Nonspecific Arm Pain

Document Type: CURRENT CONCEPTS REVIEW

Authors

1 Department of Orthopedic Surgery Massachusetts General Hospital, 55 Fruit Street Boston, MA, 02114 USA.

2 Orthopedic Research Center Department of Orthopedic Surgery, Ghaem Hospital Mashhad University of Medical Sciences Ahmad-abad Street, Mashhad, 3316-913791 Iran.

3 Department of Orthopedic Surgery Massachusetts General Hospital, 55 Fruit Street Boston, MA, 02114 USA.

Abstract

 
Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness.

Keywords


Assennato G, Cuccaro F. Epidemiology of tumors in the construction industry. G Ital Med Lav Ergon. 2012;34:50-2.

  • Brackbill RM, Stellman SD, Perlman SE, Walker DJ, Farfel MR. Mental health of those directly exposed to the World Trade Center disaster: unmet mental health care need, mental health treatment service use, and quality of life. Soc Sci Med. 2013;81:110-4.

  • Cantey PT, Kurian AK, Jefferson D, Moerbe MM, Marshall K, Blankenship WR, et al. Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008. J Environ Health. 2012;75(4):14-9.

  • MacIver H, Smyth G, Bird HA. Occupational disorders: non-specific forearm pain. Best Pract Res Clin Rheumatol. 2007;21(2):349-65.

  • Maijers MC, Niessen FB. The clinical and diagnostic consequences of Poly Implant Prothese silicone breast implants, recalled from the European market in 2010. Plast Reconstr Surg. 2013;131(3):394-402.

  • Taylor CR, Siddiqi IN, Brody GS. Anaplastic large cell lymphoma occurring in association with breast implants: review of pathologic and immunohistochemical features in 103 cases. Appl Immunohistochem Mol Morphol. 2013;21(1):13-20.

  • Zambacos GJ, Molnar C, Mandrekas AD. Silicone lymphadenopathy after breast augmentation: case reports, review of the literature, and current thoughts. Aesthetic Plast Surg. 2013;37(2):278-89.

  • Bammer G, Martin B. The arguments about RSI: an examination. Community Health Stud. 1988; 12(3): 348-58.

  • Ireland DC. Psychological and physical aspects of occupational arm pain. J Hand Surg Br. 1988;13(1):5-10.

  • Tyrer S. Repetitive strain injury. J Psychosom Res. 1994;38(6):493-8.

  • Winspur I. Arm pain without physical findings: medicine vs. the law? J Hand Surg Br. 2001;26(5):409-13.

  • Kahneman D. Thinking, fast and slow. New York: Farrar, Straus and Giroux; 2011.

  • Bell DS. Epidemic occupational pseudo-illness: the plague of acronyms. Curr Rev Pain. 2000;4(4):324-30.

  • Gordon DA. Fibromyalgia--real or imagined? J Rheumatol. 2003;30(8):1665.

  • Hadler NM. “Fibromyalgia” and the medicalization of misery. J Rheumatol. 2003;30(8):1668-70.

  • Szabo RM, King KJ. Repetitive stress injury: diagnosis or self-fulfilling prophecy? J Bone Joint Surg Am. 2000;82(9):1314-22.

  • Tomaino MM, Brach PJ, Vansickle DP. The rationale for and efficacy of surgical intervention for electrodiagnostic-negative cubital tunnel syndrome. J Hand Surg Am. 2001;26(6):1077-81.

  • Malleson A. Whiplash and other useful illnesses. Canada: McGill-Queen’s Press-MQUP; 2002.

  • Alpar EK, Killampalli VV. Idiopathic arm pain. J Bone Joint Surg Am. 2005;87(3):677.

  • Alpar EK, Onuoha G, Killampalli VV, Waters R. Management of chronic pain in whiplash injury. J Bone Joint Surg Br. 2002;84(6):807-11.

  • Sakhel J, Ahlhelm F, Schwerdtfeger K, Steudel WI, Kelm J, Loew C, et al. Atypical symptoms in carpal tunnel syndrome - treatment and results. Fortschr Neurol Psychiatr. 2002;70(1):46-51.

  • Downs DG. Nonspecific work-related upper extremity disorders.Am Fam Physician. 1997;55(4):1296-302.

  • Helliwell PS, Mumford DB, Smeathers JE, Wright V. Work related upper limb disorder: the relationship between pain, cumulative load, disability, and psychological factors. Ann Rheum Dis. 1992;51(12):1325-9.

  • Helliwell PS. Diagnostic criteria for work-related upper limb disorders. Br J Rheumatol. 1996;35(12):1195-6.

  • Shanahan EM, Jezukaitis P. Work related upper limb disorders. Aust Fam Physician. 2006;35(12):946-50.

