Persistent Post-traumatic Upper Limb Pain and Paraesthesia Following a Fall on an Outstretched Hand: A Case of Inconclusive Localisation.

Persistent upper limb pain following trauma can present a diagnostic challenge, particularly when clinical findings and investigations are discordant. We report the case of a 31-year-old female patient with persistent right upper limb and anterior chest wall pain associated with sensory disturbance in a multi-regional distribution, following a fall on an outstretched hand (FOOSH). Five years after the initial injury, the patient's symptoms, pain severity, functional limitations and neurological findings remained unchanged despite extensive conservative and interventional management, including physiotherapy, pharmacological treatment, corticosteroid injections, manipulation under anaesthesia and specialist multidisciplinary review. Magnetic resonance imaging (MRI) demonstrated no structural abnormality or nerve root compression sufficient to explain the patient's presentation, while electromyography (EMG) demonstrated findings suggestive of a mild T1 radiculopathy. These findings were not fully concordant with the clinical presentation. Clinicians should consider a broad differential diagnosis and carefully correlate clinical findings with imaging and electrodiagnostic studies when evaluating persistent post-traumatic upper limb pain.