. . .

. The most important information for the diagnostician comes from the individual’s history. What symptoms were present initially, where they occurred, what made them worse, how and to what parts of the body they spread, and whether or not they affected seemingly unrelated parts of the body are all important. Careful questioning about trivial activities of daily life gives further clues as to the location of the disorder. The arms, neck, and especially the area above the collarbone need to be examined thoroughly. Two inveterate findings upon testing are: first, an increase of characteristic pain, as well as numbness and tingling, with the passive raising of a straightened arm rotated away from the body; second, a similar increase in symptoms occurring with gentle pressure or tapping in the area above the collarbone. Common findings on inspection will also include swelling above the collarbone, swelling in the hand, a sensitivity to cold accompanied by mottling, and significant thermal asymmetries. Frequently, tenderness at the elbow or wrist with electric-like pain to tapping will occur, and one can often find fibromyalgic-like points about the shoulder blades, at the fascial planes in the arm, in the front of the shoulder at the insertion of the pectoralis minor tendon, and in the chest and back of the head.   .