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Range of Motion: Passive

Exams and Signs

Historical Overview

Historically, physicians have used a metric ruler or goniometer to measure passive range of motion (ROM).1 By 2006, a new goniometer was developed, particularly for the measurement of small joints.2

Description

  • For an examination of passive ROM, the physician moves the patient’s affected area(s) of the hand, wrist and/or elbow. This will show the passive range of strength for each joint.1
  • Typical degrees of motion for each joint in the hand and for the wrist and elbow are provided in the Table.3,4
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

 

Pathophysiology

  • Loss of passive ROM may be due to rheumatoid arthritis (RA), Dupuytren’s disease, cerebral palsy5 or a neurological injury.6
  • There will be a typical pattern of tenodesis when a patient loses motion from a neurological injury.6
  • In infants and children with cerebral palsy, it is helpful to exercise with passive ROM, so that the patient does not develop further fixed-joint stiffness.5

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. Assist the patient to flex, extend, abduct, and adduct the affected area(s). Measure each joint separately with a goniometer.1
  3. If the patient experiences a change in passive motion 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

  • Also check the ulnar deviation and radial deviation of the wrist.

Related Signs and Tests

  • Pulp-to-palm, passive
  • Passive stretch test
  • ROM, active
  • Grip strength
  • Neuromuscular testing1
  • Nerve conduction studies
  • Radiographs
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • 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 with Digital Goniometer
  • 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
  • Measuring PIP joint range of motion with the digital goniometer.
Definition of Negative Result
  • A negative result occurs when the patient does not achieve full ROM with assistance, within the typical ranges for each joint of the hand, wrist and/or elbow.
Comments and Pearls
  • If there is a difference between joint active and passive ROM, this is called active-passive mismatch. Tendon adhesions may cause this mismatch.1
  • After further studies, dynamic EMG/motion laboratory analysis may be an important tool for diagnosing cerebral palsy and measuring its severity.5  The arc of motion that a joint allows when it is normal can easily be measured and observed; therefore abnormalities in joints and joint function can be assessed by loss    of motion. Measuring this loss helps to quantify the patient’s deficits.
  • Range of motion can be assessed as either active or passive.  When doing a passive range of motion assessment, the examiner places the joint in the maximum position allowed by the soft tissue constraints of the joint without the patient’s muscle power.
  • The muscles around any given joint provide a range of flexion, extension, rotation, and deviation which is inherent to each particular joint. When measuring ROM, we measure by either visual assessment or by a goiniometer.
  • It is critical to compare measurements to the contralateral joint to determine a baseline and assess for deficits if any.
Diagnoses Associated with Exams and Signs
Videos
Demonstrating active vs passive range of motion.
Demonstrating passive 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. 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
  3. Rayan G, Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
  4. Adams BD, Grosland NM, Murphy DM, et al. Impact of impaired wrist motion on hand and upper-extremity performance. J Hand Surg Am 2003;28:898-903. PMID: 14642503
  5. Bunata R, Icenogle K. Cerebral palsy of the elbow and forearm. J Hand Surg Am 2014;39(7):1425-32. PMID: 24969499
  6. Kenney RJ, Hammert WC. Physical Examination of the Hand. J Hand Surg Am 2014;39(11):2324-34. PMID: 25442747
  7. Dutton M. Orthopaedic Examination, Evaluation and Intervention. McGraw-Hill, 2004, pp. 537, 613-615
  8. 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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