Upper Extremity Joint Problems
Our elbow is like a hinge allowing the lower arm (the forearm) to swing up and down and
position the hand in space. The anatomy of the elbow is complex with multiple muscles
inserting and originating about the bony structures. Thus, the elbow is quite sensitive to
overuse and repetitive motion. The most widely known and most diagnosed ailment is
tennis elbow (lateral epicondylitis). It’s cousin, the golfer’s elbow (medial epicondylitis), is a similar condition that affects the hinge joint of the upper body.. By virtue
of the motion of the fly-cast and other activities we ask of our hinge during fishing, like
rowing or carrying our gear, these conditions are frequently encountered by the angler.
You don’t have to play tennis or golf to suffer from these ailments. In fact, the majority
of people afflicted by these conditions don’t swing a club or racquet. It is likely that
fishermen’s elbow is a combination of tennis and golfer’s elbow.
Tennis Elbow: Symptoms
-Aching,burning, or sharp pain that lies over the outside of the elbow joint and may radiate to the wrist or back of the hand.
-The outer bony prominence of the elbow (lateral epicondyle) is tender to the touch.
-Grasping, making a fist, writing, lifting, or extending the wrist and fingers may increase
pain.
- In severe forms, it may cause a constant ache at night, preventing sleep.
Golfer’s Elbow: Symptoms
-Aching, burning, or sharp pain that lies over the inner aspect of the elbow joint and
may radiate to the inner forearm.
-Tenderness to touch over the inner bony prominence of the elbow (medial epicondyle).
-Pain may increase with grasping, making a fist, flexing the wrist and fingers downward,
twisting the wrist and forearm into a palm down position (pronation).
-In early and severe stages, this may cause a constant ache at night, preventing sleep.
Treatment
An ounce of prevention is worth a pound of trout! Training the wrist and hand during
the off-season helps to prevent these types of overuse injuries. A well-trained
musculoskeletal system that has been maintained during the winter months can prevent
many overuse injuries in the spring, as the muscles and their tendons have been kept at a
higher level of fitness and strength . Avoiding falls on slippery rocks can reduce
traumatic onset of tendonitis, but are more difficult to control or eliminate. Seek medical
attention for any significant complaint that does not respond to self-help. Contact a local
physical therapist or orthopedic surgeon if your progress stalls while using these
suggestions.
1. Protection: Use of a counter-force brace on the forearm is a common way to reduce
loads to the tendon. Placing one of these straps around the widest part of the forearm
helps to restrict how hard the extensor tendon muscles contract during grasp activities.
The brace should be just tight enough to stay in position on the forearm so that when
grasp occurs, muscular expansion creates a sense of pressure under the brace. Apply the
brace only during the period of time that strong grasping activities will be performed.
2. Rest: No matter where you fall along this spectrum, relative rest and protection are
the first order of business. Giving the tendon a break from at least fifty percent of the
amount of workload it has been performing is necessary to allow rebuilding of the injured
fibers. The concrete finisher needs a larger dose of rest from his work and should stay
away from his work continuously for a week or two to allow healing. The weekend
gardener may get away with weeding only one day on the weekend rather than two. In
any event, rebalancing your “treatment scale” is necessary for healing. Decrease the
speed of breakdown on one side of the scale to work their magic.
3.Friction Massage: Friction massage should be one of the early treatment techniques
employed to begin stimulating increased blood flow and improve collagen qualities in the
tendon. Using several fingertips over the tender areas, move the skin back and forth
across the tendon quickly in a direction that is perpendicular to the length of the
tendon/muscle. As tenderness improves, gradually push deeper into the tendon and
lengthen the time that you massage towards a goal of 15 minutes. Perform friction
massage 2-3 times per day as tolerated.
4. Ice and Anti-inflammatory Medications: Reducing inflammation in the extensor
tendon can be accomplished using ice and anti-inflammatory medications frequently and
consistently. Ice massage should be applied to the painful area of the elbow 2-3 times per
day for about 8-10 minutes each session. Ibuprofen or Aleve taken at the maximum
dosage listed on the bottle for 10-14 days can make significant reductions in
inflammation levels. Always take these medications with food as they can cause an ulcer
in a hurry in those with a sensitive stomach. Discontinue taking these and contact your
doctor if stomach or gastrointestinal irritation develops. Consistency is the key word
with both of these treatment modalities. Icing the elbow once every other day and taking
anti-inflammatory medications once a day will not have much impact on inflammation.
5. Stretching: Stretch 3-5 reps each exercise, holding at least 30 seconds each rep,
perform all exercises 1-3 times/day. Stretch to the point of pain and not beyond! A long
duration and low-intensity stretch is more effective in lengthening a tendon and muscle
than a intense short-duration stretch. Stretching frequently has the added benefit of
loading the tendon along its length and pulls gently on its attachment to the bone, thus
improving its tensile strength. The trick is not overloading the system by pulling too
hard.
Wrist Flexion:
Reach your arm out in front with the elbow straight and palm facing down towards floor,
use the other hand on back of wrist and fingers to pull further into flexion, twist the
forearm and hand to the outside while holding the palm down, hold 30 seconds. Repeat 35 reps.
Wrist Extention:
Reach your arm out in front with the elbow straight, lilft hand up with palm facing
forward, use the other hand to pull back on fingers and palm, hold 30 seconds. Repeat 35 reps.
6. Strengthening: It is easy to overdo strengthening exercises by performing them too
early in the recovery cycle. A good rule of thumb is to wait until pain is intermittent
before starting these exercises. The elbow should be pain-free while performing these
exercises. Adding in one set of reps at a time is another way to sneak into these exercises
without causing a bump op of pain and inflammation. For instance, start the first day by
performing 1x10 reps. On days 3 through 5, perform 2x10 reps with a 30-second break
between sets. Day 6 through 10 perform 3x10 reps with the same 30-second break
between sets. When you can perform 3 sets of 10 reps with ease and good control,
increase to 3x15 reps. When this becomes easy, start to add weight as tolerated. Contrary to the usual American mentality of ‘more is better”, these exercises should only be performed one session per day to avoid causing more inflammation and to allow the muscles
and tendons time to recover.
Wrist Extention: Lean forward and place your forearm on thigh with the wrist and hand
off the end of knee with palm facing down, grasp a 1 pound dumbbell in hand, slowly lift
the hand up as far as possible without lifting forearm off of the knee, return down
slowly. Follow the same progression listed in the paragraph above. The eventual goal
should be to perform 3x15 reps, one time per day using 8-10 pound weight.
Wrist Flexion: Use the same starting position as above, but with the palm facing up.
Lift your hand up and down slowly through the available range of motion. Follow the
same progression as described for the first exercise. Goal”3x15 reps, one time per day
using 8-10 pound weight.
Wrist Pronation/Supination:Place a hammer in your hand with more weight extending
above thumb side than below, rotate the wrist slowly to palm-down position, then slowly
to palm-up position. Reach farther down the handle to increase the lever arm length as
the exercise becomes easier. Progress to a heavier or longer tool as the hammer gets
easy. Goal: 3x15 reps, one time per day.
Ball Squeeze: Place a small ball in your hand and squeeze it holding tight for 3-5
seconds, progress from soft sponge, to a racquetball. Goal: 3x30 repetitions, once/day.