ROM The Thumb

Question 0

ROM: Thumb CMC Extension

Answer 0

Test position: forearm and hand supported in full supination, wrist neutral, fingers and thumb relaxed
Stabilization: prevent wrist motion
Test: extend the CMC joint by pushing in the palmar surface of the MC moving the thumb toward the radial side of the hand
Alignment: same as CMC flexion
End feel: firm

Question 1

ROM: Thumb CMC Flexion

Answer 1

Test position: forearm and hand supported in full supination, wrist neutral, Fingers and thumb relaxed
Stabalization: prevent wrist motion
Test: flex the CMC joint by pushing on the dorsal surface of the 1st metacarpal, moving the thumb toward the ulnar aspect of the hand
Alignment:
Axis- over palmar aspect of CMC
Prox arm- over ventral midline of radius using radial head and radial styloid process for references
Distal arm- ventral midline of 1st MC
End feel: May be soft due to soft tissue approximation, firm due to tension in capsule
NOTE: initial position of goniometer may read 30-50 degrees rather than 0 degrees, depending on shape of hand and wrist position. End position should be subtracted from the beginning degrees for actual ROM

Question 2

ROM: thumb CMC abduction/adduction

Answer 2

Test position: forearm supported on table in mid position, wrist neutral, all thumb joints neutral
Stabilization: prevent wrist motion
Test: abduct the CMC joint by moving the MC away from the palm of the hand
Alignment:
Axis- over lateral aspect of radial styloid process
Prox arm- lateral midline of 2nd MC, using midline of 2nd MCP for reference
Distal arm- lateral midline of 1st MC, using center of 1st MCP joint as reference
End feel: firm

Question 3

ROM: thumb CMC Opposition

Answer 3

Test position: supported forearm and hand in full supination, wrist neutral, fingers neutral
Stabilization: prevent wrist motion by stabilizing 5th metacarpal
Test: move the 1st MC away from the palm of the hand and toward the little finger, allowing the 5th MC to move toward the thumb
Alignment: use the ruler end of the goniometer to measure the distance btw the tip of the thumb and the palm or the base of the 5th finger
End feel: soft from ST approximation, firm from tension in capsule

Question 4

ROM: Thumb MCP Flexion/ Extension

Answer 4

Test position: supported forearm and hand in full supination, wrist neutral, fingers neutral
Stabilization: stabilize 1st metacarpal to prevent wrist motion and flexion of thumb CMC joint
Alignment:
Axis- dorsal aspect of MCP joint
Prox arm- dorsal midline of the metacarpal
Distal arm- dorsal midline of proximal phalanx
End feel: flexion- hard or firm
extension- firm

Question 5

ROM: Thumb IP Flexion/Extension

Answer 5

Test position: supported forearm and hand in full supination, wrist neutral, fingers neutral
Stabilization: at proximal phalanx to prevent flexion or extension
Alignment:
Axis- over dorsal aspect of IP joint
Prox arm- dorsal midline of proximal phalanx
Distal arm- dorsal midline of distal phalanx
End feel: flexion- usually firm, sometimes hard extension- firm