Clinical neurological examination vs electrophysiological studies: Reflections from experiences in occupational medicine

Abstract

Seventy-five percent of upper limb disorders that are related to work are regarded as diagnostically unclassifiable and therefore challenging to the clinician. Therefore it has been generally less successfully to prevent and treat these common and frequently disabling disorders. To reach a diagnosis requires the identification of the responsible pathology and the involved tissues and structures. Consequently, improved diagnostic approaches are needed. This editorial discusses the potentials of using the clinical neurologic examination in patients with upper limb complaints related to work. It is argued that a simple but systematic physical approach permits the examiner to frequently identify patterns of neurological findings that suggest nerve afflictions and their locations, and that electrophysiological studies are less likely to identify pathology. A diagnostic algorithm for the physical assessment is provided to assist the clinician. Failure to include representative neurological items in the physical examination may result in patients being misinterpreted, misdiagnosed and mistreated.

Keywords: Neurological examination, Electrophysiology, Work-related disorders, Occupational medicine, Nerve afflictions, Upper limb disorders

Core tip: Patients with work-related upper limb disorders should be subjected to a systematic upper limb examination including neurological items with the main focus on muscle strength testing. A refined version of the classical neurological upper limb examination can be rewarding because it permits the clinician to frequently identify patterns in accordance with nerve afflictions with specific locations. This examination is suitable in any clinical setting because it is simple, inexpensive, noninvasive, and highly reproducible.