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. 2000 Jan;59(1):5–11. doi: 10.1136/ard.59.1.5

The Southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb

K Palmer 1, K Walker-Bone 1, C Linaker 1, I Reading 1, S Kellingray 1, D Coggon 1, C Cooper 1
PMCID: PMC1752977  PMID: 10627419

Abstract

OBJECTIVES—Following a consensus statement from a multidisciplinary UK workshop, a structured examination schedule was developed for the diagnosis and classification of musculoskeletal disorders of the upper limb. The aim of this study was to test the repeatability and the validity of the newly developed schedule in a hospital setting.
METHOD—43 consecutive referrals to a soft tissue rheumatism clinic (group 1) and 45 subjects with one of a list of specific upper limb disorders (including shoulder capsulitis, rotator cuff tendinitis, lateral epicondylitis and tenosynovitis) (group 2), were recruited from hospital rheumatology and orthopaedic outpatient clinics. All 88 subjects were examined by a research nurse (blinded to diagnosis), and everyone from group 1 was independently examined by a rheumatologist. Between observer agreement was assessed among subjects from group 1 by calculating Cohen's κ for dichotomous physical signs, and mean differences with limits of agreement for measured ranges of joint movement. To assess the validity of the examination, a pre-defined algorithm was applied to the nurse's examination findings in patients from both groups, and the sensitivity and specificity of the derived diagnoses were determined in comparison with the clinic's independent diagnosis as the reference standard.
RESULTS—The between observer repeatability of physical signs varied from good to excellent, with κ coefficients of 0.66 to 1.00 for most categorical observations, and mean absolute differences of 1.4°-11.9° for measurements of shoulder movement. The sensitivity of the schedule in comparison with the reference standard varied between diagnoses from 58%-100%, while the specificities ranged from 84%-100%. The nurse and the clinic physician generally agreed in their diagnoses, but in the presence of shoulder capsulitis the nurse usually also diagnosed shoulder tendinitis, whereas the clinic physician did not.
CONCLUSION—The new examination protocol is repeatable and gives acceptable diagnostic accuracy in a hospital setting. Examination can feasibly be delegated to a trained nurse, and the protocol has the benefit of face and construct validity as well as consensus backing. Its performance in the community, where disease is less clear cut, merits separate evaluation, and further refinement is needed to discriminate between discrete pathologies at the shoulder.



