A man with seropositive rheumatoid arthritis had pain, morning stiffness and restriction of motion in the right wrist. The range of motion is examined by asking the patient to extend and flex the wrists maximally by pressing against the other hand. The patient received a 1 ml injection of methyl prednisolone and bupivacaine into the joint space of the wrist. The patient had also carpal tunnel syndrome, and part of the drug was injected close to the median nerve (but carefully avoiding intraneural injection by asking the patient about "electric shock" pain).
Restricted motion of the wrist and injection in a patient with rheumatoid arthritis