The Diagnosis of Soft Tissue Disorders of the Upper Limb

Abstract

Background: Pain in the upper limbs is a common symptom and a cause of significant morbidity. Pain may arise as a result of specific disorders such as rotator cuff tendinitis or lateral epicondylitis, or may occur in the absence of diagnostic physical signs. Until recently, research in this field has been hampered by the lack of an agreed system of classification of soft tissue upper limb disorders but in 1997, new diagnostic criteria were proposed by a UK multidisciplinary workshop. Working from these consensus criteria, we developed and tested a new examination algorithm.

Methods: We conducted a comprehensive computerised literature review in order to derive a workable examination schedule. In two separate studies in a hospital clinic and a general population sample, we tested its feasibility for use by trained research nurses and its reproducibility and face validity in two different populations.

Results: The between-observer reproducibility of physical signs in the hospital clinic was good to excellent (kappa coefficients 0.66-1.0 for most categorical variables). In the general population, between-observer reliability of physical signs was generally less good, but the rehability of agreement of specific diagnoses remained acceptable, with a median kappa coefficient of 0.66 (range 0.21-0.93). When compared against the standard of physicians’ diagnoses, the schedule was sensitive (58-87%) and highly specific (84-100%).

Conclusion: The Southampton examination schedule represents a feasible, and reproducible tool with face validity; suitable for use in future research into upper limb disorders, and has the backing of UK consensus criteria.

Key Words:

• upper limb
• musculoskeletal pain
• soft tissue disorders
• diagnosis