Pain above the injury level is predominantly musculoskeletal in origin and involves the structures of the upper extremity that must assume increased mobility and weight-bearing stresses in performance of transfers and wheelchair propulsion. This article discusses the recognition, diagnosis, and management of painful issues of the shoulder, elbow, wrist, and hand. A brief discussion is presented on pain entities that are familiar to pain treatment centers but possibly not to other health care workers, namely chronic fatigue syndrome and facet syndrome.
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