# Right Upper-Limb Symptoms and History

Date: Friday 30 October 2026

Last Updated: Friday 30 October 2026

Type: Letter

## Summary

This document records the right upper-limb symptoms, healthcare contacts, and examination findings reported or recorded up to 11 September 2026.

A separate lower-limb problem was already under MSK care and is not the main subject of this record.

The reported symptoms include reduced right-hand strength and changes in right-hand function, together with right shoulder-blade and neck symptoms. An FCP assessment and referral took place on 7 September 2026. The record includes the reported symptoms and the examination findings from that appointment.

## Background

The right upper-limb symptoms began 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 advised the patient to seek physiotherapy / MSK follow-up for the right upper-limb symptoms.

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 symptoms.

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 patient attended the First Contact Practitioner (FCP) assessment on **Monday 7 September 2026**, and an assessment and referral were completed on the same day. The findings from that appointment are recorded below.

## Details

### Right Upper-Limb Symptoms

Symptoms recorded 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 remained substantially worse than previously;
- intermittent numbness or altered sensation around the right shoulder-blade area, which had reduced but had not resolved;
- intermittent pain or pulling around the right shoulder-blade / shoulder area;
- neck stiffness that varied in severity;
- noticeable differences between the right and left shoulder-blade areas during some movements.

The reduction in right-hand strength remained present when this history was recorded.

The numbness or altered sensation around the right shoulder-blade area had become less noticeable but had not disappeared.

In early September 2026, 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 remained smooth and did not cause pain;
- the right and left shoulder-blade areas felt different from each other;
- there was a mild pulling sensation on the right that felt stronger than it did previously;
- a sound could repeatedly be heard around the right shoulder-blade area that had not been noticed when performing the same type of warm-up movement in the past.

This was noticed on approximately three to four occasions within one week in early September 2026, with the right-sided sound occurring each time.

The movement was performed cautiously and not through the maximum range previously used during exercise. It was therefore unclear whether the range of movement itself had changed.

### 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 was reported in the hand / fingers, while later intermittent altered sensation was reported around the right shoulder-blade area.
- At the FCP assessment on 7 September 2026, no current upper-limb paraesthesia was recorded.

### Monday 7 September 2026 — FCP assessment and referral

The First Contact Practitioner (FCP) assessment and referral took place on **Monday 7 September 2026**. The assessment added clinically recorded findings to the patient-reported history.

The clinical record 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.

The available source record does not provide individual positive or negative results for each of the three named right-shoulder manoeuvres. No additional findings have been inferred.

## Notes

This document preserves the right upper-limb symptoms, healthcare-contact history, and FCP examination findings recorded by **11 September 2026**, including the FCP assessment and referral completed on **7 September 2026**.

No subsequent MSK assessment findings are included in this record.

A separate lower-limb problem was already being managed through MSK.

This document records the right upper-limb history without proposing a diagnosis or a causal relationship between symptoms.

This document reflects the information the patient has been able to identify and organise as relevant. It may not contain every detail that could be clinically useful.

### Please ask me about any additional details that may help with the assessment.