I BOT_Hand ROM_Punita V. Solanki_14.06.2022.pdf

Notes on Hand ROM

1. CourseSyllabus:KeralaUniversityof
HealthSciences(KUHS)BOTProgramme
2020
CourseCode:022
Year:First(I)BOT
Subject:105-Introductionto
OccupationalTherapyandTherapeutic
Activities
Lecture:ModuleVIII:RangeofMotion
(ROM)-Hand
Punita V. Solanki
MSc (OT), Fellow ACOT (AIOTA), ADCR (Mumbai)
Principal (BOT Programme)
Mobile:[phone] (Personal)
Email: [email protected] 2022

2. Table of Contents
Punita V. Solanki
1. Anatomy of Hand
2. Range of Motion Testing
3. Quiz Time
4. References
June 2022

3. Punita V. Solanki
Anatomy of Hand
Anatomy of Right Hand -Dorsal Surface
19 Bones & 19 Joints
in the Hand
(5 CMC, 5 MCP,
5 PIP & 4 DIP)
3 of 8 Carpal
Bones + Radius +
Radio-Ulnar Disc
(Wrist Complex)
June 2022
CMC: Carpo-Metacarpal; MCP: Meta-Carpo-Phalangeal; PIP: Proximal Inter Phalangeal;
DIP: Distal Inter Phalangeal; D: Distal; P: Proximal; L: Lateral; M: Medial
D
P
ML

4. Punita V. Solanki
Anatomy of Hand
Anatomy of Right Hand –Volar/Palmar Surface
3 Arches of Hand
Carpal Tunnel
June 2022
D: Distal; P: Proximal; L: Lateral; M: Medial
D
P
LM

5. Punita V. Solanki
Degrees of Freedom of Motion: Hand
❑CMC Joint of Thumb: 3°of FoM (Sagittal, Frontal & Transverse)
❑MCP Joints Fingers: 2°of FoM (Sagittal & Frontal)
❑MCP Joint Thumb: 2°of FoM (Sagittal&Frontal [Limited])
❑PIP Joints: 1°of FoM (Sagittal Plane: from Extension to Flexion
with No Hyperextension) (Thumb IP Joint: SagittalPlane: from
Extension to Flexion and Some Hyperextension)
❑DIP Joints: 1°of FoM (Sagittal Plane: from Extension to Flexion
with Slight Hyperextension.
June 2022
FoM: Freedom of Motion; CMC: Carpo-Metacarpal; MCP: Meta-Carpo-Phalangeal;
PIP: Proximal Inter Phalangeal; DIP: Distal Inter Phalangeal; IP: Inter Phalangeal
£ Reference No. 1 (Norkin)
Circumduction is possible in joints with ≥2 Degrees of Freedom of Motion

6. Punita V. Solanki
Range of Motion Testing
❑Typesofgoniometerforhandrangeofmotiontesting
❑Normsofrangeofmotionvaluesbyvariousacademicbodies
e.g.,AmericanAcademyofOrthopaedicSurgeons(AAOS),
AmericanMedicalAssociation(AMA),AmericanSocietyfor
SurgeryoftheHand(ASSH),InternationalFederationofSocieties
forSurgeryoftheHand(IFSSH)
❑Standardizedpositionsofthepatients,oftheelbow,forearm,
jointsofwristandhand&thegoniometer,whilstperforming
rangeofmotiontesting
❑Methodsofdocumentationsofrangeofmotion,bilateral
assessmentsalongwithdocumentingnormalrangeofmotion
andendfeels.
❑A5-degreemarginoferrorisacceptableforgoniometric
measurementsofjointsinthehandbyanexperiencedexaminer
usingstandardizedprotocols.
~(Bear-Lehman,JaneandAbreu,BeatrizC;1989)
June 2022

7. Punita V. Solanki
Types of Goniometer
Types of Finger Goniometer (FG):
Rolyan Finger/Toe Goniometer
Rolyan Flexion/Hyperextension FG
Jamar 8-Inch Goniometer
Baseline Stainless Steel FG
June 2022

