Stop guessing: A clinician's guide to demystifying spine-related arm pain in primary care

Musculoskelet Sci Pract. 2026 Mar 24:103549. doi: 10.1016/j.msksp.2026.103549. Online ahead of print.

ABSTRACT

Pain in the arm could arise from a wide range of conditions, from non-specific musculoskeletal disorders to serious spinal pathology. Spine-related arm pain (SAP), i.e., pain that is best explained by processes in the spine or spinal nerves, poses a particular diagnostic challenge in primary care due to its diverse overlapping symptoms and evolving presentations. This paper proposes a structured, literature-informed, consensus-based guide to assist clinicians in classifying SAP according to predominant pain mechanisms and stratifying the level of clinical concern. The guide takes the form of a diagnostic algorithm derived from contemporary frameworks, including the terminology and mechanistic descriptors proposed by the International Association for the Study of Pain and the recommendations of the Neuropathic Pain Special Interest Group. It is illustrated through three hypothetical clinical scenarios that demonstrate how the algorithm can be applied to integrate subjective and objective findings, including a mandatory neurological examination and ongoing safety-netting. The algorithm is intended as a pragmatic knowledge-translation and educational tool to support mechanism-based reasoning, improve confidence in managing SAP in primary care, and help students and early-career clinicians navigate its diagnostic complexity.

PMID:41956881 | DOI:10.1016/j.msksp.2026.103549