Symptom Finder -Arm and Hand Pain
Arm and Hand Pain
The patient presenting with acute arm and hand pain should usually be no problem. A fracture dislocation, cellulitis, or even “tennis elbow” is
obvious. Perhaps the clinician will miss referred pain from acute coronary insufficiency, but this is not likely. It is chronic recurrent pain in the arm
and hand that often confounds the clinician. First, palpate the joints for the various forms of arthritis. Next, look for tenderness of the radial–humeral joint (tennis elbow) and lateral epicondyle (golfer elbow). If these techniques fail to reveal the diagnosis, it is time to look for the neurologic
causes of the pain in four places:
Begin by palpating the cervical roots and performing a cervical compression test and Spurling test.
Next, perform Adson tests for the various types of thoracic outlet syndrome.
Now, tap the ulnar groove in the elbow for ulnar entrapment. Sensation to touch and pain should be reduced in the little finger and
the lateral one-half of the ring finger if this is present. In some cases, the hypothenar eminence and interossei muscles are atrophied.
Finally, tap the medial surface of the wrist (Tinel sign), and flex the wrist for 3 minutes (Phalen test) to pin down the diagnosis of carpal
tunnel syndrome. Sensation to touch and pain will be diminished in the first three fingers and the medial one-half of the ring finger if
this is present. In advanced cases, there may be atrophy of the thenar eminence.
Obviously, a neurologist will perform a more detailed examination, but a primary care physician should be able to pick up most causes of chronic
arm or hand pain using these techniques.
The patient presenting with acute arm and hand pain should usually be no problem. A fracture dislocation, cellulitis, or even “tennis elbow” is
obvious. Perhaps the clinician will miss referred pain from acute coronary insufficiency, but this is not likely. It is chronic recurrent pain in the arm
and hand that often confounds the clinician. First, palpate the joints for the various forms of arthritis. Next, look for tenderness of the radial–humeral joint (tennis elbow) and lateral epicondyle (golfer elbow). If these techniques fail to reveal the diagnosis, it is time to look for the neurologic
causes of the pain in four places:
Begin by palpating the cervical roots and performing a cervical compression test and Spurling test.
Next, perform Adson tests for the various types of thoracic outlet syndrome.
Now, tap the ulnar groove in the elbow for ulnar entrapment. Sensation to touch and pain should be reduced in the little finger and
the lateral one-half of the ring finger if this is present. In some cases, the hypothenar eminence and interossei muscles are atrophied.
Finally, tap the medial surface of the wrist (Tinel sign), and flex the wrist for 3 minutes (Phalen test) to pin down the diagnosis of carpal
tunnel syndrome. Sensation to touch and pain will be diminished in the first three fingers and the medial one-half of the ring finger if
this is present. In advanced cases, there may be atrophy of the thenar eminence.
Obviously, a neurologist will perform a more detailed examination, but a primary care physician should be able to pick up most causes of chronic
arm or hand pain using these techniques.
