Right Upper-Limb Symptoms and Referral Background
Date: Friday 11 September 2026
Type: Letter
Summary
This document records the current right upper-limb symptoms and the referral background for clinical 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. A subsequent FCP assessment recorded a working impression of posterior mechanical cervical-spine pain with right rotator-cuff-related shoulder pain, but the precise cause of the persistent hand weakness remains unresolved.
Background
The right upper-limb problem developed in July 2026.
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 the current assessment pathway is to evaluate the right upper-limb problem and determine the appropriate referral or treatment pathway. The later FCP assessment provides additional clinical examination findings but does not fully explain the persistent reduction in right-hand function.
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.
Earlier transient hand altered sensation — July 2026
- On 18 July 2026, mild intermittent numbness or altered sensation was reported mainly in the right palm and extending towards four fingers, particularly when making a fist.
- This was a transient historical symptom rather than a continuously present finding.
- The hand / finger altered sensation later resolved and was no longer continuing by 6 August 2026.
- This earlier episode is distinct from the later intermittent altered sensation described around the right shoulder-blade area.
- The later FCP record of no current upper-limb paraesthesia refers to the position at that assessment and does not conflict with the earlier transient July episode.
FCP assessment — clinical findings and working impression
A subsequent First Contact Practitioner (FCP) assessment added clinically recorded findings to the patient-reported history.
The FCP recorded a working impression of:
- posterior mechanical cervical-spine pain; and
- right rotator-cuff-related shoulder pain (RCRP).
The clinical record also documented the history of:
- right upper-limb symptoms beginning in July 2026;
- inability to lift the same frying pan that had previously been lifted one-handed;
- reduced gripping ability;
- posterior right-shoulder pain aggravated by lifting;
- posterior neck pain;
- no identified traumatic mechanism of injury.
At the time of the FCP assessment:
- lifting aggravated the symptoms;
- rest eased them;
- pain was recorded as moderate;
- sleep was not affected;
- no analgesia was being used;
- no current upper-limb paraesthesia was reported.
The FCP also recorded negative screening findings including:
- no recent infection;
- no unexpected weight loss;
- no significant fatigue reported in the context of that screening;
- no unremitting night pain;
- no change in balance or coordination;
- no unexplained sudden falls;
- no recent two-week change in bladder or bowel function.
Objective findings recorded by the FCP included:
- no forward-chin posture;
- no scapular protraction or winging;
- no pain on palpation of the posterior-lateral upper neck, mid-scapular region, acromioclavicular joint, sternoclavicular joint, coracoid process, or clavicle;
- posterior neck pain during cervical active movement / rotation;
- right and left cervical rotation recorded at approximately 60 degrees;
- neck muscle strength recorded as 4+;
- Spurling / Bakody testing recorded as NAD (no abnormality detected);
- right-shoulder testing including resisted external rotation, Neer and Hawkins-Kennedy manoeuvres, with the overall clinical impression recorded as right RCRP.
These findings provide a clinical assessment of the neck / shoulder component of the problem. They do not establish the precise cause of the persistent right-hand weakness.
Questions / Requests
Please assess the continuing right upper-limb symptoms and advise on the appropriate next step.
In particular, please advise:
- whether the persistent right-hand weakness requires further assessment beyond the current neck / shoulder working impression;
- whether the problem is suitable for routine MSK physiotherapy or requires another MSK or specialist pathway;
- whether any further examination or investigation is appropriate if the functional weakness persists.
Notes
This document records the current right upper-limb symptoms, referral background, and FCP findings available as of 11 September 2026. Any later clinical findings or management decisions should be added in a future updated version.
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.