Table 1

 Key clinical features of specific disorders that may present with upper limb pain

General class of disorderExamplesKey signs
ROM, range of movement.
Nerve compression syndromeCarpal 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 syndromeAdson’s test: pain, numbness, and weakened pulse with hyperextension of shoulder and chin thrust forward
Cervical radiculopathyAppropriate dermatomal signs; Spurling’s test: pain radiating down arm with top of head compression and slight neck extension
Musculotendinous problemsTenosynovitisSwelling, crepitus, and pain on active movement of tendon; triggering (especially digital flexor tendons)
Bicipital tendonitisPain in shoulder region with pain on resisted elbow supination
Frozen shoulderShoulder pain with limited passive ROM in all planes
Rotator cuff syndromeShoulder pain with normal passive ROM but pain on resisted shoulder motion; painful arc of motion
Medial epicondylitisLocalised tenderness; pain on resisted wrist flexion
DeQuervain’s tenosynovitisPain in anatomical snuff box; positive Finklestein’s test
Lateral epicondylitisLocalised tenderness; pain with full wrist flexion in extended elbow; pain with resisted wrist extension
ArthritisOsteoarthritisHeberden’s nodes, Bouchard’s nodes, squaring of carpometacarpal, loss of passive ROM
Acromioclavicular syndromeTenderness to palpation of the acromioclavicular joint
Rheumatoid arthritisPain and stiffness considerably worse in the morning; boggy swelling of joint; late changes include gross joint destruction