Assessing Joint Movement | Hand & Wrist Exam - MedSchool
Sign up to start your free trial of MedSchool Premium!Get Started
 
 
 
Hand & Wrist Exam
 

Assessing Joint Movement

 
 

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
Last updated on August 17th, 2019
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
 

Read More...

Backhouse KM. Innervation of the Hand. Hand. 1975. 7:107.
De Souza RM, Choi D. Peripheral Nerve Lesions. Surgery. 2012; 30(3): 149-154.
Dinsdale G, Herrick AL. Vascular diagnostics for Raynaud’s phenomenon. J Vasc Diagn. 2014;2:127-39.
 Hainer BL, Matheson E, Travis Wilkes R. Diagnosis, treatment, and prevention of gout. American family physician. 2014 Dec 15;90(12). Hughes M, Herrick AL. Assessment and management of Raynaud's phenomenon. Prescriber. 2017 Jul;28(7):11-6. Lowe G, Tait C. Limb Pain and Swelling. Medicine. 2009 Feb; 37(2): 96-99. Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: What is the cause of my patient's painful swollen joint?. Cmaj. 2009 Jan 6;180(1):59-65. Palmer KT. Pain in the Forearm, Wrist and Hand. Best Practice and Research Clinical Rheumatology. 2003; 17(1): 113-135. Reddy RS. Compson J. Examination of the Wrist - Surface Anatomy of the Carpal Bones. Current Orthopaedics. 2005; 19; 171-179. Ricceri F, Prignano F. Gottron papules: a pathognomonic sign of dermatomyositis. Cmaj. 2013 Feb 5;185(2):148-. Rothschild BM, Pingitore C, Eaton M. Dactylitis: implications for clinical practice. InSeminars in arthritis and rheumatism 1998 Aug 1 (Vol. 28, No. 1, pp. 41-47). WB Saunders. Siva CH, Velazquez CE, Mody A, Brasington RI. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. American family physician. 2003 Jul 1;68(1):83-92. Skirven T. Clinical Examination of the Wrist. Journal of Hand Therapy. 1996 Apr-Jun; 9(2): 96-107. Thaper A, Zhang W, Wright G, Doherty M. Relationship between Heberden’s nodes and underlying radiographic changes of osteoarthritis. Annals of the rheumatic diseases. 2005 Aug 1;64(8):1214-6. Turesson C, O’fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Annals of the rheumatic diseases. 2003 Aug 1;62(8):722-7. Young D, Papp S, Giachino A. Physical Examination of the Wrist. Orthopedic Clinics of North America. 2007; 38(2): 149-65.
Feedback