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Passive Range of Motion

Information

Description of Intervention

Passive range of motion (ROM) is used to describe movement of the injured hand or wrist with the use of the non-involved hand, or with the aid of a therapist or physician. It shows the ability of a joint to be moved in its usual arc of motion, while relaxed. Tightness of a muscle or tendon can also limit passive ROM.1

The order of prescribing active and passive ROM depends on the patient’s injury or condition. Active ROM may be prescribed before passive ROM, to allow patients to mobilize their fingers and/or thumbs and return to their usual active range.2 During the acute phase of recovery from a hand injury, as determined by the physician, the therapist should delay using passive ROM. Using passive ROM too early, especially against the grain of the tendon, can cause further injury.1  On the contrary, patients with flexor tendon injuries may be encouraged to start passive ROM and progress to active, as recommended by published protocols. In some cases of joint dysfunction, including post-traumatic and post-surgical, active ROM may not be possible for the patient. In these cases, gentle passive motion may help to maintain the patient’s usual range.

Indications for Intervention

Variations in passive ROM in the hand or fingers can be post-traumatic, or post-surgical, after flexor or extensor tendon repair. Variations can also occur due to sprains, dislocations, fractures, burns, an acute phase in rheumatoid arthritis (RA), or due to the effects of Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD).

Diagnosis​

  1. Ask for the patient’s medical history, including any recent injuries to the arm, hand or fingers. If the patient has had a recent flexor tendon surgery, find out how many sutures were used.
  2. With a goniometer, measure the passive ROM arc of motion.3
  3. Measure the injured area, using the Littler Line Method and area under the Gaussian curve, or asses active pulp to distal palmar crease measurements.4
  4. Examine the contralateral arm and hand, to establish the patient’s usual arc of motion and sensation to be sure parasthesias aren’t altering the patients perception of motion.
  5. Ask the patient for any comorbidities, including smoking, diabetes or osteopenia.
  6. If the patient’s passive ROM measurements have changed since a previous appointment, note whether this change results from pain, stiffness or both.3

Intervention Options

Once passive ROM is advised by the physician, the patient must interrupt immobilization each day, to allow for passive ROM exercises. These exercises may include the wrist, elbow and shoulder.2 As recovery continues, resisted ROM can be introduced gradually. The timing of resisted motion depends on tensile strength, timeliness / phase of healing, and the response of each individual patient to surgery.

Respecting comorbidities and connective tissue disorders is also vital to an optimally functioning hand. Patients with RA may need to pause exercise programs for times of flare up, extreme pain or surgical recovery. Medications will help them to resume exercises. When patients with RA experience active inflammation, passive or gentle assisted motion is recommended. Passive exercises will improve the patient’s ability to use large objects and clean the hand.2 Patients with RA can also use therapeutic splinting to help relieve pain and inflammation of the hand and wrist.

Patients with CRPS, after addressing pain management, may also benefit from gentle passive ROM exercises. With CRPS, ROM of any type can flare up the CRPS if it’s too aggressive or intense. These exercises can become part of a multi-faceted treatment program.1

Patients with Dupuytren’s disease, after surgery, should include gentle passive flexion in their home therapy exercises. They should also use static night extension splints for 6 months; these splints should be modified as the fingers begin to recover extension.5

Young patients with symphalangism, for 6 months after surgery, should use passive ROM exercises, to increase abilities in daily activities. Parents and guardians should understand that the exercises may cause some pain, but they should encourage their children to continue exercising, as part of the rehabilitation process.6

Diagnoses Where This Intervention May be Relevant
Comments and Pearls
  • Patients under the age of 12, who have flexor tendon injuries, should keep their injured hand immobilized in a cast for 3-4 weeks, depending on their ability to follow the exercise recommendations. They can interrupt this immobilization for passive ROM activities.
  • Patients with RA may seek counseling, in addition to hand therapy, to aid in motivation for dealing with joint changes, to continue with activities they enjoy.2
References
  1. Wietlisbach C. Cooper’s Fundamentals of Hand Therapy. Missouri: Elsevier, 2020.
  2. Salter M, Cheshire L. Hand Therapy: Principles and Practice. Oxford: Reed Educational and Professional Publishing Ltd, 2000.
  3. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  4. Catalano LW III, Browne RH, Carter PR, et al. The Littler line method and the area under a Gaussian curve: a new method of assessing digital range of motion. J Hand Surg 2001;26A:23-30. PMID: 11172364
  5. Sampson S, Badalamente MA, Hurst LC, et al. The use of a passive motion machine in the postoperative rehabilitation of Dupuytren’s disease. J  Hand Surg 1992;17A:333-8. PMID: 1564284
  6. Baek GH, Kim J, Park JW. Mobilization of joints of the hand with symphalangism. Hand Clin 2017;33(3):551-60. PMID: 28673631
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