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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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