Range of Motion: Passive

Historical Overview

Historically, physicians have used a metric ruler or goniometer to measure passive range of motion (ROM).¹ By 2006, a new goniometer was developed, particularly for the measurement of small joints.²

Description

• For an examination of passive ROM, the physician moves the patient’s affected area(s) of the hand, wrist and/or elbow. This will show the passive range of strength for each joint.¹
• Typical degrees of motion for each joint in the hand and for the wrist and elbow are provided in the Table.^3,4

 

Pathophysiology

• Loss of passive ROM may be due to rheumatoid arthritis (RA), Dupuytren’s disease, cerebral palsy⁵ or a neurological injury.⁶
• There will be a typical pattern of tenodesis when a patient loses motion from a neurological injury.⁶
• In infants and children with cerebral palsy, it is helpful to exercise with passive ROM, so that the patient does not develop further fixed-joint stiffness.⁵

Instructions

1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate on a scale from 1-10 how much pain s/he usually experiences at the affected area(s).
2. Assist the patient to flex, extend, abduct, and adduct the affected area(s). Measure each joint separately with a goniometer.¹
3. If the patient experiences a change in passive motion from the previous examination, record the reason, if known.¹
4. Examine the contralateral area(s) in the affected hand, wrist and/or elbow.

Variations

• Also check the ulnar deviation and radial deviation of the wrist.

Related Signs and Tests

• Pulp-to-palm, passive
• Passive stretch test
• ROM, active
• Grip strength
• Neuromuscular testing¹
• Nerve conduction studies
• Radiographs
• Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

• To improve reliability in diagnosing RA, use plain radiographs to test joints for damage.

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Measuring PIP joint range of motion with the digital goniometer

• A negative result occurs when the patient does not achieve full ROM with assistance, within the typical ranges for each joint of the hand, wrist and/or elbow.

• If there is a difference between joint active and passive ROM, this is called active-passive mismatch. Tendon adhesions may cause this mismatch.¹
• After further studies, dynamic EMG/motion laboratory analysis may be an important tool for diagnosing cerebral palsy and measuring its severity.⁵  The arc of motion that a joint allows when it is normal can easily be measured and observed; therefore abnormalities in joints and joint function can be assessed by loss    of motion. Measuring this loss helps to quantify the patient’s deficits.
• Range of motion can be assessed as either active or passive.  When doing a passive range of motion assessment, the examiner places the joint in the maximum position allowed by the soft tissue constraints of the joint without the patient’s muscle power.
• The muscles around any given joint provide a range of flexion, extension, rotation, and deviation which is inherent to each particular joint. When measuring ROM, we measure by either visual assessment or by a goiniometer.
• It is critical to compare measurements to the contralateral joint to determine a baseline and assess for deficits if any.

Cited references:

1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
2. Stam HJ, Ardon MS, den Ouden AC, et al. The compangle: a new goniometer for joint angle measurements of the hand. A technical note. Eura Medicophys 2006;42(1):37-40. PMID: 16565684
3. Rayan G, Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
4. Adams BD, Grosland NM, Murphy DM, et al. Impact of impaired wrist motion on hand and upper-extremity performance. J Hand Surg Am 2003;28:898-903. PMID: 14642503
5. Bunata R, Icenogle K. Cerebral palsy of the elbow and forearm. J Hand Surg Am 2014;39(7):1425-32. PMID: 24969499
6. Kenney RJ, Hammert WC. Physical Examination of the Hand. J Hand Surg Am 2014;39(11):2324-34. PMID: 25442747
7. Dutton M. Orthopaedic Examination, Evaluation and Intervention. McGraw-Hill, 2004, pp. 537, 613-615
8. Trumble, T., & Budoff, J. (2006). Anatomy and Physical Examination of the Hand. In Hand, elbow & shoulder core knowledge in orthopaedics (p. 3). Philadelphia, Pennsylvania: Mosby.