Intrinsic upper limb conditions interfering with driving

Intrinsic upper limb conditions interfering with driving Intrinsic upper limb conditions interfering with driving

Painful shoulder syndrome

Shoulder pain may be caused by many conditions.

  • Rotator cuff lesions, if chronic, affect and compromise the surrounding structures, and may finally result in a stiff shoulder.
  • Subdeltoid bursitis causes acute and severe pain that prevents sleep and greatly limits motility. This is a long process that may lead to joint stiffness
  • A lesion in the long biceps tendon causes pain in the bicipital notch with anterior irradiation. Tendon rupture may occur. This lesion often requires surgery if no improvement is seen with conservative treatment.
  • Stiff shoulder starts with true contractures and continues until a chronic subdeltoid bursitis occurs, eventually leading to ankylosis. Treatment ranges from rest to surgery.
  • Pain is the predominating sign in chronic acromioclavicular pathology, and may irradiate to the trapezius, back of the neck, and arm. Both the symptoms and the underlying cause should be treated.
  • Shoulder osteoarthritis is common in overloaded unstable joints. If pain is disabling, surgery is required.
  • Senile shoulder dislocation causes severe pain and functional impotence. Treatment consists of physical therapy and postural correction.
  • The scapulocostal syndrome causes shoulder stiffness with pain due to muscular compensation.
  • Amyotrophic neuralgia is characterized by a sudden, continuous scapular pain, with contracture that blocks the shoulder and subsides after 2-3 weeks. Flaccid paralysis of some muscles subsequently occurs. This condition cures spontaneously within 6 months to a year.
  • Peripheral neuropathy due to changes in suprascapular and circumflex nerves causes sudden pain following a forced movement or trauma and is associated with loss of strength.

Rest and medical treatment are helpful in some cases, while others require surgical decompression.

Tips 

  • Patients cannot drive while they are experiencing pain, loss of strength, and sensitivity changes.
  • Joint stiffness impairs many movements required for driving, those preventing a rapid response when faced with an unexpected situation in the road.
  • The vehicle should have a high, comfortable seat, with a straight back and a good neck rest.
  • Both distance to the driving wheel and rearview mirrors should be adjusted to prevent forced shoulder and neck motion.
  • Pain and neurological or motion restrictions may lead the physician to advise against driving.
  • 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.
  • Surgical shoulder decompression requires a subsequent period of functional joint recovery in which driving will not be allowed until a favourable report is issued by the specialist.
  • Patients must not drive while they have symptoms.

Acute osteomyelitis of humeral diaphysis

This causes local pain, limited motion, and flexion contracture in joints. This condition causes fever and malaise eventually leading to a severe condition if not treated from the start.

Tips 

  • Patients cannot drive until complete resolution of the clinical condition occurs leaving no sequelae.

Bone tumours

  • Benign bone tumours such as fibroma, chondroma, osteoma, essential bone cyst, and hemangioma cause variable local pain depending on the location and joint. Spontaneous fracture sometimes occurs.
  • Malignant bone tumours such as primary osteolytic sarcoma, secondary sarcoma, reticulosarcoma, and bone metastases cause pain, deformity, and functional impotence.

Individualised treatment often leads to definitive sequelae in functional capacity, including limb amputation.

Tips

  • Pain and functional limitation in the upper limbs prevent driving in many cases.
  • Depending on the required treatment and existing sequelae, the specialist will determine in each case the ability to drive of the patient and will report it at each revision.
  • Limb amputation requires adequate adaptation of the vehicle according to law, and a learning period of the new driving conditions.

Joint lesions

  • Osteochondritis dissecans of the elbow causes joint block, with sudden extension limitation, that spontaneously resolves with motion. Repetition causes joint effusion.
  • Osteoarthritis progresses with age, causing pain, functional limitation, and deformity, and worsens with trauma.
  • Chondromatosis is characterised by joint cracking and marked functional limitation of the joint.
  • Osteoperiosteal conditions, such as humeral epicondylitis and radial and ulnar styloiditis, usually occur in the shoulder-hand syndrome, and also in local inflammation due to overload, causing pain and functional limitation.

Tips

  • Pain and functional limitation prevent driving in many cases.
  • Depending on the required treatment and existing sequelae, the specialist will determine in each case the ability to drive of the patient and will report it at each revision.
  • Whenever required, the physician may advise against driving until clinical improvement allowing the patient to drive safely has occurred.