Keeping Moving
By Julie K. Silver, M.D. and Maria H. Cole OTR/L

Reprinted with the gracious permission of Accent on Living - Spring 2000


Julie K. Silver, M.D., completed her residency at National Rehabilitation Hospital in Washington, DC. A California native, Dr. Silver earned her BS at the University of Califomia/Davis, and her MD at Georgetown University. She interned at the former Framingham Union Hospital. Dr. Silver pursues her interests in musculoskeletal rehabilitation and Post-Polio Syndrome as Director of the new Spaulding Neighborhood Rehabilitation Center in Framingham and is on the faculty of Harvard Medical School.

Spaulding Rehabilitation Hosptial is an affiliate of The Massachusetts General Hospital and Partners HealthCare System, Inc and is associated with Harvard Medical School, Tufts University School of Medicine and MGH Institute of Health Professions

Dr. Silvers has written a new book on Post-Polio Syndrome that will be published early in the year 2000 by Yale University Press.

Maria H. Cole OTR/L is a staff occupational therapist at Spaulding Rehabilitation Hopital's Outpatient Center in Framingham, Massachusetts.

We all need to know how to protect our arms from injuries
and how to treat injuries if they do occur.

Protect Your Arms.

Our arms are the keys to our ability to remain as mobile and independent a possible. We need them to bathe ourselves, feed ourselves, and use a telephone, computer or fax.

As we age, our arms become more susceptible to injuries. For individuals with pre-existing disabilities, these injuries may occur at an earlier age and be more severe because of the increased demands that are required of the arms for day-to-day activities. We can protect our arms from injuries and learn to treat injuries early to promote healing.

This article will cover four common arm injuries that are treatable and generally curable. Part one of the article is in this issue and part two will be in the next issue of Accent on Living.

Keep in mind that many other types of injuries exist and that the treatment is entirely dependent on having an appropriate diagnosis made by a medical doctor. This article is written in order to encourage prevention of injuries to the arms and to encourage readers who have arm pain weakness, numbness or tingling to seek early treatment after an appropriate diagnosis is made by a medical doctor.


The occupational and/or physical therapist can provide a wealth of information on how to avoid poor techniques and position of our arms and how to avoid re-injury.

Tendons are the structures that are found at both sides of a muscle and are used to attach the muscles to bones. Tendons often become irritated and inflamed through overuse and, because they don't have a good blood supply, can be a little tricky to heal.

Symptoms of tendon injuries generally include pain at the site of the injury. This pain is often worse with activity but may be quite severe at night when resting. Tendon injuries do not cause numbness and tingling feelings in the arms.

Described below are two common types of tendon injuries in the arms.

Medical Treatment for Tendinitis

Medical treatment generally consists of rest from activities that provoke the symptoms of pain. Using ice on the inflamed tendons can be very useful (the authors recommend using an ice pack or ziplock bag of ice water applied directly to the elbow or shoulder for 20 minutes at a time, two-three times each day). A doctor may prescribe anti-inflammatory medications. Injections of local steroid medication (similar to cortisone) can also help heal these injuries. Occasionally, surgery is necessary and if recommended is generally successful.

Rehabilitation Management of Tendinitis

Since tendinitis can impact our ability to perform everyday activities, the goal in rehabilitation is to reduce pain, increase flexibility, strengthen and, most importantly, restore function.

Therefore the initial goal of the physical and/or occupational therapist is to evaluate and individual's strength, posture and flexibility as well as to determine which activities may be contributing to the injury and causing pain. The therapist then can give expert advice on how to reduce the stress placed on the tendons that will generally include proper seating and posture instruction as well as providing tips on making simple adjustments at home and at work in order to avoid aggravating activities.

As part of the treatment, the therapist may use treatment "modalities" such as ultrasound that provides deep heat to warm the tissues - improving blood flow and relieving pain.

An exercise program is usually initiated on the first visit, but is recommended in a very specific manner. Most often, the exercises include only a stretching program because strengthening is not recommended until the tendons become less inflamed and less painful.

In the case of tendinitis at the wrist, either the physician or the therapist may recommend a splint for the wrist. The splint provides rest for the tendons and relieves the pressure from the overworked muscles.

If the symptoms persist despite treatment, surgery may be an option. In the case of post-operative rehabilitation, the focus again is on reducing pain and restoring strength, flexibility and function.

Part two of this article [will discuss nerve injuries, including carpal tunnel syndrome] will be in your next issue of Accent on Living [Summer 2000 issue].

Reprinted with permission.
Copyright, © ACCENT On Living, 2000, Julie K. Silver, M.D. and Maria H. Cole OTR/L
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