Arm Problems

Carpel tunnel syndrome, golfers elbow, tennis elbow, occupational over use syndrome (OOS), tenosynovitis, bursitis and shoulder problems are all treated similarly because they represent, in most cases, different focal representations of the same broad underlying causes.

Carpel Tunnel Syndrome (CTS)

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CTS is normally associated with entrapment of the median nerve.

 

It is usually diagnosed by the presence of certain symptoms including; pain, paraesthesia (dead arm or hand), and weakness of grip.

 

Definitive diagnosis is by nerve conduction testing.

 

Medical treatment includes splinting, steroid injections and in the worst cases surgery.

Causes

We find that the cause of CTS are multitudinous and, more often than not, include direct problems with the articulations (joints) that make up the carpel tunnel as well as those of related structures including the elbow joint, spine, and ribs.  

 

Returning the bones of the wrist, forearm, shoulder, and neck to their optimal positions can improve symptoms dramatically.

Golfers Elbow & Tennis Elbow

Golfers elbow, or medial epicondylitis is an inflammatory disorder of the medial epicondyle (inside aspect of the upper arm bone at the elbow end) and tennis elbow is the same condition afflicting the lateral or outside epicondyle of the same bone. These present as pain, swelling and/or tenderness over the point of inflammation.

Solutions

 

The medical approach is to splint the area, to apply steroids by injection or in chronic cases to debride the epicondyle (surgically remove unwanted tissue).

 

While each of these approaches may be successful where the underlying cause is transient, they usually will not stop reoccurrence if the underlying causes are ongoing.

 

Causes 

As with CTS (above) there are multiple possible underlying causes.

 

High amongst these are aberrant movement of the elbow and wrist articulations (joints). Weaknesses of muscles that operate over these joints and shoulder neck or spinal functional problems that result in elbow and wrist related muscles having to carry a greater load.

Occupational Over Use Syndrome (OOS) 

Tenosynovitis, and Bursitis

These are dealt with together because they are all soft tissue inflammatory disorders and usually include repetitive movement in the presence of dysfunctional muscle joint complex.

 

What we have noted about OOS/tenosynovitis (OOS/T) is that repetition in and of itself is not enough to cause the problem. It is almost always repetition in the presence of stress and underlying structural (mechanical) faults that leads to poor co-ordination between agonist (moving in the same direction) and antagonist (moving in the opposite direction) muscle groups that results in the inflammation. So yet again the solution does not lie in addressing the actual inflammation directly but rather in identifying and treating the underlying causes.

A bursa is a small sac of synovial fluid (lubricant found in joints). The purpose of a bursa is to allow muscles and tendons to move over bony surfaces with a minimum of friction. Bursitis is inflammation of a bursa. Medical treatment consists of rest (doing nothing), anti-inflammatory drugs and/or injecting the bursa with steroids. As with epicondyleitis, each of these approaches may be successful where the underlying cause is transient, however they usually will not stop reoccurrence if the underlying causes are ongoing.  

While nearly anything can contribute to a bursitis repetition in the presence of poor co-ordination between agonist (moving in the same direction) and antagonist (moving in the opposite direction) muscle groups we find is common with bursitis. Behind this aberrant movement is often joint restriction or muscle weakness relating to the area where the bursa is located.

Shoulder Problems

When patients refer to shoulder problems there are usually referring to pain in either the acromioclavicular joint, the glenohumeral joint, the upper ribs or any of the muscles or ligaments associated with these areas. Depending on which of these are involved these are some of the most challenging problems to resolve.  What is important to remember is that except where there is frank arthritis (relatively rare) or complete rupture of one or more of the rotator cuff muscles or the biceps muscle (less rare), the underlying causes can usually be identified and successfully treated.

 

The joints that make up or influence the function of the shoulder girdle complex include the acromioclavicular joint, the glenohumeral joint, the sternoclavicular joint, the manubriosternal joint, the joints of the cervical spine and upper thoracic spine and the upper costothoracic joints. These and all their associated musculature, plus second level joints such as those of the elbow or wrist can all be implicated in shoulder problems.  To these must be added all the other underlying causes of functional failure which can contribute to shoulder dysfunction. It is because of the sheer complexity of the shoulder girdle complex that these are some of the most difficult problems to resolve.

 

Having said this we still improve or fix a majority of shoulder problems we treat by carefully deconstructing the underlying causes and improving their function one by one.