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Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain
Joost T P Kortlever1, Stein J Janssen1, Jeroen Molleman1
1Department of Orthopaedic Surgery, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
The Archives of Bone and Joint Surgery
|August 13, 2016
Summary
Most patients with nonspecific arm pain do not receive a specific diagnosis, even after follow-up. Further research is needed to determine if nonspecific diagnoses are better for patients than specific diagnoses when discrete pathophysiology is absent.
Area of Science:
- Orthopedics
- Pain Management
- Medical Diagnostics
Background:
- Nonspecific symptoms cause patient and caregiver frustration when a clear cause isn't identified.
- Understanding factors associated with diagnosing specific pathophysiology for nonspecific pain is crucial.
Purpose of the Study:
- To identify demographic and psychological factors linked to diagnosing specific pathophysiology for nonspecific arm pain.
- To determine the percentage of patients with nonspecific arm pain who eventually receive a specific diagnosis and assess if these diagnoses explain the symptoms.
Main Methods:
- The study evaluated 634 patients diagnosed with isolated nonspecific upper extremity pain.
- Patients were monitored for subsequent diagnoses of discrete pathophysiology by the same or different physicians within the health system for the same pain.
Main Results:
- A very low percentage of patients (0.16%) were diagnosed with definite discrete pathophysiology (nodular fasciitis) by the index surgeon, which was resolved with surgery.
- Subsequent evaluations identified possible or speculative pathophysiology in a small number of patients, but these diagnoses accounted for only a fraction of the reported symptoms.
Conclusions:
- Nonspecific diagnoses appear to be non-harmful.
- Prospective randomized research is recommended to compare the efficacy of nonspecific, descriptive diagnoses versus specific diagnoses that imply pathophysiology in the absence of verifiable discrete pathophysiology.
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