8. Punita V. Solanki
Range of Motion Testing
Documentation Template: Fingers
Joints Left Hand Right Hand Norms
Fingers (IF to LiF)PROMEnd
Feel
PROMEnd
Feel
ROM End
Feel
MCP Extension to
Flexion
0°-90°¥≠ Hard
to
Firm*
MCP Extension to
Hyperextension
0°-15°-45°¥£Firm*
MCP Abduction
MCP Adduction
0°-25°¥
NoNorms
Firm*
Firm £
PIP Extension to
Flexion
0°-110°¥
0°-100°≠
Hard
to
Firm*
DIP Extension to
Flexion
0°-80°¥
0°-90°≠
Firm*
IF: Index Finger; LiF: Little Finger; MCP: Meta-Carpo-Phalangeal; PIP: Proximal Inter
Phalangeal; DIP: Distal Inter Phalangeal
*American Academy of Orthopaedic Surgeons (1974) (Both Pedretti and Trombly follow AAOS)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also
≠Reference No. 3 (Trombly) ¥ Reference No. 4 (Pedretti); £ Reference No. 1 (Norkin)
June 2022

9. Punita V. Solanki
Range of Motion Testing
Fingers Meta-Carpo-Phalangeal (MCP) Joint Flexion
¥≠
June 2022
FingersMetacarpophalangealFlexion:0°to90°*
¥≠
PositionoftheClient
Seatedwiththeelbowflexed,theforearminmidposition,thewristat
0-degreeneutralposition,andtheforearmandhandsupportedona
firmsurfaceontheulnarborder.
PositionoftheGoniometer
TheaxisiscenteredonthedorsalaspectoftheMCPjointforallfingers
:IF,LF,RFandLiF.
Thestationarybarisontopofthemetacarpal,andthemovablebaris
ontopoftheproximalphalanx.
End-Feel
HardorFirm*
IF: Index Finger; LF: Long (Middle) Finger; RF: Ring Finger; LiF: Little Finger
*American Academy of Orthopaedic Surgeons (1974)
¥ Reference No. 4 (Pedretti); ≠Reference No. 3 (Trombly)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

10. Punita V. Solanki
Range of Motion Testing
Fingers Meta-Carpo-Phalangeal (MCP) Joint Hyperextension
IF: Index Finger; LF: Long (Middle) Finger; RF: Ring Finger; LiF: Little Finger
*American Academy of Orthopaedic Surgeons (1974)
¥ Reference No. 4 (Pedretti); £ Reference No. 1 (Norkin)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) alsoJune 2022
FingersMetacarpophalangealHyperextension:0°to45°*
¥£
PositionoftheClient
Seatedwiththeelbowflexed,theforearminmidposition,thewristat
0-degreeneutralposition,andtheforearmandhandsupportedona
firmsurfaceontheulnarborder.
PositionoftheGoniometer
TheaxisiscenteredonthelateralaspectoftheMCPjointofindex
finger(IF)orlittlefinger(LiF)andonthevolaraspectofthehandfor
long(middle)finger(LF)andringfinger(RF).
Thestationarybarisparalleltothemetacarpal,andthemovablebaris
paralleltotheproximalphalanx.
End-Feel
Firm*

11. Punita V. Solanki
Range of Motion Testing
Fingers Meta-Carpo-Phalangeal (MCP) Joint Abduction
¥
IF: Index Finger; LF: Long (Middle) Finger; RF: Ring Finger; LiF: Little Finger
MP: Meta-Carpo-Phalangeal; *American Academy of Orthopaedic Surgeons (1974)
¥ Reference No. 4 (Pedretti)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) alsoJune 2022
Fingers Metacarpophalangeal Abduction: 0°to 25°*
¥
Position of the Client
Seated with the forearm pronated, the wrist at 0-degree neutral
deviation, the fingers straight, and the hand resting on a firm surface.
Position of the Goniometer
The axis is centered over the MCP joint being measured. The stationary
bar is over the corresponding metacarpal, and the movable bar is over
the proximal phalanx.
End-Feel
Firm*