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Selected References

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  1. Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol. 1974;3(3):145–153. doi: 10.3109/03009747409097141. [DOI] [PubMed] [Google Scholar]
  2. Bergenudd H., Lindgärde F., Nilsson B., Petersson C. J. Shoulder pain in middle age. A study of prevalence and relation to occupational work load and psychosocial factors. Clin Orthop Relat Res. 1988 Jun;(231):234–238. [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  4. Buchbinder R., Goel V., Bombardier C., Hogg-Johnson S. Classification systems of soft tissue disorders of the neck and upper limb: do they satisfy methodological guidelines? J Clin Epidemiol. 1996 Feb;49(2):141–149. doi: 10.1016/0895-4356(95)00519-6. [DOI] [PubMed] [Google Scholar]
  5. Cunningham L. S., Kelsey J. L. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health. 1984 Jun;74(6):574–579. doi: 10.2105/ajph.74.6.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dimberg L., Olafsson A., Stefansson E., Aagaard H., Odén A., Andersson G. B., Hansson T., Hagert C. G. The correlation between work environment and the occurrence of cervicobrachial symptoms. J Occup Med. 1989 May;31(5):447–453. [PubMed] [Google Scholar]
  7. Dimberg L. The prevalence and causation of tennis elbow (lateral humeral epicondylitis) in a population of workers in an engineering industry. Ergonomics. 1987 Mar;30(3):573–579. doi: 10.1080/00140138708969746. [DOI] [PubMed] [Google Scholar]
  8. Dunne C. A., Thompson P. W., Cole J., Dunning J., Martyn C. N., Coggon D., Cooper C. Carpal tunnel syndrome: evaluation of a new method of assessing median nerve conduction at the wrist. Ann Rheum Dis. 1996 Jun;55(6):396–398. doi: 10.1136/ard.55.6.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. England S., Farrell A. J., Coppock J. S., Struthers G., Bacon P. A. Low power laser therapy of shoulder tendonitis. Scand J Rheumatol. 1989;18(6):427–431. doi: 10.3109/03009748909102106. [DOI] [PubMed] [Google Scholar]
  10. Ferry S., Silman A. J., Pritchard T., Keenan J., Croft P. The association between different patterns of hand symptoms and objective evidence of median nerve compression: a community-based survey. Arthritis Rheum. 1998 Apr;41(4):720–724. doi: 10.1002/1529-0131(199804)41:4<720::AID-ART20>3.0.CO;2-6. [DOI] [PubMed] [Google Scholar]
  11. Green S., Buchbinder R., Forbes A., Bellamy N. A standardized protocol for measurement of range of movement of the shoulder using the Plurimeter-V inclinometer and assessment of its intrarater and interrater reliability. Arthritis Care Res. 1998 Feb;11(1):43–52. doi: 10.1002/art.1790110108. [DOI] [PubMed] [Google Scholar]
  12. Hagberg M., Wegman D. H. Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups. Br J Ind Med. 1987 Sep;44(9):602–610. doi: 10.1136/oem.44.9.602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Harrington J. M., Carter J. T., Birrell L., Gompertz D. Surveillance case definitions for work related upper limb pain syndromes. Occup Environ Med. 1998 Apr;55(4):264–271. doi: 10.1136/oem.55.4.264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Harrington J. M., Gompertz D., McCaig R. H. Repetitive strain injuries. Lancet. 1997 Jun 7;349(9066):1701–1702. doi: 10.1016/s0140-6736(05)62677-3. [DOI] [PubMed] [Google Scholar]
  15. Herberts P., Kadefors R., Högfors C., Sigholm G. Shoulder pain and heavy manual labor. Clin Orthop Relat Res. 1984 Dec;(191):166–178. [PubMed] [Google Scholar]
  16. Hollingworth G. R., Ellis R. M., Hattersley T. S. Comparison of injection techniques for shoulder pain: results of a double blind, randomised study. Br Med J (Clin Res Ed) 1983 Nov 5;287(6402):1339–1341. doi: 10.1136/bmj.287.6402.1339. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Katz J. N., Larson M. G., Fossel A. H., Liang M. H. Validation of a surveillance case definition of carpal tunnel syndrome. Am J Public Health. 1991 Feb;81(2):189–193. doi: 10.2105/ajph.81.2.189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kilbom A. Intervention programmes for work-related neck and upper limb disorders: strategies and evaluation. Ergonomics. 1988 May;31(5):735–747. doi: 10.1080/00140138808966717. [DOI] [PubMed] [Google Scholar]
  19. Lawrence J. S. Disc degeneration. Its frequency and relationship to symptoms. Ann Rheum Dis. 1969 Mar;28(2):121–138. doi: 10.1136/ard.28.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Luopajärvi T., Kuorinka I., Virolainen M., Holmberg M. Prevalence of tenosynovitis and other injuries of the upper extremities in repetitive work. Scand J Work Environ Health. 1979;5 Suppl 3:48–55. [PubMed] [Google Scholar]
  21. McCormack R. R., Jr, Inman R. D., Wells A., Berntsen C., Imbus H. R. Prevalence of tendinitis and related disorders of the upper extremity in a manufacturing workforce. J Rheumatol. 1990 Jul;17(7):958–964. [PubMed] [Google Scholar]
  22. Mäkelä M., Heliövaara M., Sievers K., Impivaara O., Knekt P., Aromaa A. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol. 1991 Dec 1;134(11):1356–1367. doi: 10.1093/oxfordjournals.aje.a116038. [DOI] [PubMed] [Google Scholar]
  23. Neustadt D. H. Local corticosteroid injection therapy in soft tissue rheumatic conditions of the hand and wrist. Arthritis Rheum. 1991 Jul;34(7):923–926. doi: 10.1002/art.1780340721. [DOI] [PubMed] [Google Scholar]
  24. Palmer K., Coggon D., Cooper C., Doherty M. Work related upper limb disorders: getting down to specifics. Ann Rheum Dis. 1998 Aug;57(8):445–446. doi: 10.1136/ard.57.8.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Silverstein B. A., Fine L. J., Armstrong T. J. Hand wrist cumulative trauma disorders in industry. Br J Ind Med. 1986 Nov;43(11):779–784. doi: 10.1136/oem.43.11.779. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stevens J. C., Sun S., Beard C. M., O'Fallon W. M., Kurland L. T. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. 1988 Jan;38(1):134–138. doi: 10.1212/wnl.38.1.134. [DOI] [PubMed] [Google Scholar]
  27. Stock S. R. Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta-analysis. Am J Ind Med. 1991;19(1):87–107. doi: 10.1002/ajim.4700190111. [DOI] [PubMed] [Google Scholar]
  28. Viikari-Juntura E. Neck and upper limb disorders among slaughterhouse workers. An epidemiologic and clinical study. Scand J Work Environ Health. 1983 Jun;9(3):283–290. doi: 10.5271/sjweh.2416. [DOI] [PubMed] [Google Scholar]
  29. Viikari-Juntura E., Vuori J., Silverstein B. A., Kalimo R., Kuosma E., Videman T. A life-long prospective study on the role of psychosocial factors in neck-shoulder and low-back pain. Spine (Phila Pa 1976) 1991 Sep;16(9):1056–1061. doi: 10.1097/00007632-199109000-00008. [DOI] [PubMed] [Google Scholar]
  30. Waris P., Kuorinka I., Kurppa K., Luopajärvi T., Virolainen M., Pesonen K., Nummi J., Kukkonen R. Epidemiologic screening of occupational neck and upper limb disorders. Methods and criteria. Scand J Work Environ Health. 1979;5 Suppl 3:25–38. [PubMed] [Google Scholar]
  31. Withrington R. H., Girgis F. L., Seifert M. H. A comparative study of the aetiological factors in shoulder pain. Br J Rheumatol. 1985 Feb;24(1):24–26. doi: 10.1093/rheumatology/24.1.24. [DOI] [PubMed] [Google Scholar]
  32. Wolfe F., Smythe H. A., Yunus M. B., Bennett R. M., Bombardier C., Goldenberg D. L., Tugwell P., Campbell S. M., Abeles M., Clark P. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990 Feb;33(2):160–172. doi: 10.1002/art.1780330203. [DOI] [PubMed] [Google Scholar]
  33. de Krom M. C., Kester A. D., Knipschild P. G., Spaans F. Risk factors for carpal tunnel syndrome. Am J Epidemiol. 1990 Dec;132(6):1102–1110. doi: 10.1093/oxfordjournals.aje.a115753. [DOI] [PubMed] [Google Scholar]

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