Key clinical features of specific disorders that may present with upper limb pain
| General class of disorder | Examples | Key signs |
|---|---|---|
| ROM, range of movement. | ||
| Nerve compression syndrome | Carpal tunnel (median nerve at the wrist) | Paraesthesiae and altered sensation in thumb and index finger, sparing the palmer triangle; Tinel’s sign; Phalen’s sign |
| Cubital tunnel (ulnar nerve at the elbow) | Paraesthesia in little finger and ulnar border of the hand, worse with elbow flexion; Tinel’s sign | |
| Pronator syndrome (median nerve in forearm) | Paraesthesiae and altered sensation in thumb and index finger, including the palmer triangle; pain in the forearm, worse with resisted pronation with elbow extended but not so much with elbow flexed | |
| Ulnar tunnel syndrome (ulnar nerve at the wrist) | Weakness, paraesthesiae, and altered sensation of little and ulnar half of ring finger but not ulnar border of the hand; confirm by electrophysiology | |
| Radial tunnel syndrome (radial nerve in the forearm) | Pain in the extensor mass just below the elbow; no sensory or motor loss; middle finger extension test; pain with resisted supination of fully extended elbow | |
| Thoracic outlet syndrome | Adson’s test: pain, numbness, and weakened pulse with hyperextension of shoulder and chin thrust forward | |
| Cervical radiculopathy | Appropriate dermatomal signs; Spurling’s test: pain radiating down arm with top of head compression and slight neck extension | |
| Musculotendinous problems | Tenosynovitis | Swelling, crepitus, and pain on active movement of tendon; triggering (especially digital flexor tendons) |
| Bicipital tendonitis | Pain in shoulder region with pain on resisted elbow supination | |
| Frozen shoulder | Shoulder pain with limited passive ROM in all planes | |
| Rotator cuff syndrome | Shoulder pain with normal passive ROM but pain on resisted shoulder motion; painful arc of motion | |
| Medial epicondylitis | Localised tenderness; pain on resisted wrist flexion | |
| DeQuervain’s tenosynovitis | Pain in anatomical snuff box; positive Finklestein’s test | |
| Lateral epicondylitis | Localised tenderness; pain with full wrist flexion in extended elbow; pain with resisted wrist extension | |
| Arthritis | Osteoarthritis | Heberden’s nodes, Bouchard’s nodes, squaring of carpometacarpal, loss of passive ROM |
| Acromioclavicular syndrome | Tenderness to palpation of the acromioclavicular joint | |
| Rheumatoid arthritis | Pain and stiffness considerably worse in the morning; boggy swelling of joint; late changes include gross joint destruction | |