Range of Motion: Active

Historical Overview

Historically, physicians used a metric ruler or goniometer to measure active range of motion (ROM).¹ Manual goniometers help to measure joints efficiently; however, their use may result in up to 10° of inaccuracy.² By 2006, a new goniometer was developed, particularly for the measurement of small joints.³

Description

• For an examination of active ROM, the patient must move the affected areas of the hand, wrist and/or elbow without assistance. This will show the range of strength for each joint.¹
  • It is often helpful to compare typical functional ROM measurements with the patient’s functional ROM measurements.⁴ The Jebsen hand function test for functional ROM includes writing, simulated feeding, and lifting heavy objects.⁵
  • Before and after reconstructive surgery, it is useful to include an assessment of functional ROM.⁶
• Typical degrees of motion for each joint in the hand and for the wrist and elbow are shown in the Table.^5,7

DIP, distal interphalangeal; MP, metacarpophalangeal; PIP, proximal interphalangeal; ROM, range of motion

Pathophysiology

• Loss of active ROM may be due to rheumatoid arthritis (RA), Colles’ fracture, Dupuytren’s disease, trigger finger, or a neurological injury.⁸
• Pain, fracture, or tenosynovitis also can restrict active ROM. In inflammatory tenosynovitis, there will be a decrease of active flexion.⁷

Instructions

1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate on a scale from 1-10 how much pain s/he usually experiences at the affected area(s).
2. Check the patient’s ability to flex, extend, pronate, supinate, abduct, adduct, and rotate the affected area(s). Measure each joint separately with a goniometer.¹
3. If the patient experiences a loss in active ROM from the previous examination, record the reason, if known.¹
4. Examine the contralateral area(s) in the affected hand, wrist and/or elbow.

Variations

• To measure the total active motion (TAM), add the figures from each area/joint level.¹

Related Signs and Tests

• Dorsal-volar technique for wrist ROM²
• Pulp-to-palm, active
• ROM, passive
• Jebsen hand function test⁵
• Grip strength
• Nerve conduction studies
• Radiographs
• Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

• For measuring active wrist flexion and extension, the dorsal-volar technique shows a high degree of inter-rater reliability.²
• To improve reliability in diagnosing RA, use plain radiographs to test joints for damage. 

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• A positive result occurs when the patient achieves full ROM without assistance, within the typical ranges for each joint of the hand, wrist and/or elbow.

• A negative result occurs when the patient is not able to achieve full ROM without assistance, within the typical ranges for each joint of the hand, wrist and/or elbow.

• It is very important to compare right and left joints being measured to determine a baseline.
• If there is a difference between joint active and passive ROM, this is called active-passive mismatch. Tendon adhesions may cause this mismatch.¹
• For patients with RA, therapy gloves may improve active ROM.⁹

Cited References:

1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
2. Carter TI, Pansy B, Wolff AL, et al. Accuracy and reliability of three different techniques for manual goniometry for wrist motion: a cadaveric study. J Hand Surg Am 2009;34:1422-28. PMID: 19703734
3. Stam HJ, Ardon MS, den Ouden AC, et al. The compangle: a new goniometer for joint angle measurements of the hand. A technical note. Eura Medicophys 2006;42(1):37-40. PMID: 16565684
4. Gates DH, Walters LS, Cowley J, et al. Range of motion requirements for upper-limb activities of daily living. Am J Occup Ther 2016;70(1) Epub ahead of print. PMID: 26709433
5. Adams BD, Grosland NM, Murphy DM, McCullough M. Impact of impaired wrist motion on hand and upper-extremity performance(1). J Hand Surg Am 2003;28(6):898-903. PMID: 14642503
6. Hume MC, Gellman H, McKellop H, Brumfield RH Jr. Functional range of motion of the joints of the hand. J Hand Surg Am 1990;15(2):240-3. PMID: 2324451
7. Rayan G, Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
8. Kenney RJ, Hammert WC. Physical examination of the hand. J Hand Surg Am 2014;39(11):2324-34. PMID: 25442747
9. Nasir SH, Troynikov O, Massy-Westropp N. Therapy gloves for patients with rheumatoid arthritis: a review. Ther Adv Muskuloskelet Dis 2014;6(6):226-37. PMID: 25435925

General References:

1. Dutton M. Orthopaedic Examination, Evaluation and Intervention. McGraw-Hill, 2004, pp. 537, 613-615
2. Trumble, T., & Budoff, J. (2006). Anatomy and Physical Examination of the Hand. In Hand, elbow & shoulder core knowledge in orthopaedics (p. 3). Philadelphia, Pennsylvania: Mosby.