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Goniometry for Wrist & Fingers
- 1. GONIOMETRY FOR WRIST &FINGERS
- 2. WHY HAND ISSO SPECIAL… • 27 bones • 27 Joints • 34 muscles • 3 major nerves • 100 ligaments & tendons • 2 major arteries • Major representation in Brain • & so on…..
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- 4. HAND PHYSIOTHERAPY – ASUPER SPECIALITY • Micro & Macro surgeries – Vascular, Orthopaedic, Plastic surgeons, Neuro surgeons etc • Hand surgeons, Thumb surgeons etc., • Toe to thumb transfers • Tendon repair & transplants • Hand transplant – Transplants from cadaver. • & Many more HAND PHYSIOTHERAPY
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- 11. BASELINE DIGIT FINGERGONIOMETER
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- 16. WRIST FLEXION Test Position •Subject sitting • Forearm stabilized on table • Flex wrist (fingers relaxed) Goniometer Alignment • Axis – lateral wrist • Stationary arm – aligned with ulna • Moving arm – aligned with fifth metacarpal Normal Range • 75° ± 6.6° (American Academy of Orthopaedic Surgeons) • 60° (American Medical Association) • 76.4° (mean) 6.3° (standard deviation), (Boone and Azen)
- 17. WRIST EXTENSION Test Position •Subject sitting • Forearm stabilized on table • Extended wrist (fingers relaxed) Goniometer Alignment • Axis – lateral wrist (triquetrum) • Stationary arm – aligned with ulna • Moving arm – aligned with fifth metacarpal Normal Range 74° ± 6.6° (American Academy of Orthopaedic Surgeons) 60° (American Medical Association) 74.9° (mean) 6.4° (standard deviation), (Boone and Azen)
- 18. WRIST RADIAL DEVIATION TestPosition • Subject sitting with forearm resting on table • Stabilize forearm to prevent pronation or supination Goniometer Alignment • Axis – capitate • Stationary arm – aligned with forearm (lateral epicondyle) • Moving arm – aligned with metacarpal of middle finger Normal Range • 21° ± 4.0° (American Academy of Orthopaedic Surgeons) • 20° (American Medical Association) • 21.5° (mean) 4.0° (standard deviation), (Boone and Azen)
- 19. WRIST ULNAR DEVIATION TestPosition • Subject sitting with forearm resting on table • Stabilize forearm to prevent pronation or supination Goniometer Alignment • Axis – capitate • Stationary arm – aligned with forearm (lateral epicondyle) • Moving arm – aligned with metacarpal of middle finger Normal Range • 35° ± 3.8° (American Academy of Orthopaedic Surgeons) • 30° (American Medical Association) • 36.0° (mean) 3.8° (standard deviation), (Boone and Azen)
- 20. METACARPOPHALANGEAL JOINT FLEXION Test Position •Subject sitting with forearm resting on table • Wrist and interphalangeal joints relaxed • Forearm neutral • Stabilize metacarpal to prevent motion Goniometer Alignment • Dorsal metacarpophalangeal joint • Stationary arm - aligned with metacarpal Normal Range • 86° (index), 91° (ring), 105° (little) (American Academy of Orthopedic Surgeons - active motion) • 90° (American Medical Association)
- 21. METACARPOPHALANGEAL JOINT EXTENSION Test Position •Subject sitting with forearm resting on table • Wrist and interphalangeal joints relaxed • Forearm neutral • Stabilize metacarpal to prevent motion Goniometer Alignment • Dorsal metacarpophalangeal joint • Stationary arm - aligned with metacarpal Normal Range • 22° (index), 18° (long), 23° (ring), 19° (little) (American Academy of Orthopedic Surgeons - active motion) • 20° (American Medical Association)
- 22. METACARPOPHALANGEAL JOINT ABDUCTION Test Position •Subject sitting with forearm resting on table • Wrist neutral • Forearm neutral • Stabilize metacarpal to prevent motion Goniometer Alignment • Dorsal metacarpophalangeal joint • Stationary arm - aligned with metacarpal • Moving arm – aligned with proximal Normal Range • 25° (Physiopedia)
- 23. METACARPOPHALANGEAL JOINT ADDUCTION Test Position •Subject sitting with forearm resting on table • Wrist neutral • Forearm neutral • Stabilize metacarpal to prevent motion Goniometer Alignment • Dorsal metacarpophalangeal joint • Stationary arm - aligned with metacarpal • Moving arm – aligned with proximal Normal Range • Either 0° or usually not measured.
