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Range of Motion: Active

Exams and Signs

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
Approximate Typical ROM, Active
 

Joint

Motion

Degrees (°)

Hand

MP

Extension

0

Flexion

90

PIP

Extension

0

Flexion

120

DIP

Extension

0

Flexion

40-50

Wrist 

Extension

30-70

Flexion

40-80

Radial deviation

10-30

Ulnar deviation

20-40

Elbow 

Extension

0

Flexion

130-140

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. 

Additional Information

Presentation Photos and Related Diagrams
Measuring Range of Motion
  • Digital Goniometer
    Digital Goniometer
  • Measuring digital range of motion with goniometer.
    Measuring digital range of motion with goniometer.
  • Measuring MP joint range of motion with the digital goniometer.
    Measuring MP joint range of motion with the digital goniometer.
  • Measuring PIP joint range of motion with the digital goniometer.
    Measuring PIP joint range of motion with the digital goniometer.
Definition of Positive Result
  • 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.
Definition of Negative Result
  • 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.
Comments and Pearls
  • 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
Diagnoses Associated with Exams and Signs
Videos
Demonstrating active vs passive range of motion.
Demonstrating active range of motion.
References

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.
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