Hand & Thumb ROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm and wrist in neutral. Start with MCP joint extended. 

Axis: Dorsal aspect of the MCP joint (of digit being measured) 

Goniometer Stationary arm: Dorsal aspect and the midline of the metacarpal being measured

Goniometer Moveable arm:  Dorsal aspect of the proximal phalanx of the digit being measured

Instruct Client:  "Bend your finger as far as you can at this larger joint."  

Directions: Client will flex the MPC joint, realign the goniometer as needed

Norm: 0-90° 

Assess AROM and then PROM

Client Position: Client seated, with the arm resting on the treatment table, forearm and wrist in neutral. 

Axis: Dorsal aspect of the MCP joint (of digit being measured) 

Goniometer Stationary arm: Dorsal aspect and the midline of the metacarpal being measured

Goniometer Moveable arm:  Dorsal aspect of the proximal phalanx of the digit being measured

Instruct Client:  "Straighten finger as far as you can." 

Directions: Client will extend the finger at the MCP joint. Joint may hyperextend. If this is the case, document the hyperextension with a "+" sign. 

Norm: 90° -0° 

Assess AROM and then PROM

Client Position: Client seated, with hand resting on table, forearm pronated, fingers spread apart. 

Axis: dorsal MCP joint (being measured)

Goniometer Stationary arm: Dorsal aspect and midline of the metacarpal being tested. 

Goniometer Moveable arm:   Dorsal aspect and midline of proximal phalanx being tested. 

Instruct Client:  "Close your fingers together so they touch."

Directions: Client brings fingers in towards midline (middle finger) 

Norm: Compare with other hand 

Assess AROM and then PROM

Client Position: Client seated, with hand resting on table, forearm pronated, fingers together. 

Axis: Dorsal MCP joint (being measured)

Goniometer Stationary arm: Dorsal aspect and midline of the metacarpal being tested. 

Goniometer Moveable arm:   Dorsal aspect and midline of proximal phalanx being tested. 

Instruct Client:  "Spread your fingers apart." 

Directions: Client spreads fingers apart, movable arm is positioned to align with the digit (proximal phalanx) being tested. 

Norm: Compared to the other hand. 

Assess AROM and then PROM

Client Position: Client seated, with the arm resting on the treatment table, forearm and wrist in neutral. 

Axis: Dorsal aspect of the PIP joint (of digit being measured) 

Goniometer Stationary arm: Dorsal aspect and the midline of the proximal phalanx of the digit being measured

Goniometer Moveable arm:  Dorsal aspect of the middle phalanx of the digit being measured

Instruct Client:  "With your fingers starting in a hook position, now straighten your finger(s) as far as you can. Keep your large joint straight." 

Directions: Client will extend the fingers and move the goniometer with the client into extension.

Norm: 100°-0° 

Assess AROM and then PROM

Client Position: Client seated, with the arm resting on the treatment table, forearm and wrist in neutral. Start with PIP joint extended. 

Axis: Dorsal aspect of the PIP joint (of digit being measured) 

Goniometer Stationary arm: Dorsal aspect and the midline of the proximal phalanx being measured

Goniometer Moveable arm:  Dorsal aspect of the middle phalanx of the digit being measured

Instruct Client:  "Keeping your large joint straight, bend your finger as far as you can go, making a hook position."  

PIP Flexion 

end position

Directions: Client will flex the PIP joint, realign the goniometer as needed.

Norm: 0-100° 

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm and wrist in neutral. 

Axis: Dorsal aspect of the DIP joint  while in flexion (of digit being measured) 

Goniometer Stationary arm: Dorsal aspect and the midline of the middle phalanx of the digit being measured

Goniometer Moveable arm:  Dorsal aspect of the distal phalanx of the digit being measured

Instruct Client:  "With your fingers starting in a hook position, now straighten your finger(s) as far as you can. Keep your large joint straight." 

Directions: Client will extend the DIP joint, realign the goniometer as needed.

Norm: 90° - 0°

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm and wrist in neutral. Start with DIP joint extended. 

Axis: Dorsal aspect of the DIP joint (of digit being measured) 

Goniometer Stationary arm: Dorsal aspect and the midline of the middle phalanx being measured

Goniometer Moveable arm:  Dorsal aspect of the distal phalanx of the digit being measured

Instruct Client:  "Keeping your large joint straight, bend your finger as far as you can go, making a hook position."  

Directions: Client will flex the DIP joint, realign the goniometer as needed.

