Hand & Wrist Exam
 

Assessing Movement

 
 
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Active Movement

    • 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.
    • Significance

    • 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.
    • Causes of Limited Active Movement

    • Joint pain / stiffness - see below
    • Upper motor neuron lesion - stroke, tumour, trauma, hypoxia, demyelination, deposition, inflammation
    • Lower motor neuron lesion - trauma, compression, demyelination, neuromuscular disorders, diabetes
    • Poor compliance

Passive Movement

    • How to Assess

    • Move the patient's joint. Note the range of motion and whether it is limited by pain, swelling or stiffness. Note any crepitus.
    • Significance

    • Passive movement is a measure of the objective range of motion of the joint. It may be limited by stiffness of the joint, or active resistance on the patient's part.
    • Causes of Limited Range of Motion

    • Trauma - dislocation, fracture
    • Arthritis - osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis, Reiter’s syndrome
    • Intra-articular haemorrhage
    • Tendinitis
    • Bursitis
    • Intra-articular bleed
    • Tear - meniscus, ligament
    • Loose intra-articular body
    • Fibrous adhesions - surgery, trauma, overuse, inflammation
    • Muscle tightness
    • Prolonged joint immobilisation
    • Compartment syndrome

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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