- 24. INTERPHALANGEAL JOINT FLEXION TestPosition • Subject sitting with forearm resting on table • Wrist, metacarpal, and non-tested interphalangeal joints relaxed • Forearm neutral • Stabilize proximal bone to prevent motion Goniometer Alignment • Dorsal proximal interphalangeal joint • Stationary arm - aligned with proximal phalange • Moving arm – aligned with middle phalange Normal Range American Academy of Orthopedic Surgeons • PIP fingers - 102° (index), 105° (long), 108° (ring), 106° (little) (active motion) • DIP fingers - 72° (index), 71° (long), 63° (ring), 65° (little) (active motion) • IP thumb - 73° American Medical Association • 100° (PIP finger), 70° (DIP fingers), 80° (IP thumb)
- 25. INTERPHALANGEAL JOINT EXTENSION Test Position •Subject sitting with forearm resting on table • Wrist, metacarpal, and non-tested interphalangeal joints relaxed • Forearm neutral • Stabilize proximal bone to prevent motion Goniometer Alignment • Dorsal proximal interphalangeal joint • Stationary arm - aligned with proximal phalange • Moving arm – aligned with middle phalange Normal Range American Academy of Orthopedic Surgeons • PIP fingers - 7° (index), 7° (long), 6° (ring), 9° (little) (active motion) • DIP fingers - 8° (all finger DIPs) • IP thumb - 5° American Medical Association • 0°
- 26. THUMB CARPOMETACARPAL JOINT FLEXION TestPosition • Subject sitting with forearm resting on table • Wrist neutral • Stabilize carpals to prevent wrist motion Goniometer Alignment • Axis - carpometacarpal joint • Stationary arm - aligned with radius • Moving arm – aligned with metacarpal of thumb Normal Range • 15° (American Academy of Orthopedic Surgeons)
- 27. THUMB CARPOMETACARPAL JOINT EXTENSION TestPosition • Subject sitting with forearm resting on table • Wrist neutral • Stabilize carpals to prevent wrist motion Goniometer Alignment • Axis - carpometacarpal joint • Stationary arm - aligned with radius • Moving arm – aligned with metacarpal of thumb Normal Range • 20° (American Academy of Orthopedic Surgeons)
- 28. THUMB CARPOMETACARPAL JOINT ABDUCTION TestPosition • Subject sitting with forearm resting on table • Wrist neutral • Forearm neutral • Stabilize carpals to prevent wrist motion Goniometer Alignment • Axis - radial styloid • Stationary arm - aligned with metacarpal of index finger • Moving arm – aligned with metacarpal of thumb Normal Range • 70° (American Academy of Orthopedic Surgeons)
- 29. THUMB CARPOMETACARPAL JOINT ADDUCTION TestPosition • Subject sitting with forearm resting on table • Wrist neutral • Forearm neutral • Stabilize carpals to prevent wrist motion Goniometer Alignment • Axis - radial styloid • Stationary arm - aligned with metacarpal of index finger • Moving arm – aligned with metacarpal of thumb Normal Range • Either 0° or usually not measured. NOTE: Thumb adduction is the return to neutral from thumb abduction. Thumb adduction is rarely measured, probably because it
- 30. THUMB CARPOMETACARPAL JOINT OPPOSITION TestPosition • Subject sitting with forearm supinated and resting on table • Wrist neutral • Stabilize fifth metacarpal Goniometer Alignment • Goniometer cannot be used • Use a ruler to measure distance between tip of thumb and base of fifth finger Normal Range • Able to touch tip of thumb to base of fifth finger (American Academy of Orthopedic Surgeons) NOTE: The American Academy of Orthopedic Surgeons suggests that opposition range is normal when the tip of thumb can touch the base of fifth finger. When range is not adequate, a ruler can be used to measure the distance between the tip of thumb and the base of the
- 31. NORMAL ROM VALUES(AAOS VALUES)
- 32. FINGERS: COMPOSITE FLEXIONOF THE MCP, PIP, AND DIP JOINTS
- 33. GRAVITY GONIOMETER/INCLINOMETER One arm hasa weighted pointer that remains vertical under the influence of gravity
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- 36. SOFTWARE/SMARTPHONE-BASED GONIOMETER APPS • GoniometerRecords • Goniometro Advance • Goniometer Pro App (G-Pro) • Goniometer Plus • DrGoniometer
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- 38. THE E-LINK ROMGONIOMETRY
- 39. ELECTRO GONIOMETER (Fariborz etal., 2015)
- 40. ELECTROGONIOMETER SIN GLE AXIS ELEC TR OGON IOMETER TW IN A XIS ELEC TR OGON IOMETER
- 41. FIBER OPTIC GONIOMETRIC GLOVE (SamWise et al., 1990)
- 42. CYBERGLOVE – VIRTUAL GONIOMETRY G.Drew Kessler et al.,
- 43. NON-CONTACT MEASUREMENT SYSTEM (INTELPERCEPTUAL TECHNOLOGY AND A SENZ3D CAMERA) (Trieu Pham et al., 2015)
- 44. 3D MOTION ANALYSIS (GabriellaFischer et al.,
- 45. REFERENCES • American Academyof Orthopedic Surgeons (Green WB, Heckman JD eds.): The Clinical Measurement of Joint Motion. 6300 North River Road, Rosemont, IL 60018, 1994, ISBN 0-89203-090-9. • American Medical Association: Guide to the Evaluation of Permanent Impairment. AMA, Chicago, 1988. • Boone DC, Azen SP: Normal range of motion of joints in male subjects. Journal of Bone and Joint Surgery 1979;61A:756-759. • Magee DJ: Orthopedic Physical Assessment, 3rd ed. WB Saunders Co, Philadelphia, 1997, ISBN 0- 7216-6290-0. • Norkin CC, White DJ: Measurement of Joint Motion: A Guide to Goniometry, 2nd ed. FA Davis Co, Philadelphia, 1995, ISBN 0-8036-6579-2. • Physiopedia