Chapter 10 - The Upper Limb

Abstract

This chapter discusses pain experienced in the upper limb of the body. Often patients approach doctors citing pain in the shoulder area or the elbow. The symptoms of the shoulder are pain and stiffness; some patients complain of swelling or deformity, but in the absence of definite and significant recent injury, the complaint gets rarely verified on examination. True frozen shoulder may cause pain as severe and initially unremitting as that of malignancy or infection. The symptoms of the elbow are pain, stiffness, and, rarely, mechanical locking caused by the presence of a loose body. Pain arising from the soft tissues—muscle origins—is much more common that pain arising from the joint itself. Pain may be referred to the elbow from above (proximal), from neck or shoulder, or from below (distal). Tennis elbow and golfers elbow are common elbow ailments that patients may face. Beyond these, other common minor soft-tissue disorders in the upper limbs like carpal tunnel syndrome, ulnar nerve entrapment, stenosing tenovaginitis of finger flexor tendons (trigger finger) and of the thumb tendons at the radial styloid (de Quervain's syndrome), Dupuytren's contracture, and ganglion constitute a big part of orthopedic referrals.