The role of physical examination in the diagnosis of work-related upper limb musculoskeletal disorders.
BACKGROUND
This paper argues that diagnostic criteria for upper limb disorders should be assessed according to their practical utility in distinguishing categories of illness that differ in their risk factors or in their prognosis and response to treatment.


METHODS
The starting point for defining disorders could be current clinical practice or empirical demonstration that certain symptoms and physical signs tend to cluster abnormally within individuals. Either way, it is necessary to test the performance of proposed diagnostic criteria in discriminating illness with distinctive risk factors or clinical outcomes. It is also important that diagnoses be repeatable within and between observers, at least in the short-term. Thus, methods for eliciting physical signs should as far as possible be standardised. To facilitate comparison between studies, it would help if consensus could be reached on the definitions and methods for eliciting relevant physical signs.


CONCLUSIONS
Currently, a wide range of upper limb disorders are distinguished by clinicians, but opinions differ on the entities that should make up diagnostic classifications, and on the criteria by which each entity should be defined. This paper considers the approaches by which epidemiologists should define and evaluate possible diagnostic systems, focusing in particular on the contribution to case definition from physical examination.
Coggon
D
D
MRC Epidemiology Resource Centre, University of Southampton, UK. dnc@mrc.soton.ac.uk
D001132:Arm; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis*; D009784:Occupational Diseases / Q000175:diagnosis*; D010808:Physical Examination