Arm Pain without Physical Findings: Medicine Vs the Law?

Abstract

Arm pain without physical findings occurring in association with light repetitive work has been with us from the time man developed factories but has become controversial since a number of reported cases in Australia in 1983. It remains a highly contentious and medically confused area. Claims for compensation for the condition against employers have been firmly rejected by courts in Australia and the USA, but large awards continue to be made in UK courts. The reason for this difference lies in recent changes in British Law and court procedure and British courts now seem to recognize this nebulous clinical condition as representing a compensable injury. In this situation, therefore, physicians must be meticulous in their examinations and record keeping. In addition, they must only use specific diagnoses when irrefutable clinical signs or confirmatory special investigation results are present and must be guarded in loose talk or discussion about "causation".

Psychological Factors Associated with Idiopathic Arm Pain

“…sychological and personality factors may be as important as, or more important than, pathological processes in the experience of pain, particularly in patients whose pain has a vague or uncertain source [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] . Patients with these vague and diffuse complaints of upper limb pain are commonly seen in hand surgery practices 17,18 .…”

“…It can be difficult to make a specific diagnosis in the absence of objective findings, and therefore specific and effective treatment is elusive 3,12,19,20 . Patients with such idiopathic upper limb pain may have relatively maladaptive psychological factors and personality traits that contribute to disability related to somatic complaints [3][4][5]7,8,[10][11][12]15,16,[20][21][22][23] . We tested the hypothesis that patients who had pain with a discrete and easily identified cause would differ from patients who had vague, diffuse pain with no clear source (idiopathic pain) when evaluated with use of validated measures of several psychological factors, including pain anxiety, catastrophizing, a tendency for somatic complaints, body consciousness, and locus of control.…”

Arm Ache

“…In Australia in 1983, an illness characterized by activity-related pain without any objective pathophysiology or impairment was labeled “repetitive strain injury” (RSI) and promoted [22, 25, 50]. An analysis of the resulting epidemic of disabling nonspecific arm pain suggests that it was a psychosocial phenomenon [4, 19, 22, 25, 50].…”

“…In Australia in 1983, an illness characterized by activity-related pain without any objective pathophysiology or impairment was labeled “repetitive strain injury” (RSI) and promoted [22, 25, 50]. An analysis of the resulting epidemic of disabling nonspecific arm pain suggests that it was a psychosocial phenomenon [4, 19, 22, 25, 50]. In other words, a well-intentioned illness construction led to a widespread of illness similar to what is observed in outbreaks of conversion disorder [4, 19, 50].…”

“…A key incentive for growth of the epidemic was claims for compensation. But the court reviewed the evidence and concluded that repetitive strain injury is a misnomer because there is no evidence of injury [4, 19, 22, 25, 41, 50].…”