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Idiopathic arm pain.

David Ring1, Daniel Guss, Leah Malhotra

  • 1Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 525, 15 Parkman Street, Boston, MA 02114, USA. dring@partners.org

The Journal of Bone and Joint Surgery. American Volume
|July 15, 2004
PubMed
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Idiopathic arm pain causes significant upper-extremity dysfunction, similar to diagnosed conditions. Psychological and sociological factors may influence reported arm pain severity and health status.

Area of Science:

  • Orthopedics
  • Rheumatology
  • Pain Management

Background:

  • Idiopathic arm pain, lacking objective abnormalities, is a frequent clinical challenge.
  • Differentiating health status impact between idiopathic and diagnosed arm pain is crucial.

Purpose of the Study:

  • To compare upper-extremity health status in patients with idiopathic arm pain versus those with discrete diagnoses.
  • To evaluate the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire's utility in assessing arm pain severity.

Main Methods:

  • Utilized the DASH questionnaire for 3888 patients over twelve months.
  • Compared DASH scores for the general sample, idiopathic arm pain group (n=496), and discrete diagnosis group (n=1379).

Main Results:

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  • Idiopathic arm pain patients reported high DASH scores (36 ± 24), indicating substantial dysfunction.
  • Discrete diagnoses also showed significant variation (SD 25, range 6-27) and floor effects.
  • Analysis of variance confirmed DASH's discriminative ability, though Tukey analysis revealed subgroup score overlap.

Conclusions:

  • Patients with idiopathic arm pain experience considerable and varied upper-extremity dysfunction.
  • Observed DASH score variations exceed expectations based on pathology, suggesting psychological/sociological influences.
  • The DASH instrument effectively differentiates severity but shows overlap among specific diagnoses.