The Experts below are selected from a list of 5463 Experts worldwide ranked by ideXlab platform

Sang Chul Lee - One of the best experts on this subject based on the ideXlab platform.

  • Ultrasound-guided myofascial trigger point injection into brachialis muscle for rotator cuff disease patients with upper Arm Pain: a pilot study.
    Annals of rehabilitation medicine, 2014
    Co-Authors: Mi Ri Suh, Won Hyuk Chang, Hyo Seon Choi, Sang Chul Lee
    Abstract:

    Objective To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper Arm Pain. Methods A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial Pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). Results US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (ДVAS=-2.8) was significantly larger than caused by oral NSAID (ДVAS=-1.5) (p

  • ultrasound guided myofascial trigger point injection into brachialis muscle for rotator cuff disease patients with upper Arm Pain a pilot study
    Annals of Rehabilitation Medicine, 2014
    Co-Authors: Mi Ri Suh, Won Hyuk Chang, Hyo Seon Choi, Sang Chul Lee
    Abstract:

    Objective To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper Arm Pain. Methods A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial Pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). Results US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (ДVAS=-2.8) was significantly larger than caused by oral NSAID (ДVAS=-1.5) (p<0.05). Conclusion In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of Pain is suspected to be originated from the muscle.

Michel W Coppieters - One of the best experts on this subject based on the ideXlab platform.

  • Baseline Characteristics of Patients With Nerve-Related Neck and Arm Pain Predict the Likely Response to Neural Tissue Management
    The Journal of orthopaedic and sports physical therapy, 2013
    Co-Authors: Robert J Nee, Gwendolen Jull, Bill Vicenzino, Joshua A Cleland, Michel W Coppieters
    Abstract:

    Study Design Planned secondary analysis of a randomized controlled trial comparing neural tissue management (NTM) to advice to remain active. Objective To develop a model that predicts the likelihood of patient-reported improvement following NTM. Background Matching patients to an intervention they are likely to benefit from potentially improves outcomes. However, baseline characteristics that predict patients' responses to NTM are unknown. Methods Data came from 60 consecutive adults who had nontraumatic, nerve-related neck and unilateral Arm Pain for at least 4 weeks. Participants were assigned to a group that received NTM (n = 40), which involved brief education, manual therapy, and nerve gliding exercises for 4 treatments over 2 weeks, or to a group that was given advice to remain active (n = 20), which involved instruction to continue their usual activities. The participants' global rating of change at a 3- to 4-week follow-up defined improvement. Penalized regression of NTM data identified the best ...

  • neural tissue management provides immediate clinically relevant benefits without hArmful effects for patients with nerve related neck and Arm Pain a randomised trial
    Journal of Physiotherapy, 2012
    Co-Authors: Robert J Nee, Gwendolen Jull, Bill Vicenzino, Joshua A Cleland, Michel W Coppieters
    Abstract:

    Question What are the benefits and hArms of neural tissue management in the short term for treating nerve-related neck and Arm Pain? Design Randomised controlled trial. Participants Sixty participants with non-traumatic nerve-related neck and unilateral Arm Pain were randomised to experimental (n=40) or control (n=20) groups. Intervention Both groups were advised to continue usual activities. The experimental group also received education, manual therapy, and nerve gliding exercises in 4 treatments over 2 weeks. Outcome measures Primary outcomes were participant-reported improvement and worsening on a Global Rating of Change scale. Secondary outcomes were neck Pain, Arm Pain, the Neck Disability Index, the Patient-Specific Functional Scale, and adverse events related to treatment. Follow-up occurred 3–4 weeks after baseline. Results Numbers needed to treat favoured the experimental intervention for participant-reported improvement (2.7, 95% CI 1.7 to 6.5), neck Pain (3.6, 95% CI 2.1 to 10), Arm Pain (3.6, 95% CI 2.1 to 10), Neck Disability Index (4.3, 95% CI 2.4 to 18.2), and Patient-Specific Functional Scale (3.0, 95% CI 1.9 to 6.7). The prevalence of worsening in the experimental (13%) and control (20%) groups were not different (RD –7%, 95% CI –28 to 13). Adverse events had minimal impact on daily activities and did not reduce the chance of improving with the experimental intervention (RR = 1.03, 95% CI 0.58 to 1.84). Conclusion These results enable physiotherapists to inform patients that neural tissue management provides immediate clinically relevant benefits beyond advice to remain active with no evidence of hArmful effects. Trial registration ACTRN 12610000446066.

  • Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and Arm Pain are absent
    European journal of pain (London England), 2012
    Co-Authors: Annina B. Schmid, Benjamin T.c. Soon, Gunnar Wasner, Michel W Coppieters
    Abstract:

    Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central Pain mechanisms. As previous studies included patients with shoulder/Arm symptoms or neck Pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and Pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the Pain during thermal Pain testing significantly higher than healthy participants. This was especially apparent for heat Pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and Arm Pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated Pain ratings may however be an early indication of central Pain mechanisms.

  • A novel protocol to develop a prediction model that identifies patients with nerve-related neck and Arm Pain who benefit from the early introduction of neural tissue management
    Contemporary clinical trials, 2011
    Co-Authors: Robert J Nee, Gwendolen Jull, Bill Vicenzino, Joshua A Cleland, Michel W Coppieters
    Abstract:

    Abstract Researchers have been encouraged to identify characteristics that predict patients' responses to different musculoskeletal interventions. We describe a novel protocol to develop a prediction model that identifies patients with nerve-related neck and Arm Pain who are likely to benefit from the early introduction of neural tissue management (NTM). Prediction models for musculoskeletal treatments have usually been developed by analyzing single group study data with standard logistic regression. However, this approach has important limitations and our two step process for model development will address these limitations. Eligible patients will be aged 18 to 60 years with a minimum four week episode of non-traumatic neck and unilateral Arm Pain that is reproduced by a mechanical provocation test for the cervical nerve roots and median nerve. The outcome being predicted by the model is patient-reported improvement four weeks after baseline. Patients rating themselves at least ‘moderately better’ on a Global Rating of Change scale will be considered ‘improved’. First, a randomized control trial (RCT) comparing standardized NTM to advice to remain active will determine whether this outcome represents a NTM treatment effect. The RCT has 80% power to detect a number needed to treat ≤ 3 favoring NTM (p ≤ 0.05). Second, a comprehensive set of examination items will be analyzed with penalized logistic regression to select the best items for the prediction model.

Sunil V. Rao - One of the best experts on this subject based on the ideXlab platform.

  • the predictors of post procedural Arm Pain after transradial approach in 1706 patients underwent transradial catheterization
    Cardiovascular Revascularization Medicine, 2019
    Co-Authors: Surya Dharma, Sasko Kedev, Tejas Patel, Ian C. Gilchrist, Sunil V. Rao
    Abstract:

    BACKGROUND Although patients prefer radial over femoral approach, some develop post-procedural Arm Pain after transradial procedures. This complication has been poorly defined in prior studies. We evaluated the extent of non-ischemic Arm Pain after transradial arterial access and identify variables that may be associated with this complication. METHODS We performed a retrospective analysis of a 1706 patient database on patients who underwent transradial catheterization at three experienced radial centers. Arm Pain was assessed by adult visual analogue scale (score > 4) defined as moderate to severe Pain at the accessed foreArm not related to hand ischemia and was evaluated at one day after the procedure. Logistic regression was used to identify the predictors of post-procedural Arm Pain. RESULTS The overall incidence of post-procedural Arm Pain one day after a transradial procedure was 4.5%. Covariate associated with post-procedural Arm Pain were hemostasis compression >4 h (odds ratio (OR) = 29.47, p < 0.001), radial artery occlusion by Doppler evaluation (OR = 3.35, p < 0.001), radial artery diameter < 2.8 mm (OR = 2.66, p = 0.01), and multiple puncture attempts (OR = 2.31, p = 0.03). CONCLUSION Approximately 1 in 20 patients undergoing transradial procedure have post-procedural Arm Pain one day after the procedure. Predictors of this complication relate to radial hemostasis, radial artery occlusion, radial artery diameter, and number of access attempts.

