Arm and Hand Pain

INTRODUCTION

The various causes of the painful arm can be considered with the diagnostic model (Table A13).

PULLED ELBOW

• Child under 8 yrs, usually 2–5 yrs

• Child refuses to use arm, which may be limp by the side

Treatment

• Parental help

• Physical manoeuvres to consider

  • – Manoeuvre A: Supination flexion: support radial head with one hand, flex elbow, then suddenly twist forearm into full supination or supinate the forearm, then flex the elbow

  • – Manoeuvre B: Hyperpronation flexion: support radial head, fully pronate forearm, then flex elbow

  • – Manoeuvre C: Gently alternate supination and pronation with elbow slightly flexed.

Note: If uncooperative, send home in sling (may resolve itself).

TENNIS ELBOW (EPICONDYLAR TENDINOPATHY)

Management

• Rest from offending activity

• RICE and oral NSAIDs if acute

• Exercises—strengthening, e.g. dumbbell exercise over table—palm facing down for lateral epicondylitis; palm facing up for medial epicondylitis or towelette wringing exercise

Additional (if refractory):

• steroid/LA injection (max. 2)

• manipulation or

• surgery

OLECRANON BURSITIS

For chronic recurrent traumatic bursitis with a synovial effusion:

• partial aspiration of fluid

• inject corticosteroid through same needle

TRIGGER FINGER/THUMB

Consider an injection of 1 mL of long-acting corticosteroid with LA into the tendon sheath adjacent to the swelling. Otherwise surgical release repair.

GAME KEEPER’S THUMB (SKIER’S THUMB)

Disruption of ligaments of metacarpophalangeal joint and possible fracture of base of proximal phalanx. Diagnosis on stress views on X-ray. May require surgical repair.

RAYNAUD PHENOMENON AND DISORDER

Exclude and treat underlying causes, e.g. CTDs.

Treatment (options)

• Total body protection from cold—layered clothing, electric blanket at night

• Gloves, mittens and thick woollen socks

• Avoid ...