Right Upper-Limb Symptoms and Referral Background for FCP
Date: Monday 7 September 2026
Type: Letter
Summary
This document records the current right upper-limb symptoms and the referral background for FCP assessment.
A separate lower-limb problem is already under MSK care and is not the main purpose of this appointment.
The main current concern is persistent right-hand weakness together with continuing right shoulder-blade and neck symptoms.
Background
The right upper-limb problem became clearly noticeable on Thursday 16 July 2026, when the patient found that the right hand could no longer lift the same frying pan that had previously been lifted one-handed without difficulty.
There was no pain during the attempt. The main problem was an inability to generate enough strength to lift the pan.
Following attendance at an Urgent Treatment Centre, the patient was referred to a separate Sunday GP service rather than the patient's usual GP practice.
At that Sunday GP assessment, the GP independently advised the patient to seek physiotherapy / MSK follow-up for the right upper-limb problem.
The patient does not know the clinical reason why physiotherapy was specifically recommended.
The patient was subsequently seen by MSK. Because the lower-limb and upper-limb problems could not both be assessed within the same appointment, MSK advised the patient to make a separate self-referral for the right upper-limb problem.
The patient then attempted the Dynamic Health physiotherapy self-referral.
During the online screening, the patient reported persistent weakness, continuing altered sensation around the right shoulder-blade area, and neck / upper-limb symptoms.
The self-referral was not accepted through the routine pathway, and the patient was advised to seek assessment through the GP practice.
The purpose of this FCP appointment is therefore to assess the right upper-limb problem and determine the appropriate referral or treatment pathway.
Details
Right Upper-Limb Symptoms
Current symptoms include:
- marked reduction in right-hand strength;
- continuing difficulty lifting heavier everyday objects with the right hand;
- continued inability to lift the same frying pan with the right hand alone as before;
- some improvement in opening food packaging, although function remains substantially worse than previously;
- intermittent numbness or altered sensation around the right shoulder-blade area, which has reduced but has not resolved;
- intermittent pain or pulling around the right shoulder-blade / shoulder area;
- neck stiffness that varies in severity;
- noticeable differences between the right and left shoulder-blade areas during some movements.
The reduction in right-hand strength remains.
The numbness or altered sensation around the right shoulder-blade area has become less noticeable, but has not disappeared.
Recently, an additional difference was noticed while trying a familiar warm-up movement that had been performed regularly in the past.
When standing relaxed and moving both arms in forward circles at the same time:
- the movement remains smooth and does not cause pain;
- the right and left shoulder-blade areas feel different from each other;
- there is a mild pulling sensation on the right that feels stronger than it did previously;
- a sound can repeatedly be heard around the right shoulder-blade area that was not noticed when performing the same type of warm-up movement in the past.
This has been noticed on approximately three to four occasions over the past week, with the right-sided sound occurring each time.
The movement has been performed cautiously and not through the maximum range previously used during exercise. It is therefore unclear whether the range of movement itself has changed.
The patient is unsure whether the right-hand weakness, shoulder-blade symptoms, and neck stiffness are related.
Questions / Requests
Please assess the current right upper-limb symptoms and advise on the appropriate next step.
In particular, please advise whether this problem is suitable for routine MSK physiotherapy or requires referral to another MSK or specialist pathway.
Notes
A separate lower-limb problem is already being managed through MSK.
This document is intended to support assessment of the right upper-limb problem only.