The Wrist/Hand
Range of Motion
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ROM Using a Goniometer (Norkin and White, 2009):
Wrist Flexion: 60-75 Wrist Extension: 60-75 Wrist Radial Deviation: 20-25 Wrist Ulnar Deviation: 30-40 MCP Flexion: active (90-100) passive (slightly more) MCP Extension: active (20-45) passive (30-60) PIP Flexion: active (100-110) passive (105-115) PIP Extension: active (0-7) passive (0-15) DIP Flexion: active (70-80) passive (75-95) DIP Extension: active (0-8) passive (0-20) Thumb CMC Flexion: 10-20 degrees short of neutral Thumb CMC Extension: 50-80 Thumb CMC Abduction: 70 Thumb CMC Adduction: 10-20 degrees short of neutral Thumb MCP Flexion: 50-60 Thumb MCP Extension: 0-15 Thumb IP Flexion: 70-80 Thumb IP Extension: 20-25 |
Manual Muscle Tests
Coming soon...
Special Tests
Wrist/Hand Research
Clinical Prediction Rule for the Diagnosis of Carpal Tunnel Syndome (Wainner et al, 2005):
- Age > 45
- Patient reports shaking hands relieves symptoms
- Wrist ratio index > .67 (AP wrist width/ML wrist width)
- Reduced median nerve sensation in digit 1 compared to thenar eminence
- Symptom Severity Scale score > 1.9
>2 positive tests: Sensitivity: .98; Specificity: .14; +LR: 1.1
>3 positive tests: Sensitivity: .98; Specificity: .54; +LR: 2.1
>4 positive tests: Sensitivity: .77; Specificity: .83; +LR: 4.6
5 positive tests: Sensitivity: .18; Specificity: .99; +LR: 18.3
Note: tests should only be performed by properly trained health care practitioners.
- Age > 45
- Patient reports shaking hands relieves symptoms
- Wrist ratio index > .67 (AP wrist width/ML wrist width)
- Reduced median nerve sensation in digit 1 compared to thenar eminence
- Symptom Severity Scale score > 1.9
>2 positive tests: Sensitivity: .98; Specificity: .14; +LR: 1.1
>3 positive tests: Sensitivity: .98; Specificity: .54; +LR: 2.1
>4 positive tests: Sensitivity: .77; Specificity: .83; +LR: 4.6
5 positive tests: Sensitivity: .18; Specificity: .99; +LR: 18.3
Note: tests should only be performed by properly trained health care practitioners.
References:
Norkin and White, . Measurement of Joint Motion: A guide to goniometry. 4th. F.A. Davis Company, 2009. Print.
Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. "Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome." Arch Phys Med Rehabil 2005 April; 86(4): 609-18.
Norkin and White, . Measurement of Joint Motion: A guide to goniometry. 4th. F.A. Davis Company, 2009. Print.
Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. "Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome." Arch Phys Med Rehabil 2005 April; 86(4): 609-18.