12. Punita V. Solanki
Range of Motion Testing
Fingers Meta-Carpo-Phalangeal (MCP) Joint Adduction
IF: Index Finger; LF: Long (Middle) Finger; RF: Ring Finger; LiF: Little Finger
MP: Meta-Carpo-Phalangeal; *American Academy of Orthopaedic Surgeons (1974)
£ Reference No. 1 (Norkin)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) alsoJune 2022
Fingers Metacarpophalangeal Adduction
MCPadductionisnotusuallymeasuredandrecordedseparatelyfrom
MCPabduction,becauseitisthereturnfromfullabductiontothe0
startingposition.ThereisverylittleadductionROMbeyondthe0
startingposition.NosourceswerefoundfornormalMCPadduction
ROMvalues.Thetestingposition,stabilization,andgoniometer
alignmentaresimilartomeasuringMCPabduction
Position of the Client
Seated with the forearm pronated, the wrist at 0-degree neutral
deviation, the fingers straight, and the hand resting on a firm surface.
Position of the Goniometer
The axis is centered over the MCP joint being measured. The stationary
bar is over the corresponding metacarpal, and the movable bar is over
the proximal phalanx.
End-Feel: Firm*

13. Punita V. Solanki
Range of Motion Testing
Fingers Proximal Inter Phalangeal (PIP) Joint Flexion
¥≠
June 2022
ProximalInterPhalangealFlexion:0°to110°*(0°to100°*≠)
PositionoftheClient
Seatedwiththeelbowflexed,theforearminmidposition,thewristat
0-degreeneutralposition,andtheforearmandhandsupportedona
firmsurfaceontheulnarborder.
PositionoftheGoniometer
TheaxisiscenteredonthedorsalsurfaceofthePIPjointbeing
measured.Thestationarybarisplacedovertheproximalphalanx,and
themovablebarisoverthemiddlephalanx.
AlternativeMethod:Thejointcanalsobemeasuredwitharuler.The
DIP,PIPandMCPjointsofthefingersareflexedtowardthepalm.A
rulerisusedtomeasurefromthepulpofthemiddle
fingertotheproximalpalmarcrease.
End-Feel
HardorFirm*
IF: Index Finger; LF: Long (Middle) Finger; RF: Ring Finger; LiF: Little Finger
MP: Meta-Carpo-Phalangeal; PIP: Proximal Inter Phalangeal; DIP: Distal Inter Phalangeal
*American Academy of Orthopaedic Surgeons (1974); ¥ Reference No. 4 (Pedretti); ≠Reference No.
3 (Trombly);*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

14. Punita V. Solanki
Range of Motion Testing
Fingers Distal Inter Phalangeal (DIP) Joint Flexion
¥≠
June 2022
DistalInterPhalangealFlexion:0°to80°*¥(0°to90°*≠)
PositionoftheClient
Seatedwiththeelbowflexed,theforearminmidposition,thewristat
0-degreeneutralposition,andtheforearmandhandsupportedona
firmsurfaceontheulnarborder.
PositionoftheGoniometer
TheaxisisonthedorsalsurfaceoftheDIPjoint.Thestationary
barisoverthemiddlephalanx,andthemovablebarisoverthedistal
phalanx.
AlternativeMethod:WiththeMCPjointsin0-degreeextension,the
clientflexestheDIPandPIPjointstowardthepalm.Witharuler,a
measurementistakenfromthepulpofthemiddlefingertothedistal
palmarcrease.
End-Feel
Firm*
IF: Index Finger; LF: Long (Middle) Finger; RF: Ring Finger; LiF: Little Finger
MP: Meta-Carpo-Phalangeal; PIP: Proximal Inter Phalangeal; DIP: Distal Inter Phalangeal
*American Academy of Orthopaedic Surgeons (1974)
¥ Reference No. 4 (Pedretti); ≠Reference No. 3 (Trombly)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

