Goniometry for Wrist & Fingers

An Introduction to Joint ROM Goniometric measurement techniques for Wrist, Carpometacarpal joint, Metacarpophalangeal joints & Interphalangeal Joints (Traditional & Recent Methods)

1. Goniometry for wrist & fingers

2. WHY HAND IS SO SPECIAL… 27 bones 27 Joints 34 muscles 3 major nerves 100 ligaments & tendons 2 major arteries Major representation in Brain & so on…..

3. THE REAL MAN…

4. HAND PHYSIOTHERAPY – A SUPER SPECIALITY Micro & Macro surgeries – Vascular, Orthopaedic , Plastic surgeons, Neuro surgeons etc Hand surgeons, Thumb surgeons etc., Toe to thumb transfers Tendon repair & transplants Hand transplant – Transplants from cadaver. & Many more HAND PHYSIOTHERAPY

5. Universal full circle goniometer

6. UNIVERSAL FINGER GONIOMETER

7. Rolyan Finger/Toe Goniometer

8. Devore Pocket Goniometer

9. Baseline digit Finger Goniometer

10. Extendable Goniometers

11. NORMAL WRIST ROM

12. NORMAL FINGER ROM

13. NORMAL THUMB ROM

14. Wrist Flexion Test Position Subject sitting Forearm stabilized on table Flex wrist (fingers relaxed) Goniometer Alignment Axis – lateral wrist Stationary arm – aligned with ulna Moving arm – aligned with fifth metacarpal Normal Range 75° ± 6.6° (American Academy of Orthopaedic Surgeons) 60° (American Medical Association) 76.4° (mean) 6.3° (standard deviation), (Boone and Azen )

15. WRIST EXTENSION Test Position Subject sitting Forearm stabilized on table Extended wrist (fingers relaxed) Goniometer Alignment Axis – lateral wrist (triquetrum) Stationary arm – aligned with ulna Moving arm – aligned with fifth metacarpal Normal Range 74° ± 6.6° (American Academy of Orthopaedic Surgeons) 60° (American Medical Association) 74.9° (mean) 6.4° (standard deviation), (Boone and Azen )

16. WRIST RADIAL DEVIATION Test Position Subject sitting with forearm resting on table Stabilize forearm to prevent pronation or supination Goniometer Alignment Axis – capitate Stationary arm – aligned with forearm (lateral epicondyle) Moving arm – aligned with metacarpal of middle finger Normal Range 21° ± 4.0° (American Academy of Orthopaedic Surgeons) 20° (American Medical Association) 21.5° (mean) 4.0° (standard deviation), (Boone and Azen )

17. WRIST ULNAR DEVIATION Test Position Subject sitting with forearm resting on table Stabilize forearm to prevent pronation or supination Goniometer Alignment Axis – capitate Stationary arm – aligned with forearm (lateral epicondyle) Moving arm – aligned with metacarpal of middle finger Normal Range 35° ± 3.8° (American Academy of Orthopaedic Surgeons) 30° (American Medical Association) 36.0° (mean) 3.8° (standard deviation), (Boone and Azen )

18. Metacarpophalangeal Joint Flexion Test Position Subject sitting with forearm resting on table Wrist and interphalangeal joints relaxed Forearm neutral Stabilize metacarpal to prevent motion Goniometer Alignment Dorsal metacarpophalangeal joint Stationary arm - aligned with metacarpal Moving arm – aligned with proximal phalange Normal Range 86° (index), 91° (ring), 105° (little) (American Academy of Orthopedic Surgeons - active motion) 90° (American Medical Association)

19. Metacarpophalangeal Joint Extension Test Position Subject sitting with forearm resting on table Wrist and interphalangeal joints relaxed Forearm neutral Stabilize metacarpal to prevent motion Goniometer Alignment Dorsal metacarpophalangeal joint Stationary arm - aligned with metacarpal Moving arm – aligned with proximal phalange Normal Range 22° (index), 18° (long), 23° (ring), 19° (little) (American Academy of Orthopedic Surgeons - active motion) 20° (American Medical Association)

20. Metacarpophalangeal Joint Abduction Test Position Subject sitting with forearm resting on table Wrist neutral Forearm neutral Stabilize metacarpal to prevent motion Goniometer Alignment Dorsal metacarpophalangeal joint Stationary arm - aligned with metacarpal Moving arm – aligned with proximal phalange Normal Range 25° ( Physiopedia )

21. Metacarpophalangeal Joint Adduction Test Position Subject sitting with forearm resting on table Wrist neutral Forearm neutral Stabilize metacarpal to prevent motion Goniometer Alignment Dorsal metacarpophalangeal joint Stationary arm - aligned with metacarpal Moving arm – aligned with proximal phalange Normal Range Either 0° or usually not measured.

