Examination of the upper limbs is the portion of physical examination involving the assessment of the shoulder, elbow, forearm Forearm The forearm is the region of the upper limb between the elbow and the wrist. The term "forearm" is used in anatomy to distinguish this area from the arm, a term that is commonly used to describe the entire upper limb. The forearm consists of 2 long bones (the radius and the ulna), the interosseous membrane, and multiple arteries, nerves, and muscles. Forearm: Anatomy, wrist, and hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy to evaluate for signs of pathology. The examination includes inspection Inspection Dermatologic Examination, palpation Palpation Application of fingers with light pressure to the surface of the body to determine consistency of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. Dermatologic Examination, tests of range of movement, and provocative maneuvers. A good history should be taken and concurrently used with the exam findings to obtain a presumptive diagnosis.
Last updated: 1 Jan, 2022
The upper limb is divided into 3 regions:
The joints involved include:
These joints are surrounded and supported by many muscles, tendons, ligaments, and fibrocartilaginous structures to ensure support and stability and to absorb shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock during locomotion.
Anatomy of the shoulder
Image: “Shoulder Joint” by OpenStax College. License: CC BY 3.0, edited by Lecturio.Bones and joints in the
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy:
CMC:
carpometacarpal
Carpometacarpal
The articulations between the carpal bones and the metacarpal bones.
Wrist Joint: Anatomy
DIP: distal interphalangeal
IP: interphalangeal
MCP: metacarpophalangeal
PIP: proximal interphalangeal
Bony anatomy of the wrist joint Wrist joint The wrist connects the forearm to the hand. It consists of 8 carpal bones, multiple joints, and various supporting ligaments, as well as the distal bones of the forearm and the proximal portion of the 5 metacarpal bones of the hand. Wrist Joint: Anatomy
Image by Lecturio.Inspect the following structures of the shoulder/shoulder girdle bilaterally:
Note:
Palpate the various components of the shoulder girdle, including:
Note:
Each shoulder joint should be assessed and compared with the others. First assess active movement and then passive movement.
Shoulder flexion
Image by Lecturio.Shoulder extension
Image by Lecturio.Shoulder abduction
Image by Lecturio.Shoulder adduction
Image by Lecturio.External rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays of the shoulder
Image by Lecturio.Internal rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays of the shoulder
Image by Lecturio.Anterior/ posterior drawer test Posterior Drawer Test Knee Ligament Injuries:
Inferior drawer test:
Anterior apprehension test:
Posterior apprehension test:
Lateral Jobe test:
Lift-off test:
Resisted external rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays:
Painful arc test:
Neer test:
Hawkins-Kennedy test:
Cross-body adduction test:
Yegason’s test:
Speed’s test:
Inspect the following structures of the elbow bilaterally:
Note:
Palpate the various components of the elbow, including:
Note:
Tennis elbow (lateral epicondylitis):
Golfer’s elbow (medial epicondylitis):
Inspect the following structures of the wrist bilaterally:
Note:
Ganglion cyst:
A ganglion cyst
Image: “Ueberbein2” by Kulzerwi. License: Public DomainPalpate the various components of the wrist, including:
Note:
Tinel test Tinel test Firm percussion over the course of the median nerve proximal to or on top of the carpal tunnel . A positive test is defined as pain and/or paresthesia in median innervated fingers on percussion over the median nerve. Carpal Tunnel Syndrome:
Tinel test Tinel test Firm percussion over the course of the median nerve proximal to or on top of the carpal tunnel . A positive test is defined as pain and/or paresthesia in median innervated fingers on percussion over the median nerve. Carpal Tunnel Syndrome for carpal tunnel Carpal Tunnel The carpal tunnel is formed by the transverse carpal ligament (flexor retinaculum) superiorly and the carpal bones inferiorly. Carpal Tunnel Syndrome syndrome
Image by Lecturio.Phalen test:
Phalen test in carpal tunnel Carpal Tunnel The carpal tunnel is formed by the transverse carpal ligament (flexor retinaculum) superiorly and the carpal bones inferiorly. Carpal Tunnel Syndrome syndrome
Image by Lecturio.Finkelstein test:
Inspect the following structures of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy bilaterally:
Note:
Deformity:
Physical exam findings in
rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a symmetric, inflammatory polyarthritis and chronic, progressive, autoimmune disorder. Presentation occurs most commonly in middle-aged women with joint swelling, pain, and morning stiffness (often in the hands).
Rheumatoid Arthritis (RA):
An individual with RA with several classic deformities: ulnar deviation (left
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy) and boutonnière deformity (3rd, 4th, and 5th fingers of the right
hand
Hand
The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves.
Hand: Anatomy)
Swan-neck deformity of the 5th finger in an individual with RA
Image: “Swan-neck deformity” by Khatam-al-Anbia Eye Research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest Center, Mashhad University of Medical Sciences, Mashhad, Iran. License: CC BY 2.5Swelling Swelling Inflammation:
Heberden nodes in
osteoarthritis
Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion.
Osteoarthritis:
Bony growth spurs at the distal
interphalangeal joints
Interphalangeal joints
Hand: Anatomy due to osteophytes
Bouchard nodes in
osteoarthritis
Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion.
Osteoarthritis:
Osteophytes of the proximal
interphalangeal joints
Interphalangeal joints
Hand: Anatomy
Extra-articular signs:
Palpate the various components of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy, including:
Note:
Palms up:
Palms down: