Upper Body Injuries


Shoulder Pain and Injuries:

 

Rotator Cuff (RTC) Injuries:

 

Rotator Cuff Strain:

 

  • The RTC is a collection of 4 muscles that work together to stabilize the shoulder joint.  They are critical for optimal function of the most mobile joint in our bodies.  Often, a RTC injury occurs due to overuse i.e., in throwing sports, overhead work such as carpenters / electricians, or due to the aging process.  RTC injuries can also occur due to a traumatic fall such as in skiing, snowboarding, slipping on the ice or mountain biking.
  • When the RTC muscles aren’t able to function properly as a group the patient will notice an aching or shooting pain that caps on the shoulder and sometimes will move down the outside part of the arm.  Fluid often can begin to accumulate in the joint leading to impingement syndrome (see below).
  • Rotator cuff injuries are often treated successfully with physical therapy without the need for invasive options.  Click here to learn more.

 

 

 

Impingement Syndrome / Bursitis:

  • Impingement syndrome occurs either due to swelling from RTC tendonitis or a traumatic incident such as a fall (secondary impingement) or from arthritic changes in the bones of the shoulder joint (primary impingement).  In both forms, the carefully balanced system begins to break down leaving less room for the RTC tendons to glide on the bursa (acts as a pillow / lubricant for the joint) and causes a pinching of the tendons and bursa between the bones of the humerus (arm bone) and AC (acromioclavicular) joint.
  • Patients often complain of a “pinching” pain when lifting their arm above the shoulder height especially out to the side up to their ear.
  • Impingement of the shoulder is often treated conservatively with physical therapy and or in conjunction with cortisone injections. 
Click here to learn more about impingement syndrome and bursitis.

 

 

Rotator Cuff Tears / Repairs:

  • When a rotator cuff strain is severe or the muscles / tendons are torn, surgical intervention may be the only option.  We are lucky to have several excellent specialists in the area with specific post-operative protocols to ensure a great outcome.
  • Try not to be impatient with your repair.  The first 12 weeks of recovery are very slow moving but this is important for recovery.  In the first 6 weeks you will be in a sling and will not be allowed to actively (on your own with the muscles) move your arm.  It will be important to see one of our specialists during this time to ensure you regain full passive (no muscle activation) range of motion!
Click here and here to learn more about this surgery from one of our many surgeons in the area.

 

 

Biceps Tendonitis:

  • Your biceps tendon is a primary (major) mover of your shoulder joint and your elbow.  It is more often injured at the shoulder vs the elbow joint.  The biceps tendon can rupture which is often called a “pop-eye muscle” as it will roll up like a lamp shade and collect into a ball in the front of your arm.
  • The biceps tendon injuries rarely occur alone, often they are associated with impingement syndrome and RTC injuries.  They sometimes will need surgical repair however; this is often for the most severe cases.  Biceps tendon injuries happen most often in overuse injuries and overhead sports such as tennis, baseball, and volleyball but can occur traumatically as well.

Click here to learn more about biceps tendonitis or see one of our specialists.

 


 

Instability:

  • Instability of the shoulder is when there is either a complete dislocation of the joint (out of place) or the shoulder slips in and out of place quickly without staying out of the socket.  Instability can occur with or without a labral tear (see below).  Patients will often complain of the shoulder going “in and out of place” or “clicking and popping.” 
  • Generally, instability is due to weak shoulder muscles and sprained or stretched ligaments of the shoulder.  It is common in throwing and overhead sports such as volleyball, swimming, baseball, football and tennis.  Instability can often be combated by a detailed and structured strengthening program which allows the muscles to create “dynamic stability” to make up for the lack of “structural stability” from the ligaments and joint capsule.
  • Instability can be treated conservatively with great success through a structured strengthening program. 

Click here to learn more about instability of the shoulder.

Click here to read an article about instability written by our therapist Lauren Ziaks.

 

 

 

Pre and postoperative care for labral repairs, rotator cuff repairs, and debridements

Labral Repair:

  • The labrum of the shoulder sits on the glenoid (on the shoulder blade) and acts as a suction cup to keep the humeral head (arm bone) in place.  When a labral tear is large enough that strengthening alone cannot stabilize the joint, often surgery is the only option for a good outcome.
  • Labral repairs are typically arthroscopic (through little cameras) vs with a big incision.  The protocol following a repair is very strict as it is vitally important that the capsule, ligaments, and labrum are able to scar down appropriately for a good long term outcome.  Often people will rush their recovery and the shoulder will “stretch back out” again in the future.  Those who follow their protocols well and keep up with their strengthening have excellent outcomes.
Click here to learn more about labral repairs.

