Table 4. Classification schemes in common use to diagnose soft tissue and rheumatic disorders of the upper limb.

Disorder	Waris et al (1979) [85] Viikari-Juntura (1983) [80]	Ohlsson et al (1994) [56]	Harrington et al (1998) [33] Palmer et al (2000) [60]	Sluiter et al 2001 [73]*
Rating †
Documentation	++	++	++	+++
Content validity	+ ++	+++	++	++
Test-retest reliability:
- within-observer	+/−	+/−	+++	+/−
-between-observers	+/−	+/−	+++	+/−
Agreement with external reference standard	+/−	+/−	+++	+/−
Content
Tension neck syndrome	Feeling of fatigue or stiffness in the neck, neck pain or headache radiating from the neck; at least two tender spots or palpable hardenings; muscle pain or tightness upon neck movement
Cervical syndrome	Pain radiating from the neck to upper extremity +limited neck movement + radiating pain provoked by test movements
Thoracic outlet syndrome	Pain radiating to arm, positive Morley’s sign, positive Adson’s test, or drooping shoulder	Pain radiating to arm in ulnar nerve distribution; paresthesia in ulnar nerve distribution; positive Roos’ test (increase of the subjective symptoms, not only fatigue); intense tenderness over the brachial plexus
Supraspinous tendinitis	Shoulder pain + local tenderness + pain during abduction, or painful arc + limited active abduction	Shoulder pain + local tenderness over the tendon insertion + pain at resisted isometric abduction	Pain in deltoid region + pain on resisted active abduction	Pain in shoulder without parasthesiae that is worsened by active elevation of the upper arm + one of more of (1) pain on resisted shoulder abduction, external rotation or internal rotation; or (2) resisted elbow flexion; or (3) painful arc
Bicipital tendinitis	Pain shoulder region + local tenderness	Shoulder pain + local tenderness over the tendon(s) + pain at resisted isometric elevation of the arm (straight and elevated 90°) and/or resisted isometric flexion of the elbow (flexed 90° and hand supinated)	Anterior shoulder pain + pain on resisted active flexion or supination of forearm
Frozen shoulder syndrome	Progressive pain and shoulder stiffness during the last 3-4 months + active and passive outward rotation limited	Shoulder pain + progressive stiffness of the shoulder during the last 3-4 months + limited outward rotation, and abduction	Pain in deltoid area + equal restriction of active and passive glenohumeral movement with capsular pattern (external rotation > abduction > internal rotation)
Acromioclavicular syndrome	Pain in shoulder region + local tenderness during palpation or percussion of the joint	Shoulder (epaulet) pain + palpable tenderness of joint + pain provoked by horizontal adduction and/or by outward rotation of the arm (90° abducted, with flexed elbow)	Pain + tenderness over the acromioclavicular joint + a positive acromioclavicular joint stress test
Epicondylitis	Local pain during rest and/or movement + local tenderness at the lateral/medial epicondyle + pain on resisted extension/flexion of the wrist and fingers	Elbow pain + palpable tenderness of epicondyle + pain at resisted isometric wrist extension/flexion; for the diagnosis lateral epicondylitis, pain and/or weakness in gripping	Epicondylar pain + epicondylar tenderness + pain on resisted wrist flexion/extension	Activity-dependent pain localised around epicondyle + local pain on resisted wrist extension or flexion
Tenosynovitis of the wrist/forearm	Local ache, pain during movement, tenderness along the course of the tendon or muscle-tendon junction, swelling, weakness in gripping	Wrist pain + palpable tenderness of the tendon(s) + local swelling, redness, or heat	Pain on movement localised to the tendon sheaths in the wrist + reproduction of pain by resisted active movement	Intermittent pain/ache in ventral or dorsal forearm or wrist + provocation of symptoms during resisted movement of the muscles + reproduction of pain during palpation of the affected tendons or palpable crepitus under symptom area or visible swelling of dorsum wrist/forearm
Infraspinous tendinitis	Pain in shoulder region + local tenderness + pain on resisted isometric outward rotation of the humerus; painful arc possible	Shoulder pain + local tenderness over tendon insertion + pain on resisted isometric outward rotation	Pain in deltoid region + pain on resisted active external rotation
De Quervain’s disease			Pain over the radial styloid + tender swelling of first extensor compartment + either pain reproduced by resisted thumb extension or positive Finkelstein’s test	Pain or tenderness localised over the radial wrist, which may radiate proximally to the forearm or distally to the thumb, and at least one of the following tests positive: 1) Finkelstein’s test, 2) resisted thumb extension, 3) resisted thumb abduction
Olecranon bursitis	Palpable painful olecranon bursa		Pain + tenderness + fluid-filled swelling over the posterior elbow
