A comparison of new approaches to the classification of neck and ULDs
| Anatomical site | Harrington5 | Sluiter6 | Helliwell7—significant variables among patients in diagnostic groups | |||
|---|---|---|---|---|---|---|
| Neck disorders | Not included | Radiating neck complaints At least intermittent pain or stiffness in the neck and pain or paraesthesia in one or more upper extremity regions, associated with head movements, for >4 days out of the past 7 days AND pain in upper extremity on active or passive cervical rotation | Not included | |||
| Shoulder disorders | Rotator cuff tendonitis History of pain in the deltoid region AND pain on resisted active movement (abduction—supraspinatus; external rotation—infraspinatus; internal rotation—subscapularis) Bicipital tendonitis History of anterior shoulder pain AND pain on resisted active flexion or supination of the forearm Shoulder capsulitis History of pain in the deltoid area AND equal restriction of active and passive glenohumeral movement with capsular pattern (external rotation>abduction>internal rotation) | Rotator cuff syndrome At least intermittent pain in the shoulder region without paraesthesia, which is worsened by actively raising the upper arm, for >4 days out of the past 7 days AND at least one of the following tests positive: (a) pain on resisted shoulder abduction, external rotation, or internal rotation; (b) resisted elbow flexion; or (c) painful arc | Shoulder tendonitis Limitation of abduction of the shoulder, painful arc on abduction of the shoulder, shoulder pain, sleep disturbance | |||
| Elbow disorders | Lateral epicondylitis Epicondylar pain AND epicondylar tenderness AND pain on resisted extension of the wrist Medial epicondylitis Epicondylar pain AND epicondylar tenderness AND pain on resisted flexion of the wrist | Lateral and medial epicondylitis At least intermittent, activity dependent pain localised around the lateral or medial epicondyle for >4 days out of the past 7 days AND local pain on resisted wrist extension (lateral) or wrist flexion (medial) Cubital tunnel syndrome At least intermittent paraesthesia in the 4th and/or 5th digit OR the ulnar border of the forearm, wrist, or hand for >4 days out of the past 7 days AND a positive combined pressure and flexion test Radial tunnel syndrome Pain in the lateral elbow region or forearm muscle mass of wrist extensors/supinator OR weakness on extending the wrist and fingers for >4 days out of the past 7 days AND tenderness in supinator region on palpation over the radial nerve 4–7 cm distal to the lateral epicondyle AND at least one of the following tests positive: (a) resisted forearm supination (b) resisted middle finger extension | Lateral epicondylitis Pain or tenderness, or pain on loading relevant muscle at lateral epicondyle | |||
| Wrist/hand disorders | De Quervain’s disease Pain over the radial styloid AND tender swelling of the extensor compartment AND EITHER pain reproduced by resisted thumb extension OR positive Finkelstein test Tenosynovitis of the wrist Pain on movement localised to the tendon sheaths of the wrist AND reproduction of pain by resisted active movement | De Quervain’s tenosynovitis Intermittent pain or tenderness localised over the radial side of the wrist, which may radiate proximally to the forearm or distally to the thumb, for >4 days out of the past 7 days AND at least one of the following tests positive: (a) Finkelstein’s test; (b) resisted thumb extension; (c) resisted thumb abduction Peritendonitis/tenosynovitis of the wrist Intermittent pain/ache in the ventral or dorsal forearm or wrist region for >4 days out of the past 7 days AND provocation of symptoms during resisted movement of the muscles under the symptom area AND reproduction of pain during palpation of the affected tendons or palpable crepitus under the symptom area or visible swelling of the dorsum wrist/forearm Guyon’s canal syndrome Intermittent paraesthesia in the palmar ulnar nerve distribution of the hand, distal to the wrist OR pain in the ulnar innervated area of the hand, which may radiate to the forearm, for >4 days out of the past 7 days AND at least one of the following tests positive: (a) weakness or atrophy in the ulnar innervated intrinsic hand muscles; (b) Tinel’s sign; (c) reversed Phalen’s test; (d) pressure test over the Guyon’s canal | Tenosynovitis Pain on movement of tendon or swelling of tendon sheath or triggering/locking/nodule on tendon located in finger flexor or extensor tendon, or thumb flexor, extensor or abductor tendon | |||
| Carpal tunnel syndrome | Pain OR paraesthesia OR sensory loss in the median nerve distribution AND ONE OF (a) Tinel’s test positive, (b) Phalen’s test positive, (c) nocturnal exacerbation of symptoms, (d) motor loss with wasting of abductor pollicis brevis, (e)abnormal nerve conduction time | Intermittent paraesthesia or pain in at least two of digits I, II, or III, which may be present at night as well (allowing pain in the palm, wrist, or radiation proximal to the wrist) for >4 days out of the past 7 days AND at least one of the following tests positive: (a) flexion compression test; (b) carpal compression test; (c) Tinel’s sign; (d) Phalen’s sign; (e) two point discrimination test; (f) resisted thumb abduction or motor loss with wasting of abductor pollicis brevis | Paraesthesia or numbness in median nerve distribution, pain at night, paraesthesia in a peripheral nerve distribution, diminished power related to a peripheral nerve at the wrist | |||
| Non-specific forearm pain | Non-specific diffuse forearm pain Pain in the forearm in the absence of a specific diagnosis or pathology (sometimes includes loss of function, weakness, cramp, muscle tenderness, allodynia, slowing of fine movements) | Non-specific UEMSDs Diagnosis of exclusion |