This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Lateral Epicondylalgia (tennis elbow)
The pain is located on the outer side of the elbow and can radiate into the top of the forearm. It is worsened by activities such as gripping and repetitive movements of the wrist and hand such as typing and tennis. It has been known as 'Tennis elbow' in the past for this reason. The symptoms can be similar to radial nerve entrapment and so need to be clearly assessed and managed.
Physiotherapy techniques such as taping, massage techniques, ultrasound, manual treatment of to the joint/tissues and acupuncture can be used to relieve symptoms. A gradual exercise programme and activity modification can also be used by a physiotherapist, helping to remodel the tissue and aid healing. There is also a new treatment called electroshockwave therapy that can help this condition. We can recommend to you where you can have this treatment.
Superior Radio-Ulnar Joint Dysfunction:
This joint can be damaged by extreme twisting movements of the wrist such as with martial arts or trauma such as falling on an outstretched hand. Injury can include fracture or weakening of the ligament that holds the joint in place. X-Ray can exclude bony injury if significant enough but ligamentous injury may need full assessment by a physiotherapist, consultant or MRI to identify. We can recommend top London consultants in this case. Injury leads to pain over the outside of the elbow, particularly with turning movement of the arm and gripping.
Physiotherapy techniques such as taping, mobilisations and strengthening exercises can be used to reduce symptoms.
Snapping Plica
The outside joint of the elbow between the end of the humerus and top of the radius has small synovial fold (plica). This plica can snap back and forth over the head of the radius. It can be caused by repeatedly bending and straightening in sport. There will be pain on the outside of the elbow and a snapping sensation when the elbow is bent.
Physiotherapy can help with advice on reducing the inflammation of the plica and avoiding aggravating activities. It may be recommended to have surgery on the plica and a medical referral is required to consider this option. We can recommend top London consultants in this case.
Radial collateral ligament instability:
This ligament passes from the outside of the bottom end of the upper arm (humerus) to the head of the radius (main forearm bone). It can be injured with trauma to the elbow including extremes of golf or tennis swing. The pain will be catching in nature and may also be associated with a feeling of the elbow being unstable with clicking or clunking sensations.
Physiotherapy can identify the injury and level of instability, give you advice on when to consider a surgical option if the injury is significant and help on managing the symptoms. Many ligament injuries can be managed well with strengthening and control based exercises. If a medical referral is required we can recommend a top London elbow consultant to you.
Pronator syndrome:
This is a condition in which the median nerve becomes pinched or trapped by the overlying musculature or tissue, commonly in the pronator muscles of the forearm. This muscle turns your forearm over so that your palm faces down. It is identified by an area of pain over the outer or front of the elbow but also by weakness in specific hand muscles used for gripping and sensory loss over the thumb and index finger due to the nerve compression.
Physiotherapy can provide symptom relief with soft tissue massage techniques, stretches, activity modification and advice on how to avoid the injury. Physiotherapy can also offer specific nerve gliding exercises to aid in the recovery of the nerve.
Fracture of the radial head:
The radial head can be fractured with heavy falls onto the hand or upper limb. This is commonly identified with an X-Ray and will present with pain over the outer elbow and forearm that is sharp on movement or with lifting and carrying.
Physiotherapy can aid in the healing and recovery after fracture by utilising joint mobilisation techniques to regain lost movement after being in plaster and using soft tissue techniques, to regain flexibility and strengthening exercises to provide support for the healing bone. Your physiotherapist can also provide you with loading exercises tailored specifically to the stage of healing to maximise bone strength. Sometimes there can be problems that interfere with the healing of bone and we can provide you with devices that have been proven to stimulate bony healing.
Osteochondritis dissecans
This is a result of the splitting of pieces of cartilage (lines the joint surfaces) into the elbow joint caused by repeatedly bending the elbow. Mostly likely is a dull ache and some swelling around the outside of the elbow. It becomes more difficult to straighten the elbow.
Physiotherapy can help by using anti-inflammatory treatments and advice on management to return to sport. Taping can be used to support the elbow during the healing process.
Pain referred from the neck (cervical referred pain):
Some pain experienced in the upper limb can be caused by nerve injury or compression in the neck. This commonly occurs when a specific nerve root is involved, such as the C5 or C6 nerves which refer their pain to the outer elbow area. This pain can also be associated with burning, tingling or numbing sensations.
Your physiotherapist will be able to determine if your pain is referred from the neck and identify which structures might be causing the problem by assessing muscle length, disc and joint health and movement and nerve involvement. Your treatment with us can then be tailored to include nerve gliding exercises, neck mobilisations, soft tissue techniques and neck exercises.
Osteoarthritis and Rheumatoid Arthritis
Osteoarthritis can occur in any joint in the body and is a the process of 'wear and tear' where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.
We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function.
Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.
We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:
- Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
- Wheelchair assessments
- Splinting
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants to help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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