The natural history of and risk factors for musculoskeletal disorders of the upper limb presenting to primary care and physiotherapy services

The aims of this thesis were to observe which factors are associated with initial general practice consultation in patients presenting with both specific diagnosable upper limb disorders and non-specific arm pain; and to describe factors relating to the natural history and clinical course of these complaints over a 12-month period in patients recruited from primary healthcare services. Three linked studies have been conducted. A case-control study was used to examine some physical and psychological risk factors associated with patients’ presentation to general practice complaining of musculoskeletal pain in the upper limb. A prospective study was undertaken to describe the natural history of upper limb disorders that presented to three different types of healthcare service within the primary care system and to observe which prognostic factors were influential in predicting morbidity at follow-up. In addition, a sample of subjects with arm pain from the longitudinal study was tested to discover whether pain tolerance threshold differed significantly in those with non-specific as compared with specific disorders. We identified no important differences in risk factors for initial presentation with upper limb pain, natural history and presence of ongoing symptoms one year later in patients with specific diagnoses compared with those with non-specific upper limb pain. Indicators of psychological distress were significantly associated with both initial GP consultation (depression and somatising tendency) and adverse outcome (fear avoidance beliefs). Neither adverse mental health scores nor non-specific pain symptoms could not be explained in terms of reduced pain tolerance to quantitative sensory testing. The findings of these studies suggest that mental health factors should be considered in the assessment and management of all types of upper limb pain complaint.