Leeds Community Healthcare NHS Trust - Shoulder, Arm and Hand/Wrist Problems

Pain in the shoulder, arm, elbow, hand and wrist is common and can come from the joints or from the ‘soft tissues’ which include the muscles, tendons and ligaments. Sometimes pain in the arm can also be related to a problem in the neck. The pain may start suddenly after an injury or increased use, or may gradually build up over time.

In most cases shoulder, arm, elbow and wrist/hand pain has a simple cause and will settle gradually over time, using self-management approaches which can be carried out at home. Some conditions can be more persistent such as osteoarthritis, but these can often be self- managed successfully too.

Here is some more information on shoulder, arm, elbow, wrist/hand problems, including advice on what you can do, some exercises to try, and information on when you should seek medical care.

QWhat can I do to help my shoulder, arm, wrist or hand pain?
A new sprain or strain or an overuse injury can usually be managed at home and should start to improve within a few days. For other shoulder, elbow, wrist and hand problems including longer-term pain, self–management at home using the advice and exercises below will usually help the problem to settle. This advice aims to reduce your symptoms and help the healing process.

Pain relief such as paracetamol or anti-inflammatory pain medication can help to control your pain so that you can keep moving normally.

Heat is a simple and safe way to relieve pain if your pain is more than a few days old.
Apply a heat pack, wheat bag or small hot water bottle to the painful area. Always wrap the hot water bottle in a towel first to reduce the risk of burns. You can keep the heat pack applied for as long as it is comfortable; just make sure to check your skin regularly. You can buy heat gels to apply to the skin. These have the same effects as applying a hot or cold pack but are more portable when you are out and about.

Splints and supports are not necessary for most types of hand and arm pain. However some people find splints useful to ease wrist and hand pain while they recover. You can buy standard splints for wrists and hands in many pharmacies or online. They come in different sizes and designs. If you do decide to wear a splint it is important that you do not wear it all the time. Make sure to remove it regularly to do some stretches and exercises with your hand and wrist.

Adjust your activities for a while. Often simply reducing the activity which caused the problem or stopping it temporarily can greatly improve your pain. You should aim to gradually re-introduce this activity and build it back up over time.

Movement is an important part of recovery. It is ok to rest from activities which you find painful at first but you should still try to use your hand and arm as much as you can. Keeping it moving with simple exercises will help ease the pain and swelling and prevent the joints from stiffening up. Avoid doing anything too strenuous or heavy for the first few days and do not continue doing any activity which makes your pain a lot worse for a long time after you have stopped the activity.

Once the pain begins to settle you can begin strengthening your hand and arm and start to get back to your normal activities.
QWhen to seek further advice or medical care
- Constant and/or severe pain present day and night that you cannot settle
- Constant and/or severe numbness or tingling in any of your fingers or thumbs
- New, severe and/or progressive weakness associated with the condition affecting your arm, wrist/hand
- Heat, redness or swelling associated with the pain in your arm, wrist, hand or finger joints
- Feeling unwell or experiencing a fever in conjunction with your arm, wrist/hand pain
- Your symptoms are worsening and are not improving despite following advice already given
- A sudden change in colour of your hand suggesting a significant problem with circulation to the extremity
Seek urgent medical attention if you have significant loss of movement or strength after a sudden, traumatic or high impact injury to your wrist, hand, elbow, arm or shoulder
QExercises for hand/wrist, elbow/arm and shoulder
The joints and muscles in the arm all work together. Problems in the shoulder, arm, elbow, wrist and hand will often benefit from exercising all areas of the arm.

Shoulder/elbow/arm exercises

Common problems causing shoulder and arm pain include muscle and tendon problems, strains, inflammation and osteoarthritis (OA), and common problems causing elbow pain include tendon problems. Self- management using the advice above and the exercises below will help the problem to settle in most cases. However if this fails to help, ask a physiotherapist or GP for help.

As a general guide carry out the exercises below twice daily. Start with 5 repetitions of each exercise, working within your pain tolerance. It can be usual to experience an increase in your pain for up to 30 minutes following these exercises, adjust the number of repetitions if symptoms increase for longer. As your strength and movement improve, you should increase the number of repetitions up to 10.

Shoulder rolls

Stand with your arms relaxed on each side of your body.

Make forward circles with your shoulders. Relax and repeat.

Arm raise on wall

Stand with once foot behind the other facing a wall/mirror/ window that slides.

Hold a towel on the wall with your hands. Shift your weight forward as you slide your arms up the wall. Slide down with the arms as you move your body back. Repeat

Wall push-ups

Stand at arm’s length from a wall. Place your hands on the wall. Bend your arms and lean your body forward towards the wall slowly. Then straighten your arms and push yourself away from the wall. Repeat

Keep your body in a straight line, and use your abdominal and gluteal muscles to keep your lower back supported.

Move your feet further back to make the exercise harder

Elbow curls

Stand or sit tall with your arm along your side and the palm of your hand facing back. Bend your elbow as far as you can while turning the palm of your hand towards the shoulder. Lower and repeat.

Back scratching for mobility

Hold your arms out to the sides and bend your arms from the elbow.

Slowly reach up behind your back to just under your shoulder blades.

Shoulder overhead raises

Stand with your elbows bent 90° and at shoulder-height.

Move your hands all the way over your head and lower under control back to the starting position (90°)

Keep your torso stabilized by engaging the glutes and abdominals to prevent arching your lower back.

Shoulder butterfly

Lie on your back with your head on a pillow.

Bring your hands behind your head, then let the elbows fall toward the ground on each side.

Return to the starting position and repeat.

Wrist and hand exercises

Common problems causing wrist hand and wrist pain include joint problems, ligament and tendon problems, strains, inflammation and osteoarthritis (OA). Self-management using the advice above and the exercises below will help the problem to settle in most cases. However if this fails to help, ask a physiotherapist or GP for help.

Finger mobility – hand pump

Hold your hands in front with your fingers straight and spread apart.

Close your hands into a fist and then open and spread your fingers.

Close and open your fingers repeatedly in a pumping action

Wrist mobility

With your arm kept straight, palm facing down, bend your wrist down as far as you can so that you feel a stretch at the back of your wrist/ forearm, then pull it up as far as you can. Repeat, alternating the up and down hand movements.

Shoulder and arm strengthening

Standing up tall with a small weight in each hand, lift your elbows to the same height as your shoulders, and the weights to head height so that your elbows are bent to 90 degrees. Then straighten your elbows to lift the weights as high as possible above your head. Then lower slowly. Repeat. You can start this exercise with no weights if you find it difficult, or increase the weights if you find it easy.

Image credits: Physiotec