29. The upper extremities

Examination of the upper limbs comprises examination of the shoulders, elbows, hands and wrists. Make sure that the patient is sufficiently unclothed, so the connections between the joints and any left-right differences can be observed. The examination should be carried out in the following order: inspection, palpation and the specific tests. It is important to observe the patient for movement limitations and pain throughout the tests, to stabilise the trunk and to use the correct hand positions for the various joints being examined and the correct ranges of motion. Any abnormalities found from physical examination should always be interpreted in light of the patient’s context (from history-taking), as an isolated abnormal test finding will often have little scientific value. Physical examination findings will more reliable if those from history-taking, inspection, movement assessment, palpation and the specific test combined are consistent with the diagnosis.