NECK/CERVICAL SPINE

Cervical Radiculopathy

History: Neck pain radiating to arm; numbness in dermatomal pattern

Exam: Positive Spurling test; dermatomal weakness and reflex changes

Tests: MRI cervical spine; EMG/NCS if diagnosis uncertain

Treatment: NSAIDs, PT, epidural steroid injection, surgery if refractory

Cervical Myelopathy

History: Gait imbalance, hand clumsiness, bilateral arm numbness

Exam: Hyperreflexia, Hoffmann sign, Lhermitte sign, gait ataxia

Tests: MRI cervical spine with cord signal changes

Treatment: Surgical decompression; conservative care rarely sufficient

SHOULDER/PERISCAPULAR

Rotator Cuff Tendinopathy/Tear

History: Lateral shoulder pain worse with overhead activity; night pain

Exam: Painful arc, positive empty can and Neer impingement tests

Tests: Ultrasound or MRI shoulder; radiographs for bony pathology

Treatment: PT, NSAIDs, subacromial injection, surgical repair if torn

Adhesive Capsulitis (Frozen Shoulder)

History: Progressive shoulder stiffness and pain; diabetes/thyroid association

Exam: Global restriction of passive ROM, especially external rotation

Tests: Clinical diagnosis; MRI to exclude other pathology

Treatment: PT, intra-articular corticosteroid, manipulation under anesthesia if refractory

Acromioclavicular Osteoarthritis

History: Superior shoulder pain localized to AC joint; worse cross-body

Exam: AC joint tenderness; painful cross-body adduction test

Tests: Radiographs; diagnostic AC joint injection confirms source

Treatment: Activity modification, NSAIDs, AC joint injection, distal clavicle excision

Thoracic Outlet Syndrome (Neurogenic)

History: Arm pain/paresthesias worsened by overhead activity; hand weakness

Exam: Positive Roos/EAST test; Adson test; hand intrinsic atrophy

Tests: EMG/NCS, MRI neurography, diagnostic scalene block

Treatment: PT with postural correction; surgical decompression if refractory

Suprascapular Neuropathy

History: Deep posterior shoulder pain; weakness in external rotation/abduction

Exam: Infraspinatus/supraspinatus atrophy; weak external rotation

Tests: EMG/NCS; MRI to exclude ganglion cyst at spinoglenoid notch

Treatment: PT, activity modification; surgical cyst excision if compressive

Parsonage-Turner Syndrome (Neuralgic Amyotrophy)

History: Sudden severe shoulder pain followed by rapid weakness/atrophy

Exam: Patchy weakness in shoulder girdle; scapular winging possible

Tests: EMG/NCS at 3–4 weeks; MRI to exclude structural lesion

Treatment: Pain management, PT; most recover spontaneously over months

UPPER ARM

Biceps Tendinopathy

History: Anterior shoulder/arm pain worse with lifting and overhead activity

Exam: Tenderness at bicipital groove; positive Speed and Yergason tests

Tests: Ultrasound or MRI; clinical diagnosis usually sufficient

Treatment: NSAIDs, PT, corticosteroid injection, tenodesis if refractory

Radial Nerve Palsy (Saturday Night Palsy)

History: Wrist/finger drop after prolonged arm compression; forearm numbness

Exam: Weak wrist/finger extension; sensory loss dorsal hand

Tests: EMG/NCS localizes at spiral groove; imaging if fracture suspected

Treatment: Cock-up wrist splint, PT; nearly 100% recovery at 6 months

Axillary Neuropathy

History: Lateral shoulder numbness/weakness after dislocation or surgery

Exam: Deltoid weakness; sensory loss regimental badge area

Tests: EMG/NCS at 3–4 weeks; MRI if mass suspected

Treatment: PT, serial monitoring; surgical exploration if no recovery by 3–4 months

ELBOW

Lateral Epicondylitis (Tennis Elbow)

History: Lateral elbow pain with gripping; worse with wrist extension

Exam: Tenderness at lateral epicondyle; pain on resisted wrist extension

Tests: Clinical diagnosis; ultrasound/MRI only if refractory or uncertain

Treatment: Eccentric exercises, counterforce brace, injection, surgery if refractory

Medial Epicondylitis (Golfer's Elbow)

History: Medial elbow pain with gripping; worse with wrist flexion/pronation

Exam: Tenderness at medial epicondyle; pain on resisted wrist flexion

Tests: Clinical diagnosis; rule out ulnar neuropathy with EMG if needed

Treatment: Eccentric exercises, counterforce brace, injection, surgery if refractory

Cubital Tunnel Syndrome (Ulnar Nerve at Elbow)

History: Ring/small finger numbness; worse with elbow flexion; night symptoms

Exam: Positive Tinel at cubital tunnel; weak finger abduction/Froment sign

Tests: EMG/NCS confirms; ultrasound for subluxation or mass

Treatment: Elbow pad, night splint, activity modification; decompression/transposition if refractory

Pronator Syndrome (Median Nerve at Elbow)

History: Volar forearm aching; thumb/index/middle finger paresthesias; rare nocturnal symptoms

Exam: Tenderness over pronator teres; pain with resisted pronation

Tests: EMG/NCS; MRI if space-occupying lesion suspected

Treatment: Rest, NSAIDs, splinting; surgical decompression if no improvement at 3–4 months

WRIST/HAND

Carpal Tunnel Syndrome (Median Nerve at Wrist)

History: Nocturnal hand numbness/tingling in first three digits; shaking relieves

Exam: Positive Durkan compression and Phalen tests; thenar atrophy late

Tests: Clinical diagnosis; EMG/NCS if uncertain or pre-surgical

Treatment: Nighttime neutral wrist splint, injection; carpal tunnel release if refractory

De Quervain Tenosynovitis

History: Radial wrist pain worse with thumb use; gripping, lifting aggravates

Exam: Positive Finkelstein test; tenderness over first dorsal compartment

Tests: Clinical diagnosis; ultrasound if uncertain

Treatment: Thumb spica splint, NSAIDs, corticosteroid injection; surgical release if refractory

Trigger Finger

History: Painful clicking/locking of finger with flexion/extension; morning stiffness

Exam: Palpable tender nodule at A1 pulley; locking with flexion

Tests: Clinical diagnosis; no imaging needed

Treatment: Corticosteroid injection (first-line), NSAIDs; A1 pulley release if refractory

Thumb CMC (Basilar Joint) Arthritis

History: Thumb base pain with pinching, gripping, or turning objects

Exam: Dorsoradial prominence; positive grind test and traction-shift test

Tests: Radiographs of thumb CMC joint; clinical diagnosis

Treatment: Thumb spica splint, NSAIDs, injection; surgical reconstruction if refractory

Ulnar Neuropathy at Wrist (Guyon Canal/Cyclist's Palsy)

History: Hand weakness and ring/small finger numbness; cycling or handlebar pressure

Exam: Intrinsic hand atrophy; positive Froment sign; Tinel at Guyon canal

Tests: EMG/NCS localizes at wrist; ultrasound/MRI if mass suspected

Treatment: Activity modification, padding; surgical decompression if structural cause

Posterior Interosseous Nerve Syndrome

History: Finger extension weakness without sensory loss; forearm aching

Exam: Weak finger/thumb extension; intact wrist extension (ECRL spared)

Tests: EMG/NCS; MRI to exclude compressive mass

Treatment: Rest, splinting, NSAIDs; surgical decompression if no improvement at 3–4 months

VASCULAR

Upper Extremity DVT (Paget-Schroetter Syndrome)

History: Acute arm swelling, pain, cyanosis; often young, active patients

Exam: Arm edema, dilated collateral veins over chest/shoulder

Tests: Duplex ultrasound; CT/MR venography if equivocal

Treatment: Anticoagulation; catheter-directed thrombolysis, first rib resection if TOS-related

Subclavian Artery Stenosis/Steal

History: Arm claudication with exertion; dizziness with ipsilateral arm exercise

Exam: Asymmetric arm blood pressures; periclavicular bruit

Tests: Duplex ultrasound; CT/MR angiography for surgical planning

Treatment: Risk factor modification; angioplasty/stenting or surgical bypass

DIFFUSE/SYSTEMIC

Peripheral Neuropathy

History: Distal symmetric numbness/burning in glove distribution; diabetes common

Exam: Reduced vibration/pinprick distally; absent deep tendon reflexes

Tests: Glucose, B12, TSH, SPEP; EMG/NCS if atypical

Treatment: Treat underlying cause; gabapentinoids, duloxetine for neuropathic pain

Complex Regional Pain Syndrome (CRPS)

History: Disproportionate limb pain after injury/surgery; burning, allodynia, swelling

Exam: Skin color/temperature asymmetry; edema, trophic changes, allodynia

Tests: Budapest criteria (clinical); triple-phase bone scan if uncertain

Treatment: PT, mirror therapy, gabapentinoids, sympathetic blocks, psycholog