Upper-Extremity Pain
Upper-Extremity Pain
For 20 years, Tom had “no aches, no pains, no nothing.” Why was
his luck changing now? Maybe his shoulder pain started because
his new van didn’t have power steering, or maybe it was because
he was doing a lot more wheeling on carpet. Regardless, now his
shoulders hurt. Thinking that the pain might go away, he waited.
But, after three or four months, the pain was so bad he couldn’t
stand it anymore. A trip to the doctor left Tom with more information
and some difficult choices.
Aging, Wear and Tear, and Overuse:
Tom’s story isn’t really unusual; we all expect a few more aches
and pains as we grow older. After all, aging and wear and tear
go together. What's different about Tom is that staying active
after his spinal cord injury meant even more wear and tear on his arms and shoulders. Studies have shown that arm
and shoulder pain is more frequent among SCI survivors than in
the nondisabled population.
How Injuries Happen:
Pain and injury from daily overuse is a frequent cause of upper
extremity pain. Overuse, however, is different for each person.
An activity that causes pain for one person may not for someone
else. In general though, the more frequently an activity is performed, and the more lifting
or straining the activity requires, the greater the opportunity
for injury and pain.
Think about the number of times you transfer from your wheelchair
everyday, then consider the extra shoulder strain when you transfer
to and from surfaces above or below your wheelchair – maybe into a bathtub, or a tall pickup truck.
The same transfers, day in and day out can cause a lot of strain
on your shoulders and wrists.
Overuse injuries can affect nearly any joint in the upper extremities,
but most often affect the shoulders and wrists. Pain may be constant
or may appear only during certain activities like wheeling long
distances. Sometimes pain begins when daily overuse is combined
with a specific injury like lifting something too heavy or too
quickly. That “something” could be a grocery bag, a wheelchair,
or your own body during a transfer.
Rotator Cuff Tears, Biceps Tendinitis, Carpal Tunnel Sydnrome:
Three frequent injuries among persons with spinal cord injuries
are rotator cuff tears, bicipital tendonitis, and carpal tunnel
syndrome.
The rotator cuff is made up of four muscles and their tendons. These muscles support
the shoulder and contribute to nearly all of its movements. Many
factors, including both activity level and aging, can combine
to increase pressure on these tendons and decrease their circulation.
Eventually, a tear may occur – either partial or complete, depending
on the amount of damage to the tendons and soft tissue. The most
common symptom is pain or weakness when reaching above your head.
Bicipital tendinitis is an inflammation of the biceps tendon and is often found in
people
who also have a rotator cuff tear. During normal arm movement
the tendon of the biceps glides in a groove in the bone of your
upper arm. Repetitive movements can cause swelling and pain in
and around the tendon. Repeated use may even cause the tendon
to fray. You usually feel pain near the middle of your shoulder
in the front, or slightly lower on the outside of your arm. You
might also have pain when you try to reach behind your back. Without
treatment, you could lose some of your active shoulder movement.
Carpal tunnel syndrome occurs when a particular nerve is pinched as it passes through
a narrow tunnel in your wrist. The usual symptom is pain or tingling
in your thumb and first two fingers. It might awaken you from
a sound sleep but then go away if you shake your hand. Bending
your wrists tends to narrow the tunnel and increase the symptoms
even more. And, as research already has shown, repetitive stress
and strain on your bent wrist does greatly increase the risk of
developing carpal tunnel syndrome. Unfortunately, SCI survivors
do many daily activities with a bent wrist – transfers, weight
shifts, wheeling, and using crutches are just a few examples.
Getting Help:
Upper extremity pain can begin with many different injuries; often
the symptoms of one are very similar to those of another. As you
evaluate the type of pain that you’re having, ask yourself: what
kind of pain is it–a sharp pain with certain movements, or a dull
nagging pain? Where is it–all over, or maybe one specific spot
on your shoulder or your wrist? When does it hurt–all of the time
or just certain times? How did it start–did it come on quickly
or has it seemed to develop slowly?
Many people endure lots of pain before they seek treatment. But,
ignoring pain
probably won't make it go away, so don't put off talking with
your doctor. In fact, ignoring pain frequently limits recovery
and function. An accurate diagnosis, and the facts about different
treatments will help you make wise choices.
Be prepared to tell your doctor exactly what activities you do
with your arms. Don’t just tell him or her that you use your arms
for transfers. Be ready to explain, or even demonstrate, how high,
how far, and how often. Not only may your daily activities be
causing your pain, but some of your doctor's recommendations will
involve altering those same activities.
Treatment Choices:
For most diagnoses, there probably will be more than one treatment
option. What you
choose will depend on what's causing your pain, and how that treatment
will affect your daily activities and independence.
Most treatments begin conservatively. “Conservative” can mean
changing or decreasing your current activities, buying new equipment,
increasing the assistance you get from others, or resting your
joints. You may need to use some imagination. What other ways
can you get the same activities done? Can some of them be done
by a family member? Can you hire an attendant or housekeeper for
heavy work to give your shoulders a rest? How about equipment?
Some equipment changes will be expensive, like a van or an electric
wheelchair. But, other, less expensive options may help too, like
transfer boards, grab bars, a tub bench or nocturnal splint. An
occupational or physical therapist can help you evaluate these
options and choose what you need.
Your doctor may recommend medication to decrease your pain or
to reduce joint swelling. Medications can be effective, especially
when combined with joint rest and the elimination of the pain-causing
activities. Keep in mind, though: many pain medications cause
constipation and can affect your bowel program. Ask about other side effects as well. And, make sure that your doctor knows all
of the other medications you're taking.
For some people, surgery is the best, or only, option. But surgery–at
least in the short
term–can significantly decrease your independence. While you recover and the repaired area heals,
you may need to rent a power wheelchair and arrange to have extra
assistance. Make sure that you discuss the recovery period, in
detail, with your doctor before surgery so that you make all the necessary arrangements.
Some Final Thoughts:
Does the possibility of shoulder pain or injury later on mean
that you should do as little as possible with your arms right
now, that you should be protecting your arms at all costs? No,
it’s not that simple. A balance of exercise and movement is important
to keep your joints healthy. But, the key word is balance. The
choices you make today will impact the quality of your life as
you get older. The bottom line is to pay attention and choose
well.
This is one of more than 20 educational brochures developed by
Craig Hospital while it was a federally-funded Rehabilitation
Research & Training Center on Aging with Spinal Cord Injury. The
opinions expressed here are not necessarily those of the funding
agency, the National Institute on Disability and Rehabilitation
Research of the US Department of Education.
For a hard copy of a METS brochure, click on your selection above
and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.
|