15. Punita V. Solanki
Range of Motion Testing
Documentation Template: Thumb
Joints Left Hand Right Hand Norms
Thumb PROMEnd
Feel
PROMEnd
Feel
ROM End
Feel
CMC Flexion 0°-15°≠Firm*
CMCExtension 0°-20°≠Firm*
CMC Radial Abduction 0°-50°¥
0°-80°≠
Firm*
CMC Palmar Abduction 0°-50°¥
0°-70°≠
Firm*†
CMC Opposition ¥ ≠
TOT £
- Soft to
Firm*
*American Academy of Orthopaedic Surgeons (Opposition is Measured with Measure Tape)
†American Society for Surgery of the Hand; Method Used: Finger Goniometry
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also
CMC: Carpo-Metacarpal
≠Reference No. 3 (Trombly); ¥ Reference No. 4 (Pedretti); £ Reference No. 1 (Norkin)
June 2022
¥≠ Reference No. 3 (Trombly) & 4 (Pedretti): Deficits in opposition may be recorded by
measuring the distance between the centers of the pads of the thumb and the fifth (little)
finger with a centimeter ruler. £ Total Opposition Test (Reference No. 1: Norkin)

16. Punita V. Solanki
Range of Motion Testing
Total Opposition Test
Thumb Carpo-Metacarpal (CMC) Joint OppositionJune 2022
£ Total Opposition Test (Reference No. 1: Norkin)

17. Punita V. Solanki
Range of Motion Testing
Thumb Carpo-Metacarpal Joint Flexion
June 2022
ThumbCarpo-MetacarpalFlexion:0°to15°*≠-25°£
PositionoftheClient
Seatedwiththeforearmmidpronationandthehandrestingonulnar
borderonafirmsurface.
PositionoftheGoniometer
Axis:Ontheradialsideofthewristatthejunctionofthe
baseofthefirstmetacarpalandthetrapezium.
StationaryArm:Paralleltothelongitudinalaxisoftheradius.
MovableArm:Paralleltothelongitudinalaxisofthefirstmetacarpal.
Foraccuracy,thearmsofthegoniometermustremaininfullcontact
withskinsurfaceoverthebones.
End-Feel
Firm
*American Academy of Orthopaedic Surgeons (1974)
≠Reference No. 3 (Trombly); £ Reference No. 1 (Norkin)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

18. Punita V. Solanki
Range of Motion Testing
Thumb Carpo-Metacarpal Joint Extension
June 2022
ThumbCarpo-MetacarpalExtension:0°to20°*≠-35°£
PositionoftheClient
Seatedwiththeforearminsupinationandthehandrestingondorsal
surfaceonafirmsurfaceandpalmfacingup.
PositionoftheGoniometer
Axis:Onthevolarsideofthewristatthejunctionofthebaseofthe
firstmetacarpalandthetrapezium.
StationaryArm:Paralleltothelongitudinalaxisoftheradius.
MovableArm:Paralleltothelongitudinalaxisofthefirstmetacarpal.
End-Feel
Firm
*American Academy of Orthopaedic Surgeons (1974)
≠Reference No. 3 (Trombly); £ Reference No. 1 (Norkin)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

19. Punita V. Solanki
Range of Motion Testing
Thumb Carpo-Metacarpal Joint Radial Abduction
June 2022
ThumbCarpo-MetacarpalRadialAbduction:0°to50°*
¥
(0°to80°*≠)
PositionoftheClient
Seatedwiththeforearmpronatedandthehandpalmdown,resting
flatonafirmsurface.
PositionoftheGoniometer
Theaxisisoverthecarpometacarpal(CMC)jointatthebaseofthe
thumbmetacarpal.Thestationarybarisparalleltotheradius,andthe
movablebarisparalleltothethumbmetacarpal.
RadialAbduction(AlternativeMethod)
PositionoftheClientandGoniometer
Theclientispositionedthesameasdescribedinthefirstmethod.The
axisisovertheCMCjointatthebaseofthethumbmetacarpal.The
stationaryandmovablebarsaretogetherandparalleltothethumb
andthefirstmetacarpals.Neitherwillbedirectlyoverthesebones.
End-Feel:Firm
CMC: Carpo-Meta-Carpal
*American Academy of Orthopaedic Surgeons (1974); ¥ Reference No. 4 (Pedretti); ≠Reference No.
3 (Trombly); *Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

