i) Active Extension - Have the patient push their palms flat against one another to assess active movement (prayer sign), The Prayer sign demonstrates both wristextension AND the ability to straighten the fingers.

A positive sign would be if the patient is unable to keep both hands flat against each other in either position indicating a loss of flexibility or deformity as seen in rheumatoid arthritis.

Prayer Sign - A negative prayer sign is shown on the left, and a positive is on the right. Note how in a positive sign the patient is unable to keep thier palms flat against one another.

ii) Active Flexion – Have the patient push the dorsal surface of their palms against one another.

A positive sign would again be if the patient is unable to keep their hands flat against one another owing to restriction of wrist flexion.

A negative test ie normal.

iii) Active Ulnar/Radial deviation – ask the patient to move their wrists laterally and medially.

If required: Passive – hold the patients wrist and move it through flexion, extension, and ulnar/radial deviation. Feel for crepitus.

i) Flexion and extension – Ask the patient to make a fist and then extend and spread their fingers.

It is common for patients with arthritis to be unable to make a closed fist.

During flexion the thumb should oppose the DIP joints and the fingertips should come into contact with the distal palmar crease.

During extension the fingers should be along the same plane as the dorsal aspect of the palm.

ii) Abduction / Adduction – Ask the patient to spread their fingers apart and back together against gravity.

Left: Finger abduction. Right: Finger adduction.

*iii) If required: Passive – move each finger through flexion, extension, abduction, adduction.

(If the patient is unable to perform these tasks, it may be due to joint disease, tendon rupture, or neurological damage.)

Assess patients ability to perform thumb flexion, extension, opposition, abduction, and adduction.

Top row left to right: flexion, extension, opposition. Bottom row left to right: abduction, adduction.