Upper Limb Conditions:   • Carpal Tunnel Syndrome       • Frozen Shoulder (Adhesive Capsulitis)      • Golfer’s Elbow (Medial Epicondylitis)   • Tennis Elbow (Lateral Epicondylitis)    • Rotator Cuff Tendonosis / Impingement      • Shoulder Instability

Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is caused by an irritation of the Median nerve, one of the nerves that comes from the neck and enters your wrist and supplies your hands and fingers. The work carpal refers to the 8 bones in the wrist. The tunnel is formed on top by a ligament that runs across the carpal bones and on the bottom by the carpal bones themselves. The median nerve runs through this tunnel and controls the feelings and muscle strength of the first three fingers, as well as the palm of your hand, exactly where people with CTS notice most of their symptoms. Overuse, improper use, as well as repetitive strain of the forearm and wrist are just a few of the ways this nerve gets irritated, resulting in tingling and pain in the hands and fingers.

People who do any type of repetitive movements with their hands and wrists are susceptible to this problem. This risk of developing CTS is even higher in people doing activities such as sewing, assembly line work, or jobs such as manufacturing, cleaning, or typing. Women are three times more likely than men to develop these symptoms as well as people with diabetes or other metabolic disorders.

Treatment for CTS may include chiropractic care, medical care or both. Surgery is a common treatment offered to people suffering from CTS, however, depending on the cause of the irritation, conservative care is often just as effective.  Targeted Soft Tissue Therapy, Acupuncture, Physiotherapy Chiropractic, Functional Rehabilitation and nutritional counselling are all effective components of a well-structures treatment plan for CTS.

Prevention however, is always best! First stretch your forearms and fingers before beginning work and at frequent intervals throughout. Secondly, alternate tasks to reduce the amount of repetitive movements that strain your wrists. Last but not least, modify or change your daily activities that put pressure on your wrists. back to top

Frozen Shoulder (Adhesive Capsulitis)
There are three clinical stages of the condition: freezing, frozen and thawing. In the freezing or acute stage moderate to severe pain exists that limits all shoulder movement. In most instances, the patient cannot recall any specific even that triggered the pain. The pain interferes with sleep, and in many instances causes patient to seek prescribed pain medication. In the frozen or middle phase, pain decreases gradually but without very much improvement in motion. The final or thawing phase is marked by slow and gradual return of motion and may be as short as 12 months but may last for years. Adhesive capsulitis has typically been classified into two forms, primary and secondary. In the primary form, no known causes can be identified. The secondary form is associated with trauma or other illnesses or events. Generally, the cause of adhesive capsulitis remains unknown. The condition tends to affect women more than men, occurs in people after their 40’s, does not show a particular preference for handedness, and can on occasion occur on both shoulders.

The most accepted theory is that adhesions develop between or within the capsule of the shoulder. Some individuals may be predisposed, such as those with diabetes, hyperthyroidism, lung disease and those who have had a heart attack.  It has been shown that, contrary to logic, this process is not due to immobilization (lack of movement). This process begins as an inflammatory process that resolves with scar tissue formation.

Because of the favourable natural history, patients can generally expect a good outcome, and in most cases conservative treatment is successful. Some patients will have residual signs and symptoms years after the onset of their disease. Mostly this is pain-free, mild loss of range of motion. Treatment is aimed at controlling pain, increasing range of motion in the shoulder and breaking down scar tissue with Physiotherapy Targeted Soft Tissue Therapy, and Acupuncture. A series of progressive Functional Rehabilitation exercises are used to regain proper movement of the shoulder. back to top

Golfer’s Elbow (Medial Epicondylitis)
Golfer’s elbow is an irritation of the forearm flexor tendons that attach to the inside of the elbow. This is the tendon of the muscles that are responsible for bending the wrist forward. The term Golfer’s elbow is used because this condition commonly affects golfers. It generally occurs in the trailing arm of the golf swing. With golfer’s, the incidence increases with age and the number of rounds played, with more than two to three rounds per week as a threshold for increased incidence. This condition is most frequently associated with overuse and excessive grip tension. Proper grip tension optimizes the function of the forearm muscles, allowing smooth, rapid movement of the forearms and reduced stress on the forearm tendon insertions at the elbow.

Golfer’s elbow is a repetitive strain injury with scar tissue formation that can become chronic if left untreated. The pain is aggravated by activities such as golfing, cooking, gardening, typing, throwing activities, swimming and lifting weights. A Functional Rehabilitation program comprised of stretching and strengthening exercises are incorporated into the treatment plan once the scar tissue has been “broken up” by Targeted Soft Tissue Therapy to reduce the possibility of re-injury. Acupuncture may also be used to treat both the pain and dysfunction of this condition. back to top

Tennis Elbow (Lateral Epicondylitis)
Tendonitis means inflammation of the tendon. Although the word “Tendonitis” is often used, it is actually an out-dated term. The suffix “itis” in tendonitis means inflammation, however, research has shown that it is really a build up of scar tissue and decrease in collagen that is the problem, not inflammation. Therefore, the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and collagen change.