20. Punita V. Solanki
Range of Motion Testing
Thumb Carpo-Metacarpal Joint Palmar Abduction
June 2022
Thumb Carpo-Metacarpal Palmar Abduction: 0°to 50°*
¥
(0°to70°*≠)
PositionoftheClient
Seatedwiththeforearmat0°midposition,thewristat0°andthe
forearmandhandrestingontheulnarborder.Thethumbisrotatedso
thatitisatrightanglestothepalmofthehand.
PositionoftheGoniometer
Theaxisisatthejunctionofthethumbandindexfingermetacarpals.
Thestationarybarisovertheradius,andthemovablebarisparallelto
thethumbandindexfingermetacarpals
PalmarAbduction(AlternativeMethod)
PositionoftheClientandGoniometer
Theclientispositionedinthesamewayasinthefirstmethod.The
axisisatthejunctionofthethumbandIFmetacarpals.Thestationary
andmovablebarsarelineduptogether,paralleltothethumbandIF
metacarpals.
End-Feel:Firm
IF: Index Finger
*American Academy of Orthopaedic Surgeons (1974); ¥ Reference No. 4 (Pedretti); ≠Reference No.
3 (Trombly); *Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

21. Punita V. Solanki
Range of Motion Testing
Documentation Template: Thumb
Joints Left Hand Right Hand Norms
Thumb PROMEnd
Feel
PROM End
Feel
ROM End
Feel
MCPExtension to
Flexion
0°-50°
≠ ¥
0°-60°
£∞
Hard
or
Firm*
MCP Extension to
Hyperextension
0°-10°†
0°* £
Firm†
IP Extension to Flexion 0°-90°¥
0°-80°
≠*†∞
Hard
or
Firm*
IP Extension to
Hyperextension
0°-20°*†
0°-30°∞
0°-40°††
Firm†
£
*American Academy of Orthopaedic Surgeons;†American Society for Surgery of the Hand
†† International Federation of Societies for Surgery of the Hand
∞American Medical Association; *Check for Total Active Motion (TAM) and Total Passive
Motion (TPM) also; MCP: Meta-Carpo-Phalangeal; IP: Inter Phalangeal
≠Reference No. 3 (Trombly); ¥ Reference No. 4 (Pedretti); £Reference No. 1 (Norkin)
June 2022

22. Punita V. Solanki
Range of Motion Testing
Thumb Meta-Carpo-Phalangeal (MCP) Joint Flexion
June 2022
ThumbMetacarpophalangealFlexion:0°to50°*¥≠-60°£
PositionoftheClient
Seatedwiththeelbowflexed,theforearmin45degreesofsupination,
thewristat0-degreeneutraldeviation,theMCPandIPjointsin
extension,andthehandandforearmsupportedonafirmsurface.
PositionoftheGoniometer
TheaxisisonthedorsalsurfaceoftheMCPjoint.Thestationarybaris
overthethumbmetacarpal,andthemovablebarisovertheproximal
phalanx.
End-Feel
HardorFirm*
MCP: Metacarpo Phalangeal; IP: Inter Phalangeal
*American Academy of Orthopaedic Surgeons (1974)
≠Reference No. 3 (Trombly); ¥ Reference No. 4 (Pedretti); £ Reference No. 1 (Norkins)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

23. Punita V. Solanki
Range of Motion Testing
Thumb Meta-Carpo-Phalangeal (MCP) Joint Hyperextension
June 2022
ThumbMetacarpophalangealHyperextension:0°to10°†(0°£)
PositionoftheClient
Seatedwiththeelbowflexed,theforearmin45degreesofsupination,
thewristat0-degreeneutraldeviation,theMCPandIPjointsin
extension,andthehandandforearmsupportedonafirmsurface.
PositionoftheGoniometer
TheaxisisonthevolarsurfaceoftheMCPjoint.Thestationarybaris
overthethumbmetacarpal,andthemovablebarisovertheproximal
phalanx.
End-Feel
HardorFirm*
MP: Metacarpo Phalangeal; IP: Inter Phalangeal
†American Society for Surgery of the Hand
£ Reference No. 1 (Norkin)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

