Pain in limb is a term used to describe discomfort affecting any part of a limb or extremity (such as an elbow or knee) or the entire limb (arm or leg). The term is general in nature and could be used to describe pain that arises from various causes. The pain may arise from the skin, nerves, muscles, bones, joints, or even the brain (in psychogenic or phantom pain). Arm pain may arise from pathology in the neck (cervical spine), whereas leg pain may originate in the low back (lumbar spine). Typically, the term "pain in the limb" would be used to describe a person's symptoms until a definitive diagnosis is made (such as broken arm, tendinitis, peripheral neuropathy, etc.).
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Source: Medical Disability Advisor
History: The individual will complain of discomfort in all or part of an extremity. Individuals may use other descriptive terms such as burning, throbbing, aching, or stabbing to further explain the type of discomfort they are experiencing. They may provide additional information such as how the pain began, exactly where the pain is, and the factors that increase or relieve the pain. They may report a history of an injury, strain, or trauma that preceded the onset of pain.
Physical exam: The physical exam may reveal tender spots, obvious deformities, redness, warmth or coolness, or swelling at the affected site. Range of motion in the affected limb may be limited, and the limb may be weaker in strength than other limbs. The affected site may also demonstrate alterations in sensation (numbness, tingling).
Tests: Blood tests may be done to check for arthritis and other diseases that affect the entire body (systemic disease). Imaging tests (x-rays, CT scans, MRI) may be done to detect abnormalities in the bone, joint, or tissue. X-ray exams of the arteries within the limb (arteriogram) may reveal the presence of blood clots (thrombi) or weakened blood vessels (aneurysms). Tests to detect nerve damage (nerve conduction velocity studies) or to evaluate the electrical condition in muscles (electromyography) may be done.
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Source: Medical Disability Advisor
Treatment depends upon the limb affected and the diagnosis made. The treatment will vary according to the underlying cause.
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Source: Medical Disability Advisor
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| ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.* |
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| * The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence. |
Source: ACOEM Practice Guidelines
The prognosis depends on the underlying cause and treatment thereof and can range between full recovery and complete disability.
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Source: Medical Disability Advisor
Chronic pain may be accompanied by issues of dependence and depression and can significantly affect treatments and outcomes. In cases in which pain persists but no cause is identified with objective testing, psychosocial factors (somatization) may be involved.
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Source: Medical Disability Advisor
Depending of the nature of the pain and the degree of disability present, restrictions may include either limited or no use of the affected limb.
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Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Is pain in limb being used as a temporary diagnosis until a more exact one can be made?
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Did exam reveal any tender spots, deformities, redness, warmth, coolness, or swelling at the affected site?
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Were range of motion and strength affected?
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Is there any numbness or tingling?
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Has individual received x-rays, a CT scan, MRI, arteriogram, nerve conduction studies, or electromyography to definitively diagnose the underlying problem?
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If no obvious reason for the pain could be determined, was the individual seen by a mental health practitioner to rule out psychogenic causes for pain?
Regarding treatment:
- Have appropriate interventions been used to treat the underlying problem (such as splinting for fractures, etc.)?
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Does individual need rehabilitation? Ergonomic assessment?
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Is individual compliant with treatment recommendations?
Regarding prognosis:
- Can individual's employer accommodate any needed restrictions?
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Does individual have any chronic comorbid conditions, such as cancer or autoimmune disorders, that may affect recovery?
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Has individual received mental health intervention as appropriate?
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Has individual been referred to a pain clinic?
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Has individual had a complete psychiatric evaluation?
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Source: Medical Disability Advisor
| Cited Centers for Disease Control and Prevention. "Disorders Associated with Repeated Trauma. In Chapter 2: Fatal and Nonfatal Injuries, and Selected Illnesses and Conditions." Worker Health Chartbook 2004. NIOSH Publication No. 2004-146 ed. Centers for Disease Control and Prevention, 2004. National Institute for Occupational Safety and Health. 6 Jul. 2009 <http://www.cdc.gov/niosh/docs/2004-146/>.Huisstede, B., et al. "Incidence and Prevalence of Upper-Extremity Musculoskeletal Disorders: A Systemic Appraisal of the Literature." BMC Musculoskeletal Disorders 7 7 (2006): 1471-2474. BMC Musculoskeletal Disorders. BioMed Central. 1 Jan. 2009 <http://www.biomedcentral.com/bmcmusculoskeletdisord>. Molenaar, E. A., et al. "Considerable Comorbidity in Overweight Adults: Results from the Utrecht Health Project (translation of article in Dutch)." Ned Tijdschr Geneeskd 152 45 (2008): 2457-2463. PubMed. 1 Jan. 2009 <PMID: 19051798>. "Musculoskeletal Disorders." U.K. Health and Safety Executive. 2 Dec. 2008. 6 Jul. 2009 <http://www.hse.gov.uk/statistics/causdis/musculoskeletal/index.htm>. |
Source: Medical Disability Advisor