The arm is made up of the humerus and muscles, such as biceps and triceps, elbow, brachial and raven-brachial muscles. These muscles mainly straighten and flex the forearm. They are innervated from the radial nerve and the musculocutaneous nerve. They are mainly equipped with axillary and brachial arteries. It affects the movements in the shoulder and elbow joints.
Disorders within the arm may be related to the cervical spine as well as the entire upper limb:
- Numbness, paraesthesia, burning sensation
- Muscle overload
- Damage to the lymphatic vessels
- Injuries (e.g., fractures)
- Nerve damage
Extra-articular, intra-articular, and multi-fracture fractures are accompanied by damage to blood vessels, which can lead to ischemic necrosis. Shaft or supracondylar fractures may cause damage to the radial nerve. Orthopaedic equipment, lymphatic drainage and magnetron are used in such cases.
Radial nerve damage results from trauma or pressure. Symptoms occur locally or throughout the limb. The damage leads to the falling hand, limitation of movement and disturbance of sensation. Such conditions are treated with electrostimulation, neuro-mobilisation and laser.
“Saturday night paralysis” is a chronic compression of the radial nerve caused by ischemia. It occurs in people who sleep in an uncomfortable position.
Physiotherapeutic treatments depend on a given condition, so a thorough diagnosis is important so as not to overlook the red flags.
The shoulder or shoulder joint is a spherical joint, thanks to which it provides great mobility for the upper limb. It performs extension, flexion, adduction, abduction, internal and external rotation. It is equipped with brachial plexus nerves that innervate the skin and muscles of the entire hand. The bones that affect the shoulder are the collarbone, scapula, and humerus. The muscles that have an impact are supraspinatus, infraspinatus, subscapularis, deltoid, teres minor, coracobrachialis. A comprehensive approach to therapy is vital due to the complex anatomy of the shoulder. The problem in the shoulder joint may be related to the position of the spine or the entire shoulder girdle. Symptoms of rapid shoulder muscle fatigue and pain may be associated with contracture of the trapezius, infraspinatus and subscapularis muscles.
The most common problems are:
- Frozen shoulder
- Damage to the rotator cuff
- Compression syndrome
- Inflammation of the subacromial bursa
- Under/dislocated shoulder
- Nerve paralysis/injuries
Damage to the rotator cuff
The damage to the rotator cuff involves four muscles: supraspinatus, infraspinatus, subscapularis and teres minor. They are responsible for the shoulder joint’s internal and external rotation, and they also initiate the abduction movement. Their task is to stabilise the joint and support the centralisation of the humeral head. The causes of damage are micro-injuries, overload, e.g. working with raised hands, degeneration, muscle weakness. When the rotator cuff ruptures, surgery is required. An experienced physiotherapist will use targeted therapies. They will instruct you on how to perform exercises and conduct self-therapy and will modify your physical activity. Manual therapy with fascial therapy, strengthening exercises, electrotherapy and dry needling can be helpful here.
A frozen shoulder is the inflammation of the shoulder-scapular joint capsule. It leads to capsule shrinking or tethering. At the same time, stiffness, pain and limitation of movements are experienced. Injuries, operations within the joint or immobilisation may be the cause of the condition. People who practise sports such as tennis, volleyball and swimming are at risk. It is influenced by repetitive movements performed, for example, at work, which lead to structural limitations in the shoulder. In the beginning, rehabilitation focuses on the analgesic effect, relieving the limb and applying pharmacotherapy. Then, relaxation and mobilisation techniques of the shoulder tissues and the surrounding structures influencing the shoulder joint are used. The physiotherapist will use Kinesio taping as a support to stabilise the relief in order to accelerate the healing processes. It is essential to adjust the exercises which enhance the neuromuscular stimulation.
Brachialgia is a pain that radiates to the arm and even to the fingers. It is caused by pressure on nerve roots such as cervical discopathy, degeneration, nerve irritation/entrapment, which in turn results from staying in one position, i.e. driving a car or working at a computer. Sneezing, coughing or head movements make the pain worse. The disorder leads to functional limitations, weakening of the muscle mass (which is why it is difficult to hold a cup) or sensory disturbances. Rehabilitation consists of manual therapy and shoulder training exercises. An effective method is PNF, Cyriax, neuromobilisation and postural re-education. Exercises, repeated at home in order to maintain the effects of the therapy, are of great importance.
In all dysfunctions, it is important to involve the patient in the physiotherapy process. The duration of rehabilitation depends on the condition development stage, at which the patient reports to the physiotherapist. Self-discipline in following the therapist’s recommendations results in faster improvement.