What is the incidence of musculoskeletal complaints in the elbow, shoulder, and neck after hand and forearm injuries?

Winiarski, L. M., Livoni, J. D., Madsen, P. V., Rathleff, M. S., & Larsen, P. (2021). Concurrent musculoskeletal complaints in elbows, shoulders, and necks after common hand and forearm injuries or conditions: A cross-sectional study among 600 patients. Journal of hand therapy: official journal of the American Society of Hand Therapists34(4), 543–548. https://doi.org/10.1016/j.jht.2020.05.002

shoulder elbow hand therapy

The Skinny:

The authors looked to determine what the incidence of shoulder elbow and neck pain after sustaining a typical hand and forearm injury.  Isolated hand injuries account for 20-29% of hand and forearm injuries in emergency rooms and orthopedic departments.  Oftentimes pain associated in the upper quadrant beyond the injury is neglected and ignored. The authors hoped to bring awareness to these concurrent musculoskeletal issues.

In the Weeds:

The authors used a cross-sectional study.  The study used patients that were referred to the shoulder elbow hand therapy department for an isolated hand or forearm injury.  The patients were asked two basic questions.  

1.) do you currently have pain and/or stiffness in the elbow, shoulder, or neck? 

If yes then,

2.) did the symptoms develop before or after their hand and forearm injury?

If the patient answered yes to question 1 and stated the symptoms developed after the hand or forearm injury they were included in the study.  

Bringing it Home:

The study took place for 15 months and a total of 600 patients met the eligibility requirements. The average age of patients was 49.1 years with the largest diagnostic group being distal radius and ulna fractures, ligament lesions in fingers (16%), finger fractures (14%).  The common areas of concurrent pain were the shoulder (62%), elbow (49%), and the neck (32%”).  Thirty-eight percent of patient reports multiple areas of musculoskeletal or stiffness in two or three regions of the upper quadrant and neck.  

Rating 4/5.  

The study brings attention to the continued need to address the entire upper quadrant when a patient sustains a hand, wrist, or forearm injury. In the future, it would be helpful to publish outcomes after addressing the musculoskeletal impairments to help justify the need for occupational and physical therapy services to prevent long-term pathologies. 


  1. Stacey Yohner on December 6, 2021 at 10:44 am

    Thank you for this article. Trying to justify therapy beyond the specific joint a patient is brought in for can be frustrating. We need more research like this.

  2. Rosenda on December 6, 2021 at 6:39 pm

    Great, good article.
    At times patients are not necessarily believed and areas of discomfort are neglected. We forget there is fascia, and dermatomes that connect all structures, and will affect above or below the injured site.

Leave a Comment

More To Read

Thumbs up for treating thumb pain in the hand therapy clinic

August 18, 2019

What do “Mommy’s thumb,” “gamer’s thumb,” and “radial styloid tenosynovitis” have in common? They are all officially called de Quervain’s tenosynovitis  De Quervain’s involves the tendons within the first dorsal compartment, abductor pollicis longus (APL) and extensor pollicis brevis (EPB) and arises when the tendons are inflamed and are not able to move through the…

Read More

Differentiating Proximal Median Nerve Entrapment from Carpal Tunnel Syndrome

August 9, 2020

By: Brittany Day Proximal Median Nerve Entrapment, Pronator Syndrome, or Lacertus Syndrome?  Pronator syndrome is a term used to describe proximal median nerve entrapment (PMNE) in the forearm. Pronator syndrome and lacertus syndrome are sometimes used interchangeably to describe proximal median nerve entrapment distal to the ligament of Struthers and proximal to the flexor superficialis…

Read More


March 28, 2021

Article Review THUMB ABDUCTION IN PATIENTS WITH CMC ARTHRITIS? HOW DO YOU MEASURE?  Corey McGee PhD, OTR/L, CHT , Virginia O’Brien OTD, OTR/L, CHT , Jennifer Skye MS, OTR/L, CHT , Katherine Wall MOT, OTR/L , Thumb Carpometacarpal Palmar and CMC Radial Abduction in Adults with Thumb Carpometacarpal Joint Pain: Inter-rater Reliability and Precision of…

Read More

Sign-up to Get Updates Straight to Your Inbox!

Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.