Saturday, 30 January 2016

Approach to pain in the arm and hand

Pain in the arm and hand: diagnostic strategy model

Probabiligy diagnosis

  • Dysfunction of the cervical spine 
  • Disorders of the shoulder
  • Medial or lateral epicondylitis
  • Overuse tendonitis of the wrist
  • Carpal tunnel syndrome 
  • Osteoarthritis of the thumb and DIP joints
Serious disorders not to be missed
  • Cardiovascular 
    • angina
    • myocardial infarction 
    • axillary vein thrombosis
  • Neoplasia
    • pancoast tumour
    • bone tumours
  • Severe infections
    • septic arthritis (shoulder/elbow)
    • osteomyelitis
    • infections of tendon sheath and fascial spaces of hand 
Pitfalls (often missed)
  • Entrapment neuropathies
  • Pulled elbow 
  • Foreign body 
  • Rarities
    • polymyalgia rheumatica
    • Reflex sympathetic dystrophy
    • Thoracic outlet syndrom e
    • Arm claudication 
    • kienbock disorder

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