Motion Assessment Instruments

The measurement of motion involves muscle/tendon continuity, contractile and gliding capacity, neuro-muscular communication, and voluntary control. Techniques for evaluating upper extremity motion include goniometric measurements and the determination of isolated muscle strength.

Range of Motion

Goniometric evaluation of the upper extremity is essential to monitoring articular motion and muscu-lotendinous function. Both passive and active motion should be recorded using an appropriate size goniometer with a 0° neutral starting position, as recommended by the American Academy of Orthopaedic Surgeons (AAOS). Digital motion may be measured

Fig. 5-8 The volumeter measures composite hand mass and has been shown to be accurate to within 10 ml when used according to specifications.

Fig. 5-9 Either lateral or dorsal placement of the goniometer is appropriate, provided that consistency is maintained for subsequent examinations.
Fig. 5-10 A shortened goniometer arm allows accurate measurement of distal interphalangeal (DIP) joints when assessing composite digital flexion,

from either the lateral or dorsal aspect of the joint, provided that consistency of placement is maintained throughout the examination and during subsequent tests. Most upper extremity specialists use dorsal placement of goniometers unless considerable swelling around the joint is present (Fig. 5-9). Proximal joints should be maintained in neutral position with a neutral wrist position especially important due to its effect on digital joint position. Deviation from established ROM measurement protocol must be documented. Normal motion values are obtained from measurement of the contralateral extremity or from norms developed by the AAOS.1 Although goniomet-ric measurement is not technically a standardized assessment tool, its reliability and validity have been studied extensively.* Composite digital motion values may be computed as total active motion and total passive motion.3,4 Total active motion (TAM) equals the summation of active flexion measurements of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of a digit, minus the active extension deficits of the same three joints. Total passive motion (TPM) is computed in a similar manner using passive motion values (Fig. 5-10). Total motion reflects both the extension and flexion capacities of a single digit and is expressed as a single numeric value (see Figures 2-5 in Appendix B, and Figures 1-3 in Appendix C).

Brand's technique of torque range of motion (TQROM) refines passive range of motion measurement by applying predetermined, consistent, and incremental amounts of force to stiffened joints and

Degrees of flexion

Fig. 5-11 This torque range of motion graph indicates that the proximal interphalangeal joint of the long finger (B) has more passive "give" than that of the index finger (A), indicating that the long finger may respond more readily to mobilization splinting.

Degrees of flexion

Fig. 5-11 This torque range of motion graph indicates that the proximal interphalangeal joint of the long finger (B) has more passive "give" than that of the index finger (A), indicating that the long finger may respond more readily to mobilization splinting.

measuring resultant passive joint motions with a goniometer.12,13 Once measured, a torque/length curve may be constructed for each joint by plotting coordinates on a graph, and the relative degree of stiffness of the joints may be visualized (Fig. 5-11). An electronic device for measuring joint stiffness has also been developed.41

Muscle Strength

Isolated muscle strength through manual muscle testing is used to define effects of peripheral nerve or musculotendinous dysfunction in the upper extremity. It is also used to identify potential donor muscles for tendon transfers. Although criteria for grading muscle strength have been improved, portions of the test are subject to examiner interpretation. Patient substitution patterns also decrease test reliability. To enhance inter-rater reliability, it is important that all members of the team use the same method of conducting and interpreting manual muscle examinations. Numerous grading systems currently exist, but the two most frequently used are Seddon's numerical system of 0 through 5 and the ratings of zero, trace, poor, fair, good, and normal recommended by the Committee on After-Effects, National Foundation of Infantile Paralysis, Inc. The latter is further refined by a plus-minus system for accomplishment of partial ranges (see Appendix B-8).

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