Extrinsic upper limb conditions interfering with driving

Pain is the main sign of many orthopaedic disorders, and this is why assessing pain characteristics is essential for diagnosis and treatment, and to evaluate its potential impact on driving.

Cervicobrachialgia

An acute or chronic vertebral block causes irritation by compression or distension of sympathetic communicating rami, resulting in a trophic irritation status in soft tissues of the shoulder, muscles, and periarticular tissue, as well as soft tissue involvement in the elbow and hand.

This is usually caused by a trauma with contusion and distension of the cervical spine producing an extensive muscle contracture.

This is a common lesion in traffic accidents.

Cervicobrachial neuralgia represents the impact of the disk-root conflict upon one of the brachial plexus roots, mainly C6, C7, and C8.

Symptoms include pain located in the spinous processes of cervical spine and in the cervical plexus territory.

Neck pain irradiating to the shoulder, contracture of cervical muscles with neck rigidity, paraesthesia, muscle weakness, and decreased sensitivity and reflexes occur.

Tension in neck muscles and straightening of cervical spine cause shoulder stiffness with restricted motion.

Symptoms of sympathetic chain irritation may occur, including dizziness, vertigo, tinnitus, blurred vision, retro-ocular pain, and facial or mandibular pain.

Medical treatment of the underlying condition and symptomatic treatment with analgesic, muscle relaxant, and anti-inflammatory drugs relieves pain, but relapse may occur.

Tips

Patients cannot drive while they are experiencing symptoms such as pain, loss of strength, and sensitivity changes.
Rest and physical therapy with massage are advised, and recommendations should be given to prevent exacerbation, including advice on driving.
Patients should avoid low, soft chairs, and cushions under the knees. The vehicle should have a high, comfortable seat, with a straight back and a good neck rest.
Pain and neurological or motion restrictions may lead the physician to advise against driving.
If the patient is experiencing a period of anxiety or stress, all symptoms are exacerbated, thus decreasing vehicle control.
Drugs used for symptomatic treatment of these clinical conditions often have a sedative effect, e.g. benzodiazepines and major tranquillisers.
Physicians should warn patients that even if symptoms have improved and they already able to drive, maintenance treatment may cause them significant and dangerous side effects that may delay driving resumption until doses are decreased or treatment is discontinued.
Patients must not drive while they have symptoms.

Neurovascular compression syndrome

This syndrome causes symptoms due to a supply disorder with neuralgic discomfort and paresis in the arm. The most common causes include:

Cervical rib: this is a bilateral rudimentary rib-like process of the seventh cervical segment with an abnormal scalene muscle insertion.
Symptoms occur in 20% of cases only. Cervical ribs become manifest more often in women over 40 years of age and as a result of trauma. They cause paresthesia, coldness, oedema, and atrophy.
Scalene syndrome: this is a similar clinical condition, but with no cervical rib, due to an increased tone in scalene muscle insertion.
Costoclavicular syndrome: this syndrome results from compression of the neurovascular bundle between the rib and collarbone.
Hyperabduction syndrome: caused by compression of the axillary artery by the humeral head.

Tips

Patients cannot drive while they are experiencing symptoms such as pain, loss of strength, and sensitivity changes.
Pain and neurological or motion restrictions may lead the physician to advise against driving.
In each individual case, the physician will tell which postures or movements enhance symptom occurrence, so that patients try and avoid them while driving.
If surgical treatment is required, patients will not be authorised to drive until complete recovery has occurred, they have no symptoms, and the specialist physician has given his/her approval.

Axilla

Axillary lymphadenitis: symptoms include skin reddening, painful swelling in the axilla, and arm contracture in adduction.
Hydradenitis: this a sweat gland phlegmon causing pain, swelling, and skin reddening.

Tips

Driving is not permitted during the acute, symptomatic episode.

Chest wall

Painful rib conditions due to contusions or osteomyelitis.
Overload of muscle insertions at the first two costochondral junctions, with a trophic irritative process and periosteal reaction (Tietze’s syndrome).

Tips

Chest wall pain of costal or muscular origin restricts motion and causes drivers to refrain form using support mechanisms because of tenderness.
In such cases, driving is not recommended until pain and its cause have disappeared.