Anatomy – Physiotherapy

Physiotherapy uses a combination of exercises to maintain joint movement and strengthen muscles. The physiotherapist will teach you exercises that you need to continue with at home.

When will I see them?

Physiotherapy may be involved at various stages of your rehabilitation from soon after your injury to further on in your recovery. The aim at all stages is to help your recovery and to improve your overall function based on your individual needs. We will review your progress regularly.

Where will I see them?

There are times that the physiotherapist may get involved in your rehabilitation:

. As an inpatient on the ward.
. In the out-patient department when you return to see your doctor or the brachial plexus practitioner.
. In the physiotherapy department after you have left hospital. They may arrange this at the hospital or at a local
physiotherapy department after discussion with you.

What does Physiotherapy involve?

The physiotherapist will use various techniques depending on your stage of rehabilitation. These may include

. Teaching you or your family exercises to keep joints of your arm and hand supple.
. Teaching you and your family how to look after your arm if there are areas where you have poor sensation.
. Advising you on your posture and how to lift and handle objects.
. Teaching exercises to encourage and strengthen movement when your nerves start to recover.
. Teaching ways of improving sensation when your nerves start to recover.
. Provide any general advice and information that you require on your injury.
. Assess and advise you on returning to work and leisure activities.
. Communicate regularly with local physiotherapy teams, doctors and yourself about your progress.

Physiotherapy Exercises

Following your injury, your physiotherapist will teach you a number of exercises designed to regain / maintain the passive movement at all joints of your injured arm. These exercises are important to ensure that your joints are supple and able to work or and when your nerves and muscle function improve. They may be taught immediately after your injury or on removal of your sling after an operation. Do not perform these exercised until you have been shown by your physiotherapist.

As each injury is different, your physiotherapist will instruct you or your carer on which exercises to perform, and the correct way to do them. The following diagrams show you some of the exercises that you may be taught.

It is extremely important that you perform these exercises regularly at home as you are the person responsible for maintaining and improving the movement in your arm.

Unless otherwise directed by your physiotherapist, each exercise should be

. Initially performed at least three times a day.
. Performed slowly and gently.
. Held for 5 seconds at the end of each exercise.
. Repeated 10 times.

All exercises must be taken as far as your joint will let you go. You should not experience any pain with these exercises. If you do, please contact your physiotherapist.

Shoulder exercises

The following shoulder exercises should be performed lying on your back.

1. Elevation

Gently hold your forearm and lift your arm up above your head. Keep your arm close to the side of your head.

2. Lateral Rotation

You may need help from somebody else to do this exercise correctly. Using your other arm, bend your injured elbow 90° whilst keeping the elbow in at the side. Rotate the arm out towards the side.

3. Abduction

Grab your forearm and bend your elbow to 90°. Take your arm out to the side until your arm is at right angles to your body. You may need assistance from somebody else for this exercise.;

Elbow exercises

All of the following exercised can be done in any position – lying, sitting or standing.

4. Flexion / Extension

Grasp your forearm with your other hand and gently bend and straighten your arm fully.

5. Rotation

Bend your elbow to 90° (you can support your forearm on a table), using your other hand to help, turn your palm up to face you and then down towards your feet. It is important that you keep your elbow bent at 90°.

Wrist exercises

6. Extension

Hold onto your hand and take your wrist backwards.

Finger exercises

7. Flexion / Extension

Using your other hand bend each of your knuckle joints down and then straighten them. Start with the largest joint and then perform
the same exercise on the middle joint and then the end joint. Repeat this exercise on all of your fingers and finally using your other hand push your fingers down into a fist.

8. Web exercises

Clasp your hands and stretch the spaces between each finger.

Thumb exercises

9. Web exercises

Keeping your hand flat on a table with your palm facing down, grasp your thumb and take it up and out so the side.

10. Flexion exercise

Grasp your thumb and bend it across the palm of your hand towards the base  of your little finger.

It is extremely important that you do not attempt to perform these exercised until you have been instructed by a physiotherapist as they will inform you of which exercises are appropriate for you.