Recognizable dysfunction syndromes

Many presentations of dysfunctional postures of the upper extremity have been described in the literature. Attempts have been made to differentiate these situations by describing their physical and pathophysiologic circumstances. Unfortunately, these attempts to define and differentiate the various conditions that are recognizable patterns of upper-extremity dysfunction syndromes have not been entirely successful. This failure is perhaps because hard and firm diagnostic criteria that would specifically delineate each of these circumstances are wanting. At best, it can be said that there are patients who will present with pain as their primary complaint and who present with physical findings that would best support a diagnosis of reflex sympathetic dystrophy. There are others who present with dysfunctional postures in which pain is not a primary presenting complaint. In addition, are those in an intermediate zone, where pain and dysfunction are intermixed, and where prolonged observation may help to place them in one category or the other. Recent evidence has suggested that patients with painless dysfunctional syndrome benefit from the attentions of psychically oriented providers. The timing and appropriateness of such interventions require further study. The literature of the behavioral scientists and that of the practitioners of the medical arts is bereft of concrete explanations for causation and specific definitive solutions.