  • The predictors of post-procedural Arm Pain after transradial approach in 1706 patients underwent transradial catheterization
    Cardiovascular revascularization medicine : including molecular interventions, 2018
    Co-Authors: Surya Dharma, Sasko Kedev, Tejas Patel, Ian C. Gilchrist, Sunil V. Rao
    Abstract:

    BACKGROUND Although patients prefer radial over femoral approach, some develop post-procedural Arm Pain after transradial procedures. This complication has been poorly defined in prior studies. We evaluated the extent of non-ischemic Arm Pain after transradial arterial access and identify variables that may be associated with this complication. METHODS We performed a retrospective analysis of a 1706 patient database on patients who underwent transradial catheterization at three experienced radial centers. Arm Pain was assessed by adult visual analogue scale (score > 4) defined as moderate to severe Pain at the accessed foreArm not related to hand ischemia and was evaluated at one day after the procedure. Logistic regression was used to identify the predictors of post-procedural Arm Pain. RESULTS The overall incidence of post-procedural Arm Pain one day after a transradial procedure was 4.5%. Covariate associated with post-procedural Arm Pain were hemostasis compression >4 h (odds ratio (OR) = 29.47, p 

Brigitte Tampin - One of the best experts on this subject based on the ideXlab platform.

  • Application and utility of a clinical framework for spinally referred neck-Arm Pain: A cross-sectional and longitudinal study protocol.
    PloS one, 2020
    Co-Authors: Camilla Kapitza, Brigitte Tampin, Kerstin Lüdtke, Nikolaus Ballenberger
    Abstract:

    Background The clinical presentation of neck-Arm Pain is heterogeneous with varying underlying Pain types (nociceptive/neuropathic/mixed) and Pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred Pain has been proposed, which classifies into (1) somatic Pain, (2) neural mechanosensitivity, (3) radicular Pain, (4) radiculopathy and mixed Pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-Arm Pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time. Method We describe a study protocol. Patients with unilateral neck-Arm Pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main Pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic Pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course. Conclusion The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying Pain mechanisms. The longitudinal analysis may help to assess possible predictors for Pain persistency.

  • Somatosensory profiles in patients with non-specific neck-Arm Pain with and without positive neurodynamic tests.
    Musculoskeletal science & practice, 2020
    Co-Authors: Karina Ottiger-boettger, Brigitte Tampin, Nikolaus Ballenberger, Gunther Landmann, Lenka Stockinger, Annina B. Schmid
    Abstract:

    Abstract Despite normal neurological integrity tests, some patients with non-specific neck-Arm Pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing. The aim of this study was to determine whether or not a nerve dysfunction is present in patients with positive neurodynamic tests compared to those with negative neurodynamic tests or healthy controls. Somatosensory profiling using quantitative sensory testing (QST) was established in 40 consecutive patients with unilateral NSNAP; 23 had positive upper limb neurodynamic tests (ULNTPOS) and 17 had negative neurodynamic tests (ULNTNEG) and in 26 healthy controls. QST included measurement of thermal and mechanical detection and Pain thresholds in the maximal Pain area on the symptomatic side as well as the corresponding contralateral area. Fifty-seven percent of patients with NSNAP had positive neurodynamic tests. Somatosensory profiling revealed a loss of function phenotype in NSNAP patients compared to healthy controls both in the maximal Pain area and asymptomatic side. Hyperalgesia (cold, heat and pressure) was present bilaterally in both NSNAP groups. Direct comparison between the patient groups revealed no significant differences in somatosensory profiles. However, the ULNTPOS group demonstrated sensory loss compared to healthy controls in more parameters than the ULNTNEG group. The ULNTNEG subgroup represented an intermediate phenotype between ULNTPOS patients and healthy controls in most detection thresholds as well as thermal and pressure Pain thresholds. Even though patients with NSNAP present as a spectrum, it remains unclear whether the sensory changes are indicative of a nerve dysfunction/lesion or rather a marker of altered central Pain processing.

  • Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-Arm Pain.
    Pain, 2012
    Co-Authors: Brigitte Tampin, Toby Hall, Gabriel Lee, Helen Slater, Noelle Kathryn Briffa
    Abstract:

    Abstract The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck–Arm Pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and Pain thresholds, Pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal Pain area, the corresponding dermatome and foot of 23 patients with Painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal Pain distribution, 31 HC and 22 patients with FM. For both neck–Arm Pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P P P P P

  • Inter-therapist agreement in classifying patients with cervical radiculopathy and patients with non-specific neck Arm Pain
    Manual therapy, 2012
    Co-Authors: Brigitte Tampin, Toby Hall, Noelle Kathryn Briffa, Gabriel Lee, Helen Slater
    Abstract:

    Abstract Identification of differences in clinical presentation and underlying Pain mechanisms may assist the classification of patients with neck–Arm Pain which is important for the provision of targeted best evidence based management. The aim of this study was to: (i) assess the inter-examiner agreement in using specific systems to classify patients with cervical radiculopathy and patients with non-specific neck–Arm Pain associated with heightened nerve mechanosensitivity (NSNAP); (ii) assess the agreement between two clinical examiners and two clinical experts in classifying these patients, and (iii) assess the diagnostic accuracy of the two clinical examiners. Forty patients with unilateral neck–Arm Pain were examined by two clinicians and classified into (i) cervical radiculopathy, (ii) NSNAP, (iii) other. The classifications were compared to those made independently by two experts, based on a review of patients' clinical assessment notes. The experts' opinion was used as the reference criterion to assess the diagnostic accuracy of the clinical examiners in classifying each patient group. There was an 80% agreement between clinical examiners, and between experts and 70%–80% between clinical examiners and experts in classifying patients with cervical radiculopathy (kappa between 0.41 and 0.61). Agreement was 72.5%–80% in classifying patients with NSNAP (kappa between 0.43 and 0.52). Clinical examiners' diagnostic accuracy was high (radiculopathy: sensitivity 79%–84%; specificity 76%–81%; NSNAP: sensitivity 78%–100%; specificity 71%–81%). Compared to expert opinion, clinicians were able to identify patients with cervical radiculopathy and patients with NSNAP in 80% of cases, our data supporting the reliability of these classification systems.

David Ring - One of the best experts on this subject based on the ideXlab platform.

  • Discrete Pathophysiology is Uncommon in Patients with Nonspecific Arm Pain
    Mashhad University of Medical Sciences, 2016
    Co-Authors: Joost Kortlever, Stein Janssen, Jeroen Molleman, Michiel Hageman, David Ring
    Abstract:

    Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific Arm Pain to eventual identification of discrete pathophysiology that corresponds with symptoms? 2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms? Methods: We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity Pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same Pain. Results: There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms. Conclusion: Nonspecific diagnoses are not hArmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology

  • Nonspecific Arm Pain.
    The archives of bone and joint surgery, 2013
    Co-Authors: Ali Moradi, Mohammad H. Ebrahimzadeh, David Ring
    Abstract:

    Nonspecific activity-related Arm Pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm Pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and Arm Pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness.

  • Health Concerns and Somatic Symptoms Explain Perceived Disability and Idiopathic Hand and Arm Pain in an Orthopedics Surgical Practice: A Path-Analysis Model
    Psychosomatics, 2010
    Co-Authors: Ana-maria Vranceanu, Steven A. Safren, James Cowan, David Ring
    Abstract:

    Background Upper-limb Pain disorders are relatively common, and often result in disability, lost time from work, and significant use of healthcare services. Objective The authors adapted and tested a cognitive-behavioral model of health anxiety in 100 patients with hand and Arm Pain in an orthopedics surgical practice, hypothesizing that increased health concerns would relate to increased perceived disability, and investigating whether patients’ Pain is related to other increased somatic symptoms. Method Patients with (non-traumatic) hand and Arm Pain received the Health Anxiety Inventory, the Whitley Index, and the Somatic Symptoms Inventory. Primary analyses were conducted via structural-equation modeling. Results There was a strong, positive, and direct relationship between health concerns and perceived disability. Health concerns were significantly and positively related to somatic symptoms, which, in turn, were significantly positively related to perceived disability and to having idiopathic versus discrete Pain. Conclusion The health-anxiety model is relevant to the development of nonspecific, vague, and diffuse (idiopathic) hand and Arm Pain.

