Screening and evaluation of the cardiovascular and pulmonary systems in patients presenting with upper extremity impairments.

UNLABELLED: NARRATIVE REVIEW: Given the prevalence of cardiovascular and pulmonary (CV-P) disease, it is likely that a substantial portion of patients seeking services from hand therapists have diagnosed or yet to be diagnosed disease in one or both of these systems. Pain originating from these systems is more common in the chest, shoulder, and scapular regions, but both systems can refer pain into the medial aspect of the forearm and hand. Pancoast's tumors of the lung, myocardial ischemia, and myocardial infarction are examples of specific pathologies capable of referring pain into these upper extremity regions. Another concern for the hand therapist is that upper extremity exercise is more stressful on the cardiovascular system than lower extremity exercise. Because of this, hand therapists need to be able to recognize when to discontinue or modify exercise interventions based on inappropriate cardiovascular system responses. Thus, the purpose of this review is to present 1) screening for potential pathology in the CV-P systems, 2) methods typically available to hand therapists for monitoring these systems, 3) criteria that indicate the need for therapy modification or medical referral, and 4) symptomatology of some common cardiac and pulmonary pathologic conditions the hand therapist may encounter.

LEVEL OF EVIDENCE: 5.