22. Interphalangeal Joint Flexion Test Position Subject sitting with forearm resting on table Wrist, metacarpal, and non-tested interphalangeal joints relaxed Forearm neutral Stabilize proximal bone to prevent motion Goniometer Alignment Dorsal proximal interphalangeal joint Stationary arm - aligned with proximal phalange Moving arm – aligned with middle phalange Normal Range American Academy of Orthopedic Surgeons PIP fingers - 102° (index), 105° (long), 108° (ring), 106° (little) (active motion) DIP fingers - 72° (index), 71° (long), 63° (ring), 65° (little) (active motion) IP thumb - 73° American Medical Association 100° (PIP finger), 70° (DIP fingers), 80° (IP thumb)

23. Interphalangeal Joint Extension Test Position Subject sitting with forearm resting on table Wrist, metacarpal, and non-tested interphalangeal joints relaxed Forearm neutral Stabilize proximal bone to prevent motion Goniometer Alignment Dorsal proximal interphalangeal joint Stationary arm - aligned with proximal phalange Moving arm – aligned with middle phalange Normal Range American Academy of Orthopedic Surgeons PIP fingers - 7° (index), 7° (long), 6° (ring), 9° (little) (active motion) DIP fingers - 8° (all finger DIPs) IP thumb - 5° American Medical Association 0°

24. Thumb Carpometacarpal Joint Flexion Test Position Subject sitting with forearm resting on table Wrist neutral Stabilize carpals to prevent wrist motion Goniometer Alignment Axis - carpometacarpal joint Stationary arm - aligned with radius Moving arm – aligned with metacarpal of thumb Normal Range 15° (American Academy of Orthopedic Surgeons)

25. Thumb Carpometacarpal Joint Extension Test Position Subject sitting with forearm resting on table Wrist neutral Stabilize carpals to prevent wrist motion Goniometer Alignment Axis - carpometacarpal joint Stationary arm - aligned with radius Moving arm – aligned with metacarpal of thumb Normal Range 20° (American Academy of Orthopedic Surgeons)

26. Thumb Carpometacarpal Joint Abduction Test Position Subject sitting with forearm resting on table Wrist neutral Forearm neutral Stabilize carpals to prevent wrist motion Goniometer Alignment Axis - radial styloid Stationary arm - aligned with metacarpal of index finger Moving arm – aligned with metacarpal of thumb Normal Range 70° (American Academy of Orthopedic Surgeons)

27. Thumb Carpometacarpal Joint Adduction Test Position Subject sitting with forearm resting on table Wrist neutral Forearm neutral Stabilize carpals to prevent wrist motion Goniometer Alignment Axis - radial styloid Stationary arm - aligned with metacarpal of index finger Moving arm – aligned with metacarpal of thumb Normal Range Either 0° or usually not measured. NOTE: Thumb adduction is the return to neutral from thumb abduction. Thumb adduction is rarely measured, probably because it is rarely limited.

28. Thumb Carpometacarpal Joint Opposition Test Position Subject sitting with forearm supinated and resting on table Wrist neutral Stabilize fifth metacarpal Goniometer Alignment Goniometer cannot be used Use a ruler to measure distance between tip of thumb and base of fifth finger Normal Range Able to touch tip of thumb to base of fifth finger (American Academy of Orthopedic Surgeons) NOTE: The American Academy of Orthopedic Surgeons suggests that opposition range is normal when the tip of thumb can touch the base of fifth finger. When range is not adequate, a ruler can be used to measure the distance between the tip of thumb and the base of the fifth finger.

29. NORMAL ROM VALUES (AAOS VALUES)

30. FINGERS: COMPOSITE FLEXION OF THE MCP, PIP, AND DIP JOINTS

31. Gravity Goniometer/Inclinometer One arm has a weighted pointer that remains vertical under the influence of gravity

32. Bubble inclinometer

33. Software/Smartphone-based Goniometer apps Goniometer Records Goniometro Advance Goniometer Pro App (G-Pro) Goniometer Plus DrGoniometer

34. Digital laser goniometer

35. The E-LINK ROM goniometry

36. ELECTRO GONIOMETER ( Fariborz et al., 2015)

37. e lectrogoniometer Single Axis Electrogoniometer Twin Axis Electrogoniometer

38. fiber optic goniometric glove (Sam Wise et al., 1990)

39. CyberGlove – virtual goniometry G. Drew Kessler et al., 1995

40. Non-Contact Measurement System (Intel Perceptual Technology and a Senz3D Camera) (Trieu Pham et al., 2015)

41. 3D motion analysis (Gabriella Fischer et al., 2020)

42. References American Academy of Orthopedic Surgeons (Green WB, Heckman JD eds.): The Clinical Measurement of Joint Motion. 6300 North River Road, Rosemont, IL 60018, 1994, ISBN 0-89203-090-9. American Medical Association: Guide to the Evaluation of Permanent Impairment. AMA, Chicago, 1988. Boone DC, Azen SP: Normal range of motion of joints in male subjects. Journal of Bone and Joint Surgery 1979;61A:756-759. Magee DJ: Orthopedic Physical Assessment, 3rd ed. WB Saunders Co, Philadelphia, 1997, ISBN 0-7216-6290-0. Norkin CC, White DJ: Measurement of Joint Motion: A Guide to Goniometry, 2nd ed. FA Davis Co, Philadelphia, 1995, ISBN 0-8036-6579-2. Physiopedia