Biceps Tendinitis or Strain

Subjective:

Pain in the biceps tendon. Look for a thin soft spot in the tendon at the point of maximal pain. This is the site of the strain. With tendinitis, there can be tendon thickening with stiffness and pain.

Assessment:

Pain will decrease and active range of motion will increase.

Light Treatment Plan:

In mild to moderate cases, a total average dose of 25–600 joules can be administered to the attachment points of the tendon plus an equal amount of joules for painting the surrounding area. This may stimulate healing while reducing swelling and pain; it also can be useful in reducing any scarring from surgery. Treat every two or three days until recovery is evident.

Adjunctive Treatment Plan:

Prescribe gentle muscle strengthening and stretching once healing has occurred sufficiently to allow the tissues to accept stress. For tendinitis, friction massage may help. Taping can be used during the acute stage of a strain to prevent further tearing and assist in rehabilitation. It can be helpful to alternate ice and heat to control inflammation and pain. If the problem persists after appropriate therapy, consider a referral to an orthopedic specialist.

Carpal Tunnel Syndrome

Subjective:

Symptoms are numbness and/or pain in the thumb and/or middle three fingers that can increase with activity or at night while sleeping. In moderate to severe cases the pain can be disabling and radiate up into the forearm and arm.

Assessment:

Successful treatment results produce decreased pain and increased function and strength.

Light Treatment Plan:

The light must be aimed at the median nerve in the carpal tunnel both vertically and slightly angled to either side of the tendons in the wrist to bathe the entire nerve in photons. A treatment dose of approximately 25 to 100 joules is initially administered in most cases, less if the pain is acute or severe.

It may also be advisable to treat the adjacent tender points in the forearm and hand with 5 to 25 joules per point or perform nerve tracing over the median nerve into the hand. Fingernails can be painted with 10 to 50 joules if additional peripheral stimulation is needed. Always consider the possibility of treating the brachial nerves in the lateral/anterior neck or at the spinal level if you believe that the problem could be cervicogenic.

Treatment can start daily for up to three or four days or until symptoms decrease. Chronic conditions may require higher doses up to 300 joules with a high power laser and frequency can be two or three times a week for up to four weeks.

Adjunctive Treatment Plan:

Daily, gentle flexion and extension stretching of the wrist can be added as long as it does not aggravate symptoms. It can be helpful to initially use ice and then alternate ice and heat directly over the carpal tunnel to control inflammation and pain. Many patients find benefit from bracing, especially at night. If the problem persists after appropriate therapy, consider a referral to an orthopedic specialist for injections or surgical intervention.

Fractured Finger or Wrist

Subjective:

Pain can be mild to severe at the fracture site. The patient may have already been treated by an orthopedic specialist and received x-rays, fracture reduction, casting, and possibly surgery.

Assessment:

Decreased pain and swelling with an increased range of motion.

Light Treatment Plan:

Acute conditions can be treated immediately to reduce swelling and pain with about 25 to 200 joules at the site fracture and the surrounding strained soft tissues. If a cast is in place, treatment can be applied to the arteries above the fracture site with 25 to 200 joules per treatment to stimulate healing in the forearm region. You may also treat the radial or ulnar arteries if the cast is on the hand. Once the temporary or plaster cast has been removed, light treatments may resume two or more times per week until an acceptable level of healing has
occurred.

Adjunctive Treatment Plan:

In cases of non-union, bone healing may be aided with light therapy. Be certain that the patient eats a balanced diet and consider multi-mineral supplementation.

It can be helpful to alternate ice/heat to stimulate circulation and control inflammation and pain once the cast has been removed.

In many cases, there will be a decreased range of motion that will require gentle active followed by a passive range of motion activities. If the problem persists after appropriate therapy, consider referral to an orthopedic specialist for further evaluation.

Fractured Clavicle

Subjective:

Mild to severe pain at the fracture site.

Assessment:

Decreased pain and swelling indicate improvement.

Light Treatment Plan:

The majority of fractures are in acute or sub-acute conditions and light can be applied even before x-rays and a sling have been provided to speed healing and reduce swelling and pain. An average treatment dose of 25 to 200 joules is applied directly over and around the fracture site. Treatment can also be initiated soon after diagnosis and treatment by a physician have been completed and the fracture has been stabilized.

After the bone has been reset, treatment can be administered every two to three days until pain and swelling have been reduced.

