Elbow and shoulder pain, physical therapy, treatment: Focus Fizikal✓

Pain in the elbows and shoulders often appears together because these two joints function as a coordinated kinetic chain responsible for positioning and using the hand. The shoulder provides a stable base with a wide range of motion, while the elbow allows precise positioning of the arm toward or away from the body. Pain develops when biomechanical balance is disrupted—restriction in shoulder movement forces the elbow to compensate, leading to chronic tendon and bursa inflammation.

The anatomy of this region includes the complex structure of the rotator cuff in the shoulder and the epicondylar tendon attachments at the elbow, which are connected through long muscle chains. Pain arises from repetitive microtrauma during activities such as lifting the arms overhead, carrying heavy objects, or prolonged computer work. In individuals with poor posture and rounded shoulders, chest muscles become shortened while stabilizers of the shoulder blade weaken, creating an unfavorable mechanical angle for both shoulder and elbow function.

Understanding the relationship between shoulder stability and elbow overload is essential for long-term symptom resolution. Early physiotherapeutic assessment helps identify the primary source of dysfunction and prevents the development of degenerative changes in both joints.

Symptoms involving the shoulder and elbow manifest as a dull ache at rest and sharp sensations during arm use. Patients often describe a feeling of “heaviness” throughout the limb and difficulty finding a pain-free position while sleeping. The clinical picture is distinctive because pain originating in the shoulder often “radiates” down the arm directly to the elbow.

The most common symptoms accompanying shoulder and elbow pain include:

• Deep, dull shoulder pain when lifting the arm: Discomfort that occurs when attempting to raise the arm above shoulder level or reach behind the back.
• Sharp, localized pain on the bony prominences of the elbow: Pain on the outer or inner side of the elbow that intensifies dramatically when gripping objects or shaking hands.
• Pain radiating along the entire arm: Continuous pain that starts in the shoulder, passes through the upper arm and elbow, and travels down the forearm to the hand.
• Tingling, “pins and needles,” and burning sensations: Altered or reduced sensation in the elbow area projecting toward the fingers, a clear sign of nerve entrapment.
• Loss of strength and function: Noticeable weakness when carrying bags, opening doors, or holding tools, often accompanied by morning stiffness in both joints.

These signs clearly indicate that the soft tissues of the upper extremity are under constant stress and that the kinetic chain is disrupted. Recognizing these signals early allows a physical therapist to apply techniques that relieve inflamed tendons and restore joint mobility.

• Tendinitis
• Bursitis
• Muscle and joint overuse or injury
• Arthritis

Causes of combined shoulder and elbow pain are most often related to occupational strain or sports injuries. Factors such as poor ergonomics, weakened trunk muscles, and asymmetric use of the arms directly contribute to inflammatory processes. Although patients may feel pain in two separate locations, the underlying cause is often hidden in poor scapular movement mechanics.

The main causes of shoulder and elbow pain include:

• Cervicobrachial syndrome (Neck-related problem): Herniated discs or cervical spondylosis exert pressure on the nerve plexus (brachial plexus), causing referred pain in the shoulder and elbow.
• Rotator cuff syndrome with secondary epicondylitis: Inflammation or partial tear of the shoulder tendons that, due to altered arm mechanics, leads to tennis or golfer’s elbow.
• Chronic myofascial syndrome: Presence of highly painful trigger points (muscle knots) in the trapezius, scapula, and upper arm that transmit pain to both joints.
• Generalized tendinitis: Simultaneous inflammation of the biceps tendon where it attaches to the shoulder and where it enters the elbow joint.
• Systemic and degenerative arthroses: Early or advanced degenerative changes in the cartilage of the shoulder and elbow joints due to aging or previous injuries.

Accurately determining the sequence of problem development allows for the creation of an individualized treatment plan that addresses the arm as a whole. Each of these causes requires a specific therapeutic approach to restore balance between strength and flexibility.

Treatment of elbow and shoulder pain at the “Fizikalna terapija Focus” center focuses on restoring full functionality of the entire upper limb, combining advanced technologies with manual techniques. Successful rehabilitation enables a freely moving arm without limitations or pain.

Our modern rehabilitation approach includes the following phases:

• Detailed functional assessment – analysis of scapula, shoulder, elbow, and wrist movements to identify imbalances.
• Physical therapy procedures – application of Tecar therapy and high-intensity laser for deep tissue and tendon stimulation.
• Manual therapy and joint mobilization – relieving pressure on soft tissues and improving mobility.
• Kinesiotherapy – focused on scapula stabilization and eccentric strengthening of the arm muscles.
• Posture and movement education – preventing non-physiological movements and reducing risk of injury.

Consistent performance of targeted exercises is crucial for long-term shoulder stability and elbow relief, allowing the patient to regain pain-free and fully functional movement.