps injury or tendonitis.
Signs and Symptoms of a Biceps tendon Rupture
In our experience the long head of biceps is far more commonly ruptured than the short head and as such these signs and symptoms relate to rupture of the long head of biceps.
Pain – sudden onset of pain over the front of the shoulder, upper arm or the elbow which is normally associated with a sudden snapping or tearing sensation. The pain may reduce to an ache at night or first thing in the morning. Occasionally there may be no pain at all.
Deformity of the biceps muscle – this is more obvious when compared to the non-injured side and on muscle contraction. The deformity appears as a bunching of the biceps muscle in the lower part of the upper arm often referred to as a “popeye” muscle.
Stiffness, swelling and bruising of the arm – if present it tends to be more noticeable the following morning and over the following days.
Weakness of the shoulder and or elbow – this will be particularly noticeable when lifting (especially above the head) and bending the elbow against resistance.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine which head of the biceps muscle has ruptured and the extent of the damage. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a ruptured long head of biceps are
- R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression bandage and keeping the arm Elevated (providing this is comfortable).
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder and elbow mobilizing techniques e.g., gentle stretching and muscle release techniques.
- Home exercise programme – a graduated mobilising and strengthening programme to ensure an optimal outcome.
- Anti-inflammatory advice – anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Bicipital Tendonitis
This is something we have a considerable experience in treating at Walker and Hall. We have treated all types of bicipital tendonitis, ranging from mild inflammation of the biceps tendon to total rupture.
With accurate diagnosis and the appropriate treatment this is a condition that responds well to physiotherapy.
Anatomy
The biceps muscle (biceps brachii) is located on the front of the arm between the elbow and the shoulder. It has two tendons that attach to the shoulder and one to the elbow. The tendons at the shoulder are called the long head and short head of biceps. The long head attaches within the shoulder joint and the short head to a process on the shoulder blade (coracoid process). Bicipital tendonitis commonly occurs to the long head of biceps as it leaves the shoulder joint at the front of the shoulder, passes through a groove (bicipital groove) on the front of the arm bone (humerus) and down the arm.
Causes of Bicipital Tendonitis
The main causes of bicipital tendonitis are repetitive use, trauma and degeneration.
Repetitive use – this commonly occurs as a result of repeated or prolonged activities involving the use of the biceps tendon. This includes excessive lifting (especially overhead), arm elevation activities (e.g. putting the washing on the line), heavy pushing or pulling, stretching the arm behind the back, throwing sports, sleeping on the affected side or use of the arm in front of the body (e.g. housework)
Trauma – with certain sports e.g., weight lifting, the bicep tendon can be suddenly subjected to a high force which can place too much strain through the tendon and cause tendonitis
Degeneration – more commonly seen in older patients, this is a gradual wear and tear of the tendon
Signs and symptoms of Bicipital Tendonitis
The symptoms of bicipital tendonitis usually develop gradually over a period of time and may include
- Pain – often felt as an ache over the front of the shoulder that increases to a sharper pain or catching pain with certain activities. It may also be experienced in the upper arm, upper back or neck.
In a minor presentation it may be present on commencing an activity and may reduce as you warm up. In a more established condition (chronic) it may prevent you from continuing with the activity. The pain usually makes it difficult to lift heavy objects (especially above the head), perform overhead activities and use the arm in front of the body.
- Loss of shoulder movement.
- Muscle wasting and weakness in the arm particularly when rotating the forearm e.g., DIY.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the cause and extent of the bicipital tendonitis. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for bicipital tendonitis are
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques.
- Home exercise program – it is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving
- anti-inflammatory advice
Fractured Humerus (also known as a Humerus Fracture and Broken Arm)
The humerus is the long bone in the upper arm. It attaches to the shoulder blade to form the shoulder joint (glenohumeral joint) and the bones of the forearm (radius and ulna) to form the elbow joint.
It can be easily broken particularly following a fall onto the shoulder or outstretched arm, or due to a direct blow to the upper arm. In either case if the stress placed on the humerus is beyond what it can withstand then the bone may break. When this occurs the condition is known as a humeral fracture. A humeral fracture can vary from a small undisplaced fracture (the bony fragments do not separate) to a severe displaced and or comminuted fracture (where the bony fragments separate and pierce the skin) with obvious deformity.
There are three areas on the humerus where fractures often occur:
- Near the shoulder (fracture of the neck of the humerus and fracture of the greater tuberosity)
- The shaft of the humerus
- Near the elbow (supracondylar fracture, fractures of the condyles and fractures of the epicondyles)
Causes of a Humeral Fracture
This normally occurs following a fall onto an outstretched hand, the elbow, or the point of the shoulder (e.g. a fall from a height, in horse riding or cycling). Occasionally it may occur due to direct trauma such as a motor vehicle collision or collision with another player during contact sports such as rugby or football.
Signs and symptoms of a Humeral Fracture
- Pain – a sudden onset of sharp intense pain at the time of injury. Usually located somewhere between the elbow and shoulder. It may increase when attempting to perform movements of the upper limb such as moving the arm away from the body, overhead activities, taking the arm across the chest or during pushing, pulling and lifting activities. It may also increase when lying on the affect side, applying pressure to the shoulder or when firmly touching the humerus at the site of injury. An ache in the upper arm may also be present that is particularly prominent at night or first thing in the morning (especially during the first few days following injury)
- An audible ‘click’, ‘pop’ or ‘snap’ at the time of injury
- Localized tenderness and swelling at the site of injury
- A bony deformity at the site of the injury
- Extensive bruising may be evident in the upper arm or sometimes spreading down into the elbow and forearm. This often occurs 1 – 2 days following the injury.
How Walker and Hall can help you
Depending upon the extent of the injury physiotherapy treatment is very effective once the arm is out of plaster or the sling (immobilisation) has been removed.
Following thorough musculoskeletal examination a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a fractured humerus are
- Pain relieving techniques e.g., gentle arm and joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques.
- Home exercise programme – it is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you start to move your shoulder.
Referred Pain
Not all pain experienced in the upper arm is necessarily coming from a problem with the upper arm. Occasionally pain felt in the upper arm can be referred or caused by a problem in another area of the body such as the neck or spine. This is called referred pain.
What is Referred Pain?
Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, and a heart attack, where the pain is felt in the shoulder, arms and neck.
What structures can refer pain into the upper arm
The following structures have the ability to refer pain into the upper arm
- The cervical and upper thoracic spines (from the 3rd cervical vertebra to the 4th thoracic vertebra – C3 to T4). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a problem in the upper arm
- The shoulder joint (gleno-humeral joint) and the acromioclavicular joint
- The muscles of the rotator cuff
- The muscle of the upper arm i.e., the biceps and triceps muscles
How can Walker and Hall help you distinguish between upper arm pain and referred pain
At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the pain in your upper arm.
It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.
You will be involved in all stages of your treatment given every opportunity to ask questions.
