Completion of a full upper extremity motor exam would be ideal to rule out items on the differential, however this module will focus only on the wrist and hand. Motor tests should be performed in a comfortable position. The wrist or hand should not be forced through any sudden motions and caution should be used in proceeding through the assessment. As always, bilateral comparison is critical to determine normal or abnormal movement.
Active Range of Motion (AROM)
Wrist extension.
Image Source: Victoria Squissato
Wrist flexion.
Image Source: Victoria Squissato
Ulnar Deviation.
Image Source: Victoria Squissato
Radial Deviation.
Image Source: Victoria Squissato
Flexion at the thumb CMC joint.
Image Source: Victoria Squissato
Extension at the thumb CMC joint.
Image Source: Victoria Squissato
Abduction at the thumb CMC joint.
Image Source: Victoria Squissato
Adduction at the thumb CMC joint.
Image Source: Victoria Squissato
Opposition of the thumb and little finger: tip-to-tip, pad-to-pad, pad-to-side respectively.
Image Source: Victoria Squissato
Passive Range of Motion (PROM)
Wrist extension.
Image Source: Victoria Squissato
Wrist flexion.
Image Source: Victoria Squissato
Ulnar Deviation.
Image Source: Victoria Squissato
Also move the wrist through radial deviation. Next explore all the ranges of motion at the thumb CMC joint (flexion, extension, abduction, adduction, opposition). Please use the above AROM pictures as reference.
Resistance Testing
Abduction at the thumb CMC joint.
Image Source: Victoria Squissato
Opposition of the thumb and little finger. This is a subjective assessment of the patient's pincer grip strength.
Image Source: Victoria Squissato
Findings
Active Range of Motion (AROM)
Wrist extension.
Image Source: Victoria Squissato
Wrist flexion.
Image Source: Victoria Squissato
Ulnar Deviation.
Image Source: Victoria Squissato
Radial Deviation.
Image Source: Victoria Squissato
Flexion at the thumb CMC joint.
Image Source: Victoria Squissato
Extension at the thumb CMC joint.
Image Source: Victoria Squissato
Abduction at the thumb CMC joint.
Image Source: Victoria Squissato
Adduction at the thumb CMC joint.
Image Source: Victoria Squissato
Opposition of the thumb and little finger: tip-to-tip, pad-to-pad, pad-to-side respectively.
Image Source: Victoria Squissato
Passive Range of Motion (PROM)
Wrist extension.
Image Source: Victoria Squissato
Wrist flexion.
Image Source: Victoria Squissato
Ulnar Deviation.
Image Source: Victoria Squissato
Also move the wrist through radial deviation. Next explore all the ranges of motion at the thumb CMC joint (flexion, extension, abduction, adduction, opposition). Please use the above AROM pictures as reference.
Resistance Testing
Abduction at the thumb CMC joint.
Image Source: Victoria Squissato
Opposition of the thumb and little finger. This is a subjective assessment of the patient's pincer grip strength.
Image Source: Victoria Squissato
Findings
- AROM: Full vs. limited
- Pain: extreme ranges or globally
- PROM: Crepitus
- Resisted muscle testing: weak thumb abduction, weak pincer grip
Reference values: normal ranges1
- Wrist
- Flexion: 80-90 degrees
- Extension: 70-90 degrees
- Abduction: 15 degrees
- Adduction: 30-45 degrees
- Finger
- MCP joints: Hyperextension/Flexion: (0-45H)/90 degrees
- DIP joints: Extension/Flexion: 0/80 degrees
- PIP joints: Extension/Flexion: 0/100 degrees
- Thumb CMC
- Extension/Flexion: Contact/45 degrees
- Adduction/Abduction: Contact/60 degrees
- Opposition of the thumb and little finger: should be able to touch tip to tip, pad to pad, pad to side