title: Screening for gastrointestinal, hepatic/biliary, and renal/urologic disease.
abstract: NARRATIVE REVIEW: Many organ systems in the body can demonstrate signs and symptoms of impairment that mimic integumentary, musculoskeletal, and/or neuromuscular conditions commonly evaluated and treated by the hand therapist. In this review, diseases and disorders affecting the gastrointestinal (GI), hepatic/biliary, and renal/urologic systems capable of referring pain and other symptoms to the upper quadrant are presented. Specifically, these organ systems can refer pain to the sternum, neck, shoulder, scapulae, and subscapular and interscapular regions. Symptom referral from the viscera to the elbow and hand is extremely rare. Symptoms of carpal tunnel syndrome/paresthesias can occur in renal disorders and with hepatic/biliary problems. Following the screening model proposed by Goodman and Snyder, potential origins from the GI, hepatic/biliary, and renal/urologic systems are discussed. The goal is to identify patients with referred pain patterns and associated signs and symptoms of conditions that require referral to a physician or other appropriate health care professional. The alert hand therapist will recognize red flag histories, clinical presentation, and risk factors suggesting the need for a more thorough examination to ensure that the patient/client has a condition requiring intervention that is within the scope of the therapist's practice. Screening principles and tips for physician referral are offered.
  
  
  METHODS
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authors.affiliation: School of Pharmacy and Allied Health Sciences, Department of Physical Therapy, University of Montana, Missoula, Montana, USA. catherine.goodman08@gmail.com
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Goodman
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D003937:Diagnosis, Differential; D004066:Digestive System Diseases / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening; D008487:Medical History Taking; D009140:Musculoskeletal Diseases / Q000175:diagnosis; D009260:Nail Diseases / Q000209:etiology; D053591:Referred Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D010808:Physical Examination; D026761:Physical Therapy Specialty; D012017:Referral and Consultation; D012871:Skin Diseases / Q000209:etiology; D034941:Upper Extremity / Q000503:physiopathology*; D014570:Urologic Diseases / Q000175:diagnosis*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal