Andrew Trenholm, MD, MSc, FRCSC, Associate Professor Orthopaedics (Upper Extremity and Trauma) Dalhousie University, Halifax, NS.
Fred Xavier, MD, PhD,Fellow, Combined Spine Program, Department of Surgery, Dalhousie University, Halifax, NS.
Sean Christie, MD, FRCSC, Associate Professor, Dalhousie University, Dept. Surgery (Neurosurgery), Halifax, NS.

Abstract
Neck and shoulder disorders are among the leading causes of pain and disability. History and physical examination are key components to clinical diagnosis and to determining whether the source of the arm pain is the neck or the shoulder. When consistent with the history, it is recommended to perform targeted provocative tests or manoeuvers. Several studies have shown that using a test item cluster improves diagnostic accuracy more than any single test item alone. Imaging, electrophysiological and laboratory studies are usually unnecessary unless there are clear clinical indications.
Key Words: Cervical radiculopathy, Neck pain, Shoulder pain, Clinical diagnosis, Provocative tests.

Introduction
Upper extremity pain is a common complaint; however, determining the origin of the pain can be a clinical challenge. Possible pain generators include irritation of neural elements, the musculoskeletal structures of both the shoulder and cervical spine or, in some cases, the thoracic viscera.^1,2 While most people develop asymptomatic degenerative changes with aging most of these do not yield clinically relevant symptoms.^3,4