Pain with use Discussion
Ill defined upper extremity pain aggravated by use may be due to a variety
of problems. Well defined predisposing conditions include localized
neuritis, tendinitis, vascular abnormalities, endocrine, toxic or other
metabolic derangements and metabolic bone disease. Painful rheumatologic
conditions may be demonstrated by objective testing in some patients, but
others defy precise definition or diagnosis. Late effects of extremity
trauma may also be difficult to clearly define or treat. Presentation may
be substantially influenced by stress, other psychological factors, and the
presence of potential secondary gain. Patients who have painful medical
disorders of the upper extremity may be more aware of their symptoms while
engaged in a work-related posture or activity, but this is not credible
evidence of causation. Mislabeling a patient's complaints and mistakenly
relating these complaints to a work injury work is harmful, particularly
when complaints are ill defined. Management must be individualized, but the
following points usually apply when the diagnosis is completely obscure:
Identify aggravating postures, muscle actions, stressful situations.
Avoid pain inducing activities, but continue working.
Generic therapy: Antiinflammatory medication, heat, cold.
Metabolic/endocrine/rheumatologic blood test series.
(CBC, SMA-18, Thyroid screen, ANA, RF, ESR, B12, Folate)
Wait and watch.
Other tests / interventions only to confirm or treat specific diagnosis.
Some patients will benefit from physical medicine techniques to evaluate
and treat pain related to myofascial syndromes. Some patients with
undefined painful disorders will defy diagnosis and remain symptomatic.
Surgical management for atypical presentation of presumed disorders is
often disappointing or detrimental and is best reserved for situations in
which there is objective evidence of a problem which requires surgical
intervention within a limited window of opportunity for cure.
Otherwise, a conservative approach is often most safe and practical.
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