UE ROM -- Hand: Fingers and Thumb
dorsal DIP joint being tested
DIP extension: axis/fulcrum
MCP in 70-90 degrees of flexion (avoid full MCP and PIP flexion or extension)
DIP extension: common substitutions
firm
DIP extension: end feel
dorsal midline of distal phalanx being tested
DIP extension: moving arm/distal arm
0 -- 8 for AROM and 20 for PROM
DIP extension: normal ROM
dorsal midline of middle phalanx being tested
DIP extension: stationary arm/proximal arm
dorsal DIP joint being tested
DIP flexion: axis/fulcrum
MCP in 70-90 degrees of flexion (avoid full MCP and PIP flexion or extension)
DIP flexion: common substitutions
firm
DIP flexion: end feel
dorsal midline of distal phalanx being tested
DIP flexion: moving arm/distal arm
70-90
DIP flexion: normal ROM
dorsal midline of middle phalanx being tested
DIP flexion: stationary arm/proximal arm
(dorsal) scaphoid or radial styloid process
1st CMC abduction: axis/fulcrum
MCP and IP joints relaxed in slight flexion, wrist motions (specifically flexion)
1st CMC abduction: common substitutions
firm
1st CMC abduction: end feel
dorsal midline of 1st metacarpal
1st CMC abduction: moving arm/distal arm
40-50
1st CMC abduction: normal ROM
lateral 2nd metacarpal
1st CMC abduction: stationary arm/proximal arm
ventral 1st CMC joint
1st CMC extension - alternate: axis/fulcrum
MCP and IP joints relaxed in slight flexion, wrist motions (specifically RD)
1st CMC extension - alternate: common substitutions
firm
1st CMC extension - alternate: end feel
ventral midline of shaft of 1st metacarpal
1st CMC extension - alternate: moving arm/distal arm
15-35
1st CMC extension - alternate: normal ROM
ventral wrist at line between start of carpals
1st CMC extension - alternate: stationary arm/proximal arm
ventral 1st CMC joint
1st CMC extension: axis/fulcrum
MCP and IP joints relaxed in slight flexion, wrist motions (specifically RD)
1st CMC extension: common substitutions
firm
1st CMC extension: end feel
ventral midline of shaft of 1st metacarpal
1st CMC extension: moving arm/distal arm
15-35
1st CMC extension: normal ROM
ventral midline of radius (styloid process)
1st CMC extension: stationary arm/proximal arm
ventral 1st CMC joint
1st CMC flexion - alternation: axis/fulcrum
MCP and IP joints relaxed in slight flexion, wrist motions (specifically UD)
1st CMC flexion - alternation: common substitutions
firm
1st CMC flexion - alternation: end feel
ventral midline of shaft of 1st metacarpal
1st CMC flexion - alternation: moving arm/distal arm
15-25
1st CMC flexion - alternation: normal ROM
ventral wrist at line between start of carpals
1st CMC flexion - alternation: stationary arm/proximal arm
ventral 1st CMC joint
1st CMC flexion: axis/fulcrum
MCP and IP joints relaxed in slight flexion, wrist motions (specifically UD)
1st CMC flexion: common substitutions
soft, firm
1st CMC flexion: end feel
ventral midline of shaft of 1st metacarpal
1st CMC flexion: moving arm/distal arm
15-25
1st CMC flexion: normal ROM
ventral midline of radius (styloid process)
1st CMC flexion: stationary arm/proximal arm
wrist motions, forearm pronation, MCP/IP flexion of thumb
1st CMC opposition: common substitutions
soft
1st CMC opposition: end feel
variable -- more than 8 cm is impaired
1st CMC opposition: normal ROM
hard or firm
MCP flexion: end feel
dorsal midline of proximal phalanx being tested
MCP flexion: moving arm/distal arm
90-100
MCP flexion: normal ROM
dorsal midline of metacarpal being tested
MCP flexion: stationary arm/proximal arm
dorsal MCP joint being tested
MCP abduction: axis/fulcrum
wrist UD/RD
MCP abduction: common substitutions
firm
MCP abduction: end feel
dorsal midline of proximal phalanx being tested
MCP abduction: moving arm/distal arm
25
MCP abduction: normal ROM
dorsal midline of metacarpal being tested
MCP abduction: stationary arm/proximal arm
dorsal MCP joint being tested
MCP extension: axis/fulcrum
extreme flexion of PIP and DIP, full extension of other metacarpals, wrist extension
MCP extension: common substitutions
firm
MCP extension: end feel
dorsal midline of proximal phalanx being tested
MCP extension: moving arm/distal arm
20-45
MCP extension: normal ROM
dorsal midline of metacarpal being tested
MCP extension: stationary arm/proximal arm
dorsal MCP joint being tested
MCP flexion: axis/fulcrum
extreme flexion of PIP and DIP, full extension of other metacarpals, wrist flexion
MCP flexion: common substitutions
dorsal PIP joint being tested
PIP extension: axis/fulcrum
avoid full MCP flexion or extension
PIP extension: common substitutions
firm
PIP extension: end feel
dorsal midline of middle phalanx being tested
PIP extension: moving arm/distal arm
0 -- 7 for AROM or 16 for PROM
PIP extension: normal ROM
dorsal midline of proximal phalanx being tested
PIP extension: stationary arm/proximal arm
dorsal PIP joint being tested
PIP flexion: axis/fulcrum
avoid full MCP flexion or extension
PIP flexion: common substitutions
any
PIP flexion: end feel
dorsal midline of middle phalanx being tested
PIP flexion: moving arm/distal arm
100-110
PIP flexion: normal ROM
dorsal midline of proximal phalanx being tested
PIP flexion: stationary arm/proximal arm
dorsal 1st IP joint
thumb IP extension: axis/fulcrum
firm
thumb IP extension: end feel
dorsal midline of distal phalanx
thumb IP extension: moving arm/distal arm
20-30
thumb IP extension: normal ROM
dorsal midline of proximal phalanx
thumb IP extension: stationary arm/proximal arm
avoid wrist and MCP extension
thumb IP extension: substitutions
dorsal 1st IP joint
thumb IP flexion: axis/fulcrum
wrist flexion, MCP flexion/extension
thumb IP flexion: common substitutions
firm
thumb IP flexion: end feel
dorsal midline of 1st distal phalanx
thumb IP flexion: moving arm/distal arm
80
thumb IP flexion: normal ROM
dorsal midline of proximal phalanx
thumb IP flexion: stationary arm/proximal arm
dorsal 1st MCP joint
thumb MCP extension: axis/fulcrum
avoid full extension of thumb IP and wrist, avoid CMC flexion
thumb MCP extension: common substitutions
firm
thumb MCP extension: end feel
dorsal midline of 1st proximal phalanx
thumb MCP extension: moving arm/distal arm
0 -- PROM some say 8-40
thumb MCP extension: normal ROM
dorsal midline of 1st metacarpal
thumb MCP extension: stationary arm/proximal arm
dorsal 1st MCP joint
thumb MCP flexion: axis/fulcrum
avoid full flexion and thumb IP and wrist, avoid CMC flexion
thumb MCP flexion: common substitutions
hard, firm
thumb MCP flexion: end feel
dorsal midline of 1st proximal phalanx
thumb MCP flexion: moving arm/distal arm
50-60
thumb MCP flexion: normal ROM
dorsal midline of 1st metacarpal
thumb MCP flexion: stationary arm/proximal arm
from digital crease of little finger to tip of thumb OR proximal digital crease of thumb to distal palmar crease directly over 5th MCP joint
two ways to measure for 1st CMC opposition
