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Hand & Wrist Exam

Assessing Joint Movement

August 17th, 2019

Assessing Range of Motion

Passive movement is used to assess the objective range of motion of a joint.
  • How to Assess

  • Ask the patient to relax, and move their joint. Note the range of motion and whether it is limited by pain, swelling or stiffness. Note any crepitus.
  • Causes of Limited Range of Motion

  • Trauma - dislocation, fracture
  • Arthropathy - osteoarthritis, rheumatoid arthritis, septic arthritis, crystal arthropathy, seronegative arthropathy, haemarthrosis, loose intra-articular body
  • Soft tissue pathology - tendinitis, bursitis, menisceal tear, ligamentous tear, fibrous adhesions
  • Muscle tightness
  • Prolonged joint immobilisation
  • Compartment syndrome

Assessing Active Movement

Active movement is an indicator of the patient's ability to move the joint. It may be limited due to weakness, pain, mechanical stiffness or poor compliance.
  • How to Assess

  • Ask the patient to move the joint themselves. Assess the neutral position and the range of motion, and ask whether range of motion is limited by pain, weakness or stiffness.
  • Causes of Limited Active Movement

  • Reduced range of motion - trauma, arthropathy, soft tissue pathology, compartment syndrome, muscle tightness, prolonged immobilisation
  • Upper motor neuron lesion - stroke, tumour, trauma, hypoxia, demyelination, deposition, inflammation
  • Lower motor neuron lesion - trauma, compression, demyelination, diabetes
  • Neuromuscular disorder
  • Myopathy
  • Poor compliance

Extra Credit

  • Additional Causes of Limited Wrist Range of Motion

  • Fracture - radius, ulna, carpals
  • Nerve damage - radius, ulna, median nerve
  • Additional Causes of Limited Finger / Thumb Range of Motion

  • Dupuytren's contracture
  • De Quervain's tenosynovitis
  • Trigger finger (entrapment of tendon within tendon sheath)
  • Arthritis - gout, septic arthritis, osteoarthritis, rheumatoid arthritis
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