Carpal tunnel syndrome	Pain or paresthesia in the median distribution of hand + positive Tinel’s sign at the carpal tunnel or positive Phalen’s wrist flexion test; diminished sensitivity to touch or pain in 3½ fingers on radial side of the hand and diminished strength of the short abductor of the thumb possible	Nocturnal numbness of the hand; paresthesia in the distribution of the median nerve; positive Tinel’s sign over the carpal tunnel; positive Phalen’s test; decreased sensibility in the distribution of median nerve; decreased strength in opposition of the thumb	Pain or paraesthesia or sensory loss in the median nerve distribution and one of: Tinel’s test positive, Phalen’s test positive, nocturnal exacerbation of symptoms, motor loss with wasting of abductor pollicis brevis, abnormal nerve conduction	Parasthesiae or pain in at least two of digits 1, 2 or 3, which may be present at night as well (allowing pain in the palm, wrist, or radiation proximal to the wrist) and at least one of the following tests positive: 1) flexion compression test, 2) carpal compression test, 3) Tinel’s sign, 4) Phalen’s sign, 5) 2- point discrimination test, 6) resisted thumb abduction or motor loss with wasting of abductor pollicis brevis
Pronator syndrome	Pain in proximal volar forearm or paresthesia or numbness on volar side of the forearm; paresthesia in 3½ fingers on radial side of the hand possible; symptoms increased by resistance to pronation of the forearm and flexion of wrist, forearm supination and elbow flexion or flexion of the middle finger at the proximal interphalangeal joint; diminished sensation in 3½ fingers on the radial side of the hand, the thenar eminence and weakness of the short abductor of the thumb possible	Pain of the medial/proximal part of the forearm; local tenderness over the edge of m. pronator teres; pain and decreased strength in pronation; decreased flexion strength in pronation; decreased flexion strength of the wrist and/or of the distal phalanxes of the fingers 1 and 2.
Ulnar nerve entrapment	Pain, paresthesia or numbness in 4th and 5th fingers, tenderness to palpation at the cubital tunnel, Tinel’s sign at the cubital tunnel possibly present; diminished sensation in 4th and 5th fingers and weakness of interossei and the 3rd and 4th lumbricales possible	Pain and paresthesia or numbness in the distribution of the ulnar nerve; decreased sensibility of the 4th and 5th fingers and of the ulnar part of the back of the hand; positive Tinel’s sign over the cubital tunnel; decreased strength in spreading the fingers and in flexion of the distal phalanx of finger 5		At least intermittent parasthesiae in the 4th and/or 5th digit or the ulnar border of the forearm, wrist, or hand and a positive combined pressure and flexion test
Ulnar nerve entrapment at Guyon’s tunnel	Pain, paresthesia, numbness and/or weakness of the 5th finger, tenderness to palpation at the Guyon’s tunnel possible; diminished sensation in 4th and 5th fingers or weak abduction of 5th finger	Pain and paresthesia or numbness in the distribution of the ulnar nerve; decreased sensibility of the fingers IV-V; positive Tinel’s sign over Guyon’s tunnel (volar/ulnar at the wrist); decreased strength in spreading the fingers		Intermittent parasthesiae in the palmar ulnar nerve distribution of the hand, distal to wrist or pain in the ulnar innervated area of the hand, which may radiate to the forearm and at least one of the following tests positive: 1) weakness or atrophy in the ulnar- innervated intrinsic hand muscles, 2) Tinel sign, 3) reversed Phalen test, 4) pressure test over the Guyon’s canal
Painful first carpometacarpal joint/Osteoarthritis of finger joints	Painful joint at palpation, pain in the joint when moved Heberden’s nodes noticed		Pain in joint + pain in joint movement
Posterious interosseus nerve entrapment (Frohse’s syndrome)	Elbow pain at rest, radiating pain downward or upward and tenderness at the edge of the superficial portion of the supinator muscle (the arcade of Frohse); extension force of the middle finger possibly diminished	Elbow pain at rest; tenderness about 2-3 inches distally of the lateral epicondyle; pain of the proximal, lateral part of the forearm and pain and decreased strength in supination; decreased strength in ulnar deviation
Radial tunnel syndrome				Pain in the lateral elbow region or forearm muscle mass of wrist extensors/supinator or weakness on extending the wrist and fingers and tenderness in supinator region on palpation over the radial nerve 4-7 cm distal to the lateral epicondyle and at least 1 of the following tests positive: 1) resisted forearm supination, 2) resisted middle finger extension
Non-specific diffuse forearm pain			Pain in forearm in the absence of a specific diagnosis or pathology (sometimes includes: loss of function, weakness, cramp, muscle tenderness, allodynia, slowing of fine movements)	Diagnosis of exclusion

^*for >4 days of last 7 days

^†+/− = poorly met/not tested; ++ = partially met; +++ = fully met