24. Punita V. Solanki
Range of Motion Testing
Thumb Inter Phalangeal (IP) Joint Flexion
¥ ≠
June 2022
ThumbInterPhalangealFlexion:0°to90°*¥(0°-80°*≠)
PositionoftheClient
Seatedwiththeelbowflexed,theforearminmidposition,thewristat
0-degreeneutralposition,andtheforearmandhandsupportedona
firmsurfaceontheulnarborder.
PositionoftheGoniometer
TheaxisiscenteredonthedorsalsurfaceoftheIPjointbeing
measured.
Thestationarybarisplacedovertheproximalphalanx,andthe
movablebarisoverthedistalphalanx.
End-Feel
HardorFirm*
IP: Inter Phalangeal
*American Academy of Orthopaedic Surgeons (1974)
≠Reference No. 3 (Trombly); ¥ Reference No. 4 (Pedretti)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

25. Punita V. Solanki
Range of Motion Testing
Thumb Inter Phalangeal (IP) Joint Hyperextension
June 2022
ThumbInterPhalangealHyperextension:0°to20°*£(0°-30°∞£)
(0°-40°†£)
PositionoftheClient
Seatedwiththeelbowflexed,theforearminmidposition,thewristat
0-degreeneutralposition,andtheforearmandhandsupportedona
firmsurfaceontheulnarborder.
PositionoftheGoniometer
TheaxisiscenteredonthevolarsurfaceoftheIPjointbeing
measured.
Thestationarybarisplacedovertheproximalphalanx,andthe
movablebarisoverthedistalphalanx.
End-Feel
HardorFirm*
IP: Inter Phalangeal; *American Academy of Orthopaedic Surgeons (1974)
†International Federation of Societies for Surgery of the Hand; ∞American Medical Association
£ Reference No. 1 (Norkin)
*Check for Total Active Motion (TAM) and Total Passive Motion (TPM) also

26. Quiz Time
Punita V. Solanki
Say True or False
❑Circumductionispossibleonlyinthosejointswiththreedegreesof
freedomofmotion.
Answer:False
❑Therearetwodegreesoffreedomofmotion
Answer:False
❑Thereare3planesand3axesofjointmotion
Answer:True
❑Aspecialfingergoniometerhasdial’scalibrationfrom0°to120°
Answer:True
❑Innormaljointmotions,therearethreetypesofend-feels:soft,firm
&hard
Answer:True
June 2022

27. Quiz Time
Punita V. Solanki
Say True or False
❑Flexion,ExtensionandHyper-Extensionoccursinsagittalplane
throughmedio-lateralaxis
Answer:True
❑AbductionandAdductionoccursinfrontalplanethroughantero-
posterioraxis
Answer:True
❑Rotationoccursintransverseplanethroughlongitudinalaxis
Answer:True
❑Rangeofmotionassessmentbygoniometerorrulerisanobjective
methodofassessment
Answer:True
❑Emptyend-feel&boggyend-feelarecomeacrossedonlyinpatients
Answer:True
June 2022

28. Recommended Reading & References
Punita V. Solanki
1.Norkin CC, White DJ. Measurement of Joint Motion: A Guide to
Goniometry. 5
th
Edition. 2016. F. A. Davis Company. [Part II. Upper
Extremity Testing. Chapter 7. The Hand. Pages: 187-252.]
2. Reese NB, Bandy WD. Joint Range of Motion and Muscle Length Testing.
3
rd
Edition. 2017. Elsevier, Inc. [Section II. Chapter 5: Measurement of Range
of Motion of the Wrist and Hand. Pages: 101-142.]
3. Radomski MV, Trombly Latham CA. Occupational Therapy for Physical
Dysfunction. 7
th
Edition. 2014. Lippincott Williams & Wilkins, a Wolters
Kluwer Business. [Section II. Chapter 7: Assessing Abilities and Capacities:
Range of Motion, Strength, and Endurance. Pages: 144-241.]
4. Pendleton HM, Schultz-KrohnW. Pedretti’s Occupational Therapy:
Practice Skills for Physical Dysfunction. 7
th
Edition. 2013. Elsevier Mosby.
[Part IV: Chapter 21. Joint Range of Motion. Pages: 497-528.]
5. Bear-Lehman J, Abreu BC. Evaluating the Hand: Issues in Reliability
and Validity. Physical Therapy 1989; 69: 1025-1033. PMID: 2685841
DOI: 10.1093/ptj/69.12.1025
June 2022

29. June 2022