  • Disability and Psychologic Distress in Patients with Nonspecific and Specific Arm Pain
    Clinical orthopaedics and related research, 2008
    Co-Authors: Ana-maria Vranceanu, Steven A. Safren, Meijuan Zhao, James Cowan, David Ring
    Abstract:

    Psychological illness influences the experience and expression of Pain and disability. We tested three null hypotheses: (1) patients with nonspecific Pain (medically unexplained and idiopathic) and patients with specific Pain (discrete and verifiable) are equally likely to screen for psychiatric illnesses based on a validated screening questionnaire; (2) the presence of psychiatric illness (from a screening questionnaire) will not predict whether patients have specific or nonspecific Pain type; and (3) across all patients and regardless of whether they have specific or nonspecific Pain, psychiatric illness will not predict disability as measured by the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. We rejected all null hypotheses. The 41 patients with nonspecific Arm Pain were more likely than the 40 patients with specific Arm Pain to screen for a somatoform disorder (34% versus 7.5%), posttraumatic stress disorder (24% versus 7.5%), and panic disorder (12.2% versus 5%). The presence of anxiety and somatoform disorders predicted Pain type (nonspecific versus specific) and Arm-specific disability (DASH). Somatoform disorder was the strongest predictor of Pain type and DASH scores. Based on a screening questionnaire, a comorbid psychiatric illness, a somatoform disorder in particular, is associated with nonspecific Arm Pain and Arm-specific disability. Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

  • Idiopathic Hand and Arm Pain: Delivering Cognitive Behavioral Therapy as Part of a Multidisciplinary Team in a Surgical Practice.
    Cognitive and Behavioral Practice, 2008
    Co-Authors: Ana-maria Vranceanu, David Ring, Meijuan Zhao, James Cowan, Ronald J. Kulich, Steven A. Safren
    Abstract:

    Abstract Cognitive behavioral therapists may have a unique and growing role in orthopedics departments. In helping patients cope with Pain, particularly where there is no specific biomedical treatment or cure, cognitive behavioral practitioners can help prevent, early on, the transition from an acute Pain complaint to a costly, disabling, and interfering chronic Pain syndrome (CPS; see Singh, M. K., Patel, J., & Galagher, R. (2005). Chronic Pain syndrome. Physical Medicine and Rehabilitation. Retrieved April 25, 2008, from. http://www.emedicine.com/pmr/topic32.htm for a thorough description). Idiopathic hand and Arm Pain is a prevalent, costly, and distressing condition. It is defined as Pain in the hand or Arm that is vague, diffuse, with unclear pathology, or Pain that is over and above what is expected based on an objective medical finding ([Ring, D., Katzielsky, J., Malhotra, L., Lee, S. G., & Jupiter, J. B. (2005). Psychological factors associated with idiopathic Arm Pain. Journal of Bone and Joint Surgery, 87, 374 --380]). Diagnosing and treating Pain in general is challenging, and it is particularly challenging when there is no clear objective pathology, as in idiopathic Pain. Patients with vague, diffuse, nonspecific Pain complaints often present to orthopedic departments in hope of Pain relief or cure via surgical procedures, yet surgeons are poorly equipped to deal with situations where pure medical management is unwarranted. This may be detrimental to patient care and lead to chronic Pain syndrome. This article reviews research and common clinical issues in patients with idiopathic hand and Arm Pain who present to orthopedic departments; presents a multidisciplinary team approach in coordinating and providing care for these patients; and describes two case examples of the use of cognitive and behavioral interventions as part of this team approach. Utilizing cognitive and behavioral approaches may be a way to increase the quality of life of patients presenting with idiopathic Arm Pain, prevent transition to chronic Pain syndrome, and circumvent costly and largely ineffective surgical procedures.