Tennis elbow is an irritation of the forearm extensor tendons that attach to the outside of the elbow. These tendons attach to muscles that are responsible for bending the wrist backward. The term Tennis elbow is used because this condition most commonly affects tennis players with their backhand stroke. Tennis elbow is a repetitive strain injury with scar tissue formation that can become chronic if left untreated. The pain is aggravated by activities such as tennis, cooking, gardening, typing, and lifting weights. The pain is usually at its worst when grasping an object with the elbow in an extended position. The loss of grip strength and accompanying pain are difficult to tolerate for an active patient.

A Functional Rehabilitation program comprised of stretching and strengthening exercising are incorporated into the treatment plan once the scar tissue has been “broken up” by Targeted Soft Tissue Therapy to reduce the possibility of re-injury. Acupuncture has a great success rate for treating this condition and may be incorporated into the treatment plan. back to top

Rotator Cuff Tendonosis / Impingement
The rotator cuff involves four muscles that surround and support the shoulder joint (subscapularis, supraspinatus, infraspinatus, and teres minor). Together with the deltoid, the rotator cuff muscles place the arm in the overhead position essential in many sports. Sometimes these muscles get strained and irritated. Several different mechanisms of rotator cuff injury are presently recognized. These can be divided into acute traumatic injuries and the more common microtrauma caused by repetitive overuse injuries as seen in overhead activities (swimming, volleyball, etc.)

The symptoms of rotator cuff injury caused by both mechanisms include pain, weakness, and limitation of motion. Pain tends to be located in the front, top or side portions of the shoulder. Patients with acute inflammation of the rotator cuff have intermittent mild pain with overhead activities.

Patients with chronic inflammation of the rotator cuff have persistent, moderate pain with overhead activities; there may be pain at rest, but much less than with overhead activities. Patients with partial and full-thickness rotator cuff tears have persistent pain at rest that is often referred to the deltoid (shoulder) muscle insertion on the side of the upper arm. The symptoms of weakness and limitation of active motion may be the result of pain or a rotator cuff tear.

Several weight training exercises, including the upright row, military (shoulder) press and lat pull downs behind the neck jeopardize the muscles and tendons of the rotator cuff. Among the rotator cuff tendons, the supraspinatus tendon is the most frequently involved, probably because of its relative lack of blood flow and location in a potentially narrowed space below the shoulder bones. Frequently, the chest and front shoulder muscles development is disproportionate to that of the scapular (postural) stabilizing muscles.

Treatment is largely non-operative. It is aimed at pain control and scar tissue breakdown utilizing Acupuncture Physiotherapy and Targeted Soft Tissue Therapy, increasing pain-free shoulder range of motion, stretching (with emphasis on the posterior capsule of the shoulder), and strengthening of the scapular stabilizers, rear shoulder muscles, and external rotators with Functional Rehabilitation. back to top

Shoulder Instability
Anterior instability of the shoulder can also be chronic during weight training. Several errors of technique can contribute to anterior instability. Behind the neck (latissimus dorsi) pull-downs load the shoulder at the extreme of external rotation; shoulder hyper-extension during the bench press produces repetitive shoulder capsule trauma and places excessive traction on the AC joint; and behind the neck military presses stress the shoulder capsule, the rotator cuff, and the inferior shoulder ligaments. The patient may report vague symptoms such as a feeling of looseness of the shoulder or transient numbness of the arm.

Patients with instability usually do not have any symptoms. When symptoms occur, they often are the result of a sudden traction on the arm that results in pain and weakness felt in the entire arm. Supporting the arm relieves symptoms. Another common presentation is difficulty working in overhead positions due to a sense of fatigue rather than pain. Most patients have an inherent looseness to their shoulder capsule (born loose). This may be accentuated by sporting activities that constantly stretch the capsule, such as with throwing sports and swimming.

Treatment of anterior shoulder instability is still somewhat controversial. An aggressive Functional Rehabilitation program is advocated involving scapular stabilization, rear deltoid (shoulder) and external rotator cuff strengthening to substitute for the laxity of the joint capsule and prevent future dislocations. Targeted Soft Tissue Therapy is performed to breakdown the scar tissue formation from the chronic overuse. In an overhead throwing athlete or high shoulder demand athlete, however, a case can be made for early evaluation for consideration of surgical repair. Avoidance of positions that further stretch the capsule is important. Surgical stabilization is rarely necessary. 
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