Adjunctive Treatment Plan:

In cases of non-union fractures, light therapy may improve bone healing. Patients should eat a balanced diet and consider multi-mineral supplementation. It can be helpful to initially use ice and later alternate ice/heat to control inflammation and pain. If the problem persists after appropriate therapy, consider a referral back to the orthopedic specialist.

Frozen Shoulder

Subjective:

Stiffness and pain in and around the shoulder joint, difficulty sleeping, and pain with motion, especially abduction.

Assessment:

Improved active and passive range of motion; lessened pain.

Light Treatment Plan:

Acute conditions can be treated with a total dose of 50 to 600 joules. This can be administered at approximately 10 to 25 joules to various points, directed to the center of the shoulder joint from the anterior, posterior, and superior aspects. The surrounding area may also be painted with approximately 25 to 100 joules. Treatment can be done every two or three days until the patient has achieved 90% of normal range of motion.

Adjunctive Treatment Plan:

Passive and active mobilization is a vital part of the therapy. Passive mobilization can be performed in all appropriate directions including posterior, inferior, and lateral glide as well as abduction and adduction. Gentle stretching at home, two to three times per day, is important. It can be helpful to alternate ice and heat to control inflammation and pain.

In some cases, acupuncture and taping can provide benefit. If the problem persists after appropriate therapy, consider a referral to an orthopedic specialist for manipulation under anesthesia.

Rotator Cuff Strain

Subjective:

Pain is usually felt with abduction. If the rupture is moderate or severe, pain can also be present at rest, with swelling, bruising, and muscle weakness.

Assessment:

Active range of motion will gradually become more pain-free.

Light Treatment Plan:

Acute conditions can be treated with an average dose of 25 to 200 joules applied to the injured area with a combination of point treatment and painting. Treatments should be given every two to three days until satisfactory relief is achieved.

Adjunctive Treatment Plan:

Gentle strengthening when there is no pain associated with the effort. Taping can help stabilize the muscle during the acute stage. Alternating ice and heat may control inflammation and pain. If the problem persists after appropriate therapy, consider a referral to an orthopedic specialist.

Tennis and Golfer’s Elbow

Subjective:

This is also called lateral or medial epicondylitis. Pain is present on palpation at the medial or lateral epicondyle tendon attachment sites. Although the problem can occur from participation in sports, almost any repetitive forearm and hand activity can create this condition. Patients may report difficulty lifting a coffee cup or carton of milk, shaking hands, or opening doors.

Assessment:

With increasing healing, there will be less pain, increased ability to lift heavier objects with the hand, and improved functional activities.

Light Treatment Plan:

This condition can be treated with a total average dose of 20 to 100 joules. This dose can be administered to tender points adjacent to the epicondyles as well as directly on the attachment site for 5 to 50 joules per point, followed by painting over the region near the epicondyle. Treatments can be done two to three times a week for two to six weeks, with decreasing frequency as symptoms abate.

Adjunctive Treatment Plan:

In acute cases, ice and heat can assist in symptom control. In chronic cases, friction, trigger point or myofascial massage, spray/stretch, and gentle strengthening can be beneficial when appropriate. No massage on the epicondyle is recommended in the acute stage, and stretching should start only after the pain has significantly decreased. Using a tennis elbow brace and taping during upper-extremity activities can be protective.

Thumb or Finger Sprain

Subjective:

Pain with active and/or passive range of motion.

Assessment:

There will be decreasing subjective complaints and improved range of motion and strength.

Light Treatment Plan:

Treatment can be given two to five times the first week and directed into the joint space from all four sides.

Adjunctive Treatment Plan:

Gentle, active range of motion may be indicated in the first week if it causes no aggravation of symptoms. Passive range of motion or mobilization can be performed once the acute injury has stabilized. It can be helpful to initially use ice and then ice/heat to control inflammation and pain. Bracing and taping can reduce pain and prevent further injury. If the problem persists after appropriate therapy, consider a referral to an orthopedic specialist.

Arm or Forearm Tendinitis

Subjective:

The patient will notice a loss of function due to forearm pain.

Assessment:

Improvement will be noted as decreased pain, increased strength, and improved function.

Light Treatment Plan:

This condition can be treated with a total average treatment dose of approximately 50 to 600 joules. This dose can be administered to tender points, followed by painting.

Remember that deeper points require longer treatment times. Treatment can be given once or twice a week for two to six weeks or until relief is obtained.

Adjunctive Treatment Plan:

In acute cases initially using ice and then ice/heat can assist in symptom control. In chronic and subacute cases, friction, trigger point or myofascial massage, spray/stretch, home application of ice or heat, and stretching can be beneficial. Night bracing is often protective.