Restricted Motion of the Wrist in a Patient with Rheumatoid Arthritis

A man with seropositive rheumatoid arthritis had pain, morning stiffness and restriction of motion in the right wrist. As a sign of carpal tunnel syndrome, he also had numbness of the middle fingers, which kept waking him up during nights. The restricted range of motion of the wrist is most easily detected by asking the patient to try to extend and flex their wrists maximally by pressing first the palms and then the backs of the hands against each other. The joint space (the place where the bending of the wrist happens) is located by palpation before injection.

The patient received an injection of methyl prednisolone and bupivacaine into the joint space of the wrist and the carpal canal (altogether 1 ml). Glucocorticoid injection locally in the carpal canal requires appropriate technical skills since an injection into a nerve may cause permanent nerve damage, see instructions on injection therapy Carpal Tunnel Syndrome (CTS).

Restricted Motion of the Wrist in a Patient with Rheumatoid Arthritis