 

Rotator Cuff Repair:
  • See above
Debridement / SAD/DCR:
  • With use and age our shoulder joint can fall victim to arthritis like any other major joint in the body.  When this occurs bony overgrowth will occur and sometimes cannot be combated alone with conservative therapy (typically if a patient is not better in 4-6 weeks of physical therapy a surgical consult will be recommended).  As the joints continue to overgrow they can sheer and tear the tendons described above running in the shoulder joint (RTC). 
  • Often the doctor can go into the joint via arthroscopic surgery and “clean up” or trim down the joint via a debridement surgery.  This is also called a SAD/DCR for subacromial decompression and distal clavicle resection.  It essentially means the doctor shaved the bones to make more room in the shoulder joint for the tendons and bursa.
  • After this surgery patients tend to start therapy right away and do very well.  Sometimes patients complain of a “bony pain” in the shoulder for up to 12 weeks as the bone ends heal over.
Click here to learn more about this surgery from one of our local specialists.

 

We specialize in conservative treatment as well as pre and postoperative care for the above conditions. Pre and postoperative care for hemi, reverse, and total shoulder replacements (arthroplasty) – TSA

     


Elbow Pain and Injuries:

 

Tennis elbow aka lateral epicondylitis:

  • Tennis elbow occurs generally as an overuse injury to the extensor muscle group but can be caused by acute / explosive damage to the elbow.  As it is named, lateral (outside) elbow pain is frequent in tennis and other racquet sports due to the repetitive extension of the wrist (bending backwards).  Tennis elbow can also occur due to excessive amounts of typing or repetitive tasks like painting or electrical work. 
  • There are braces available that help with tennis elbow and physical therapy can be extremely effective at decreasing pain, modifying activities, and strengthening the muscles appropriately to alleviate all symptoms.

Click here to learn more about this common injury.

 

 

 

Golfer’s elbow / Little Leaguer’s Elbow aka medial epicondylitis:

  • Inside elbow pain or golfer’s elbow is caused by overuse to the flexor group of the forearm muscles such as: throwing a ball, swinging a golf club, from a tightly strung racket in tennis, or from repetitive twisting tasks such as using a screwdriver.
  • A combination of bracing, rest, modalities (ice, heat, massage, cupping…) and specific exercises can be very successful at treating medial epicondylitis. 

Please click here to learn more about this elbow injury.

 

 

 

UCL sprains:

  • This ligament is frequently injured in throwing athletes and the repair is commonly known as the “Tommy John Surgery”.  The UCL is the ligament that supports the inside of the elbow can begin to tear from overuse or can tear from one explosive insult to the elbow.  When ruptured / torn surgery is often utilized and the outcomes are much better now than ever before.
  • Click here to learn more about UCL injuries and other throwing sport injuries.

     


Forearm and Wrist Pain and Injuries:

 

Carpal Tunnel Syndrome

  • Carpal tunnel is a frequent overuse injury caused by activities such as typing at the computer.  The nerve that passes into your hand can become compressed in this injury resulting in numbness and tingling into the hand and fingers and will eventually progress into shooting pains and cramps up the front of the forearm.  Often the pain will be the worst at night and result in the wrists feeling stiff in the AM.  Night splints can help greatly with management of these symptoms.
  • Modifications can be recommended for your workstation to ease the stress placed on the wrist causing carpal tunnel.  Our specialists can work with you to optimize your work environment.
  • With the proper workplace changes and treatment protocol you can be successfully returned to your regular activities pain free.  Come in for an evaluation and find out how!

Click here to learn more about this very common workplace injury.

 

 

 

Wrist and Forearm Fractures:



In an active environment like Park City wrist and forearm fractures are quite common.  You should report directly to the local urgent care center if you believe you have any of these injuries listed below:

    Radioulnar Fracture:
    These fractures include both of the long bones in the forearm and often result in obvious deformity.  These injuries occur from traumatic accidents such as a fall on an outstretched arm, a direct blow or in a car accident.  These injuries will need to be stabilized either with splinting / casting alone or with surgery.  This will be decided by you and your doctor.  After the bone has healed you may need physical therapy to restore normal strength, range of motion, and function of your wrist / hand / elbow.
    Click here to learn more about adult forearm fractures.

     

    Wrist Fractures:

    There are a variety of different types of wrist fractures.  Most occur during a fall on an outstretched hand / arm.  These fractures are best known for the way the hand will displace in relation to the rest of the arm after the fracture. 

    For more information about the different types of wrist fractures click here

     

      • Colles’ fractures occur at the end of the radius closest to the wrist causing the hand to move backwards in relation to the forearm.
      • Smith’s fractures occur at the end of the radius closest to the wrist causing the hand to move forwards in relation to the forearm.
      • Scaphoid fractures occur at the bone at the base of the thumb and can be difficult to detect.  It is important that the healing of this bone is closely monitored as it has suboptimal blood flow and can be a frequent site of non-union (not healed fully).
      • Barton’s Fractures occur at the wrist joint and are associated with a dislocation of the radiocarpal joint.
      • Chauffeur’s Fractures occur at the very end of the radius on a portion of the bone called the styloid.

        These injuries will need to be stabilized either with splinting / casting alone or with surgery.  This will be decided by you and your doctor.  After the bone has healed you may need physical therapy to restore normal strength, range of motion, and function of your wrist / hand / elbow.

 

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