Upper Limb Injections

Published on 18/03/2015 by admin

Filed under Rheumatology

Last modified 18/03/2015

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Section 3 Upper Limb Injections

Examination of the upper limb

The capsular pattern is a set pattern of loss of motion for each joint. It indicates that there is some degree of joint capsulitis caused by degeneration, inflammation or trauma. There may be a hard end feel in advanced capsulitis

Shoulder tests  
Active flexion above head Resisted abduction
Passive flexion with overpressure Resisted lateral rotation
Active abduction to ear for painful arc Resisted medial rotation
Passive lateral rotation Resisted elbow flexion
Passive abduction Resisted elbow extension
Passive medial rotation Resisted adduction
Impingement/lag/stability/proprioception tests  
Shoulder capsular pattern: most loss of lateral rotation, less of abduction, least of medial rotation  
Elbow tests  
Passive flexion Resisted flexion
Passive extension Resisted extension
Passive pronation Resisted pronation
Passive supination Resisted supination
  Resisted wrist flexion
  Resisted wrist extension
Elbow capsular pattern: more loss of flexion than extension  
Wrist tests  
Passive pronation Resisted extension
Passive supination Resisted flexion
Passive extension Resisted radial deviation
Passive flexion Resisted ulnar deviation
Passive radial deviation  
Passive ulnar deviation  
Wrist capsular pattern: equal loss of flexion and extension  
Finger tests  
Passive thumb extension Passive finger extension
Resisted thumb abduction Passive finger flexion
Resisted thumb adduction Resisted finger abduction
Resisted thumb extension Resisted finger adduction
Resisted thumb flexion  
Finger capsular patterns: Loss of:
Thumb: extension & abduction
Metacarpophalangeal joints: extension and radial deviation
Interphalangeal joints: flexion
Distal phalangeal joints: extension

Glenohumeral joint

Acute or chronic capsulitis – ‘frozen shoulder’

Acromioclavicular joint

Acute or chronic capsulitis