Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 26, 2015; 5(2): 26-30
Published online Jun 26, 2015. doi: 10.5662/wjm.v5.i2.26
Clinical neurological examination vs electrophysiological studies: Reflections from experiences in occupational medicine
Jørgen Riis Jepsen
Jørgen Riis Jepsen, Department of Occupational Medicine, Hospital of South-western Jutland, DK-6710 Esbjerg, Denmark
Author contributions: Jepsen JR solely contributed to this manuscript.
Conflict-of-interest: The author declares that he has no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jørgen Riis Jepsen, MD, Associate professor, Consultant, Department of Occupational Medicine, Hospital of South-western Jutland, Østergade 81-83, DK-6710 Esbjerg, Denmark. joergen.riis.jepsen@svs.regionsyddanmark.dk
Telephone: +45-23-285702 Fax: +45-79-182294
Received: February 28, 2015
Peer-review started: March 2, 2015
First decision: April 27, 2015
Revised: May 17, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: June 26, 2015
Processing time: 129 Days and 3.2 Hours
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.