Chapter 23: Upper Extremity Limb Pain Assessment

Upper Extremity Limb Pain Assessment begins by establishing the importance of a focused health history using the PQRST mnemonic to characterize pain and identify emergent conditions that require immediate intervention, such as acute compartment syndrome (ACS) and cervical spine trauma. The text details the mechanisms of injury to differentiate between soft tissue pathology—such as muscle strains and ligamentous sprains—and specific bone injuries, including Bennett, Boxer’s, Scaphoid, and Colles fractures. Considerable attention is given to the physical examination, outlining inspection techniques for joint deformities like Heberden and Bouchard nodes associated with osteoarthritis, and specific provocative tests including the Phalen test, Tinel sign, Finkelstein test, and Yergason test to isolate pathology in the wrist, elbow, and shoulder. The chapter also reviews essential diagnostic studies, such as joint aspiration, radiographic views, and laboratory markers like C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) to confirm inflammatory or autoimmune processes. Finally, it presents an extensive differential diagnosis of non-emergent causes of pain, covering inflammatory conditions like tenosynovitis, olecranon bursitis, and rheumatoid arthritis; traumatic and overuse injuries such as rotator cuff tears, acromioclavicular joint separation, lateral humeral epicondylitis (tennis elbow), and ganglion cysts; nerve entrapment syndromes including thoracic outlet, cubital tunnel, and carpal tunnel syndrome; and systemic disorders like systemic lupus erythematosus (SLE) and sickle cell disease.