  • Ring D, Guss D, Malhotra L, Jupiter JB. Idiopathic arm pain. J Bone Joint Surg Am. 2004;86(7):1387-91.

  • Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, et al. Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmo shoulder and neck study cohort. J Epidemiol Community Health. 2005;59(9):721-8.

  • van Eijsden-Besseling MD, Peeters FP, Reijnen JA, de Bie RA. Perfectionism and coping strategies as risk factors for the development of non-specific work-related upper limb disorders (WRULD). Occup Med (Lond). 2004; 54(2):122-7.

  • Vranceanu AM, Barsky A, Ring D. Less specific arm illnesses. J Hand Ther. 2011;24(2):118-22;

  • Vranceanu AM, Safren SA, Cowan J, Ring DC. Health concerns and somatic symptoms explain perceived disability and idiopathic hand and arm pain in an orthopedics surgical practice: a path-analysis model. Psychosomatics. 2010;51(4):330-7.

  • Keijsers E, Feleus A, Miedema HS, Koes BW, Bierma-Zeinstra SM. Psychosocial factors predicted nonrecovery in both specific and nonspecific diagnoses at arm, neck, and shoulder. J Clin Epidemiol.. 2010;63(12):1370-9.

  • Wolff B, Burns JW, Quartana PJ, Lofland K, Bruehl S, Chung OY. Pain catastrophizing, physiological indexes, and chronic pain severity: tests of mediation and moderation models. J Behav Med. 2008;31(2):105-14.

  • Reneman MF, Soer R, Gerrits EH. Basis for an FCE methodology for patients with work-related upper limb disorders. J Occup Rehabil. 2005;15(3):353-63.

  • Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB. Psychological factors associated with idiopathic arm pain. J Bone Joint Surg Am. 2005;87(2):374-80.

  • Weissman-Fogel I, Sprecher E, Pud D. Effects of catastrophizing on pain perception and pain modulation. Exp Brain Res. 2008;186(1):79-85.

  • Hadler NM. Coping with arm pain in the workplace. Clin Orthop Relat Res. 1998;351:57-62.

  • Macfarlane GJ, Hunt IM, Silman AJ. Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study. BMJ. 2000;321(7262):676-9.

  • Buckle P. Upper limb disorders and work: the importance of physical and psychosocial factors. J Psychosom Res. 1997;43(1):17-25.

  • Devereux JJ, Vlachonikolis IG, Buckle PW. Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med. 2002;59(4):269-77.

  • Reilly PA. ‘Repetitive strain injury’: from Australia to the UK. Repetitive strain injury’: from Australia to the UK. J Psychosom Res. 1995;39(6):783-8.

  • Sim J, Lacey RJ, Lewis M. The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study. BMC public health. 2006;6:234.

  • van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. 2007;369(9575):1815-22.

  • Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1-2):167-78.

  • Feleus A, Bierma-Zeinstra SM, Miedema HS, Bernsen RM, Verhaar JA, Koes BW. Incidence of non-traumatic complaints of arm, neck and shoulder in general practice. Man Ther. 2008;13(5):426-33.

  • Moloney N, Hall T, Doody C. Sensory Hyperalgesia is Characteristic of Nonspecific Arm Pain: A Comparison With Cervical Radiculopathy and Pain-Free Controls. Clin J Pain. 2013;29(11):948-56. 

  • Tampin B, Slater H, Briffa NK. Neuropathic Pain Components Are Common in Patients With Painful Cervical Radiculopathy, but Not in Patients With Nonspecific Neck-Arm Pain. Clin J Pain. 2013;29(10):846-56.

  • Andersen JH, Kaergaard A, Frost P, Thomsen JF, Bonde JP, Fallentin N, et al. Physical, psychosocial, and individual risk factors for neck/shoulder pain with pressure tenderness in the muscles among workers performing monotonous, repetitive work. Spine. 2002;27(6):660-7.

  • Cook TM, Ludewig PM, Rosecrance JC, Zimmermann CL, Gerleman DG. Electromyographic effects of ergonomic modifications in selected meatpacking tasks. Appl Ergon. 1999;30(3):229-33.

  • Voerman GE, Vollenbroek-Hutten MM, Sandsjo L, Kadefors R, Hermens HJ. Prognostic factors for the effects of two interventions for work-related neck-shoulder complaints: myofeedback training and ergonomic counselling.Appl Ergon. 2008;39(6):743-53.

  • Lawson K, Reesor KA, Keefe FJ, Turner JA. Dimensions of pain-related cognitive coping: cross-validation of the factor structure of the Coping Strategy Questionnaire. Pain. 1990;43(2):195-204.

  • Tota-Faucette ME, Gil KM, Williams DA, Keefe FJ, Goli V. Predictors of response to pain management treatment. The role of family environment and changes in cognitive processes. Clin J Pain. 1993;9(2):115-23.

  • Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1-9.