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 Shoulder/Elbow Test 5: The Shoulder and Elbow
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The Journal of Bone and Joint Surgery (American) 86:1387-1391 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Idiopathic Arm Pain

David Ring, MD1, Daniel Guss, BS1, Leah Malhotra, BA1 and Jesse B. Jupiter, MD1

1 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, ACC 525, 15 Parkman Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org

Investigation performed at Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Arm pain with little or no objective abnormality (referred to herein as idiopathic arm pain) is a common and frustrating problem for both patients and physicians. We investigated the relative effect of idiopathic arm pain and arm pain due to a discrete diagnosis on upper-extremity-specific health status.

Methods: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was completed by 3888 patients seen over a twelve-month period. Scores for the entire sample, for 496 patients diagnosed with idiopathic arm pain, and for 1379 patients diagnosed with one of twenty-one discrete conditions were compared.

Results: Patients with idiopathic pain reported substantial and highly variable upper-limb-specific dysfunction (average DASH score [and standard deviation], 36 ± 24 points). Patients with discrete diagnoses also exhibited substantial variation (average standard deviation, 25; range, 6 to 27) as well as long right tails indicating floor effects, particularly for less severe conditions (Pearson correlation of r = –0.87 between the mean DASH score and skewness). Analysis of variance confirmed the ability of the DASH instrument to discriminate among groups of diagnoses of varying severity, but post hoc Tukey analysis identified ten subgroups with substantial overlap of the DASH scores.

Conclusions: Patients with idiopathic arm pain report substantial and highly variable upper-extremity dysfunction. The wide variations observed in the DASH scores of the patients with idiopathic pain and those with discrete diagnoses are greater than would be expected on the basis of the variations in the objective pathological conditions and may reflect the strong influence of psychological and sociological factors on health status measures.


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Letters to the Editor:

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"Idiopathic Arm Pain"
Myron M. LaBan, et al.
JBJS Online, 17 Aug 2004 [Full text]
Dr. Ring responds:
David Ring
JBJS Online, 23 Aug 2004 [Full text]
Idiopathic Arm Pain
Emin K Alpar, et al.
JBJS Online, 12 Oct 2004 [Full text]
Update on Patients with Idiopathic Arm Pain
David Ring, M.D., et al.
JBJS Online, 12 Dec 2006 [Full text]