Screening for medical problems in patients with upper extremity signs and symptoms

J Hand Ther. 2010 Apr-Jun;23(2):105-25; quiz 126. doi: 10.1016/j.jht.2009.09.005. Epub 2009 Nov 26.


NARRATIVE REVIEW: Hand therapists must be able to identify signs and symptoms of systemic disease that can mimic integumentary, neuromuscular, or musculoskeletal dysfunction evaluated and treated within their scope of practice. Pneumonia, complications of pacemakers, liver disease, kidney stones, ectopic pregnancy, and myocardial ischemia are only a few examples of problems and systemic diseases that can cause shoulder or upper extremity signs or symptoms. A screening model is presented for use by therapists in all practice settings. Information gathered is combined with results from the objective evaluation in making a treatment-versus-referral decision. Knowing the risk factors for various illnesses, diseases, and conditions will help guide the therapist in knowing when to screen for specific problems. Recognizing red flag histories, signs, and symptoms will also alert the therapist to the need for additional questions. Clues to screening and tips for physician referral are offered.

Level of evidence: 5.

MeSH terms

  • Decision Making
  • Diagnosis
  • Humans
  • Mass Screening*
  • Medical History Taking*
  • Physical Therapy Specialty*
  • Referral and Consultation
  • Risk Factors
  • Surveys and Questionnaires
  • Upper Extremity / physiopathology*