Norm: 0-90° 

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm pronated and wrist in neutral. Start with the thumb CMC joint adducted.  

Axis: Dorsal aspect of the CMC joint  

Goniometer Stationary arm: Dorsal aspect and the midline of the second metacarpal

Goniometer Moveable arm:  Dorsal aspect of the midline of the first metacarpal. 

Instruct Client:  "Move your thumb out away from your palm as far as you can go."  

Directions: Client will extend the CMC, also called radial abduction, and realign the goniometer as needed.

Norm: 0-35° 

Assess AROM and then PROM 

Alternate position: Can be measured with the forearm supinated. 

In the start position, the CMC joint is already extended naturally 15-20°, but when documenting, typically 0° is written. 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated and wrist in neutral. Start with the thumb CMC joint slightly abducted.  

Axis: Volar aspect of the CMC joint  

Goniometer Stationary arm: Volar aspect and the midline of the radius

Goniometer Moveable arm:  Volar aspect of the midline of the first metacarpal. 

Instruct Client:  "Bend your thumb across your palm as far as you can go."  

Start position is assumed to be 0°. 

Directions: Client will flex the CMC and realign the goniometer as needed. Make sure the movable arm is aligned with the first metacarpal and not the proximal phalanx of the thumb. 

Norm: 0-20° 

Assess AROM and then PROM 

Alternate position: Can be measured with the forearm supinated. 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral; Thumb in abduction

Axis: At the base of where 1st and 2nd metacarpal meet (anatomical snuffbox) 

Goniometer Stationary arm: Radial aspect and the midline of the second metacarpal

Goniometer Moveable arm:  Radial aspect of the midline of the first metacarpal. 

Instruct Client:  "Bring your thumb in toward your palm."  

Start position is assumed to be 0°. 

Directions: Client will adduct the CMC and realign the goniometer as needed. 

Norm: Compare to other extremity, typically not measured. If measured, record diffence bteween start and end positions.

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral; Thumb in adduction

Axis: At the base of where 1st and 2nd metacarpal meet (anatomical snuffbox) 

Goniometer Stationary arm: Radial aspect and the midline of the second metacarpal

Goniometer Moveable arm:  Radial aspect of the midline of the first metacarpal. 

Instruct Client:  "Bring your thumb out away from your palm."  

Start position is assumed to be 0°. 

Directions: Client will palmarly abduct the CMC; realign the goniometer as needed. 

Norm: 0-70° 

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral

Axis: At the base of where 1st and 2nd metacarpal meet (anatomical snuffbox) 

Instruct Client:  "Try to touch the tip of your thumb with the tip of your small finger." 

Measurement: Using a ruler at the end of the goniometer, measure in centimeters the distance from the tip of the thumb to the tip of the small finger. 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral.

Axis: Dorsal aspect of the MP joint of the thumb

Goniometer Stationary arm: Dorsal aspect and the midline of the first metacarpal

Goniometer Moveable arm:  Dorsal aspect of the midline of the first proximal phalanx.

Instruct Client:  "Straighten your thumb as far as you can." 

Directions: Client will extend the MP joint of the thumb. 

Norm: 60°-0° 

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral.

Axis: Dorsal aspect of the MP joint of the thumb (in flexion)

Goniometer Stationary arm: Dorsal aspect and the midline of the first metacarpal

Goniometer Moveable arm:  Dorsal aspect of the midline of the first proximal phalanx.

Instruct Client:  "Bend your thumb as far as you can go across your palm." 

Directions: Client will flex the MP joint of the thumb. 

Norm: 0°-60° 

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral.

Axis: Dorsal aspect of the IP joint of the thumb

Goniometer Stationary arm: Dorsal aspect and the midline of the proximal phalanx

Goniometer Moveable arm:  Dorsal aspect of the midline of the first distal phalanx.

Instruct Client:  "Straighten your thumb as far as you can." 

Directions: Client will extend the IP joint of the thumb. 

Norm: 90°-0° 

Assess AROM and then PROM 

Client Position: Client seated, with the arm resting on the treatment table, forearm supinated, and wrist in neutral.

Axis: Dorsal aspect of the IP joint of the thumb

Goniometer Stationary arm: Dorsal aspect and the midline of the proximal phalanx

Goniometer Moveable arm:  Dorsal aspect of the midline of the first distal phalanx.

Instruct Client:  "Straighten your thumb as far as you can." 

Directions: Client will flex the IP joint of the thumb. 

Norm: 0°-90° 

Assess AROM and then PROM