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.

Reevaluate regularly.

Metabolic/endocrine/rheumatologic blood test series. (CBC, SMA-18, Thyroid screen, ANA, RF, ESR, B12, Folate)

Bone scan.

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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