A NARRATIVE REVIEW ON CLASSIFICATION OF PAIN CONDITIONS OF THE UPPER EXTREMITIES
Jesper Nørregaard, Søren Jacobsen and Jens H. Kristensen
Local and regional musculoskeletal discomfort and pain in the shoulder girdle or upper extremities are often reported, especially in the work- ing population. In this review we describe the most important problems and factors when classifying musculotendinous pain in the upper extremities and shoulders. This includes an analysis of how four common diagnoses (wrist tenosynovitis, lateral epi- condylitis, rotator-cuff tendinitis, myofascial pain syndrome) fulfil basic criteria of validity. It is evident that there are some serious problems regarding the validity of the current classification of the conditions. Clinical criteria are often poorly defined and the reliability insufficiently tested. The relationship to objective pathoanatomic or physiological findings seems inconsistent. Although magnetic resonance and ultrasonographic imaging are promising, they are still only preliminary methods for evaluation of tendon and connective tissue structures. The prog- nosis with and without treatment also seems hetero- geneous and can vary between studies. A generally accepted terminology is lacking in the pathogeneti- cally complex regional muscle pain conditions
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