Active examination can assess the patient’s ability to move around the axis of motion and reflect their functional capacity under normal circumstances, as well as in cases of pain, degenerative joint disease, muscle hypertonicity, sprains, or strains. Static structural or postural examinations provide clues about movement patterns.
The normal range of motion depends on the patient’s body type and the disease causing the patient’s dysfunction. Therefore, the range of motion varies among different patient categories. Considering factors such as different muscle types and elasticity in patients of varying body shapes, doctors can gain a better understanding of the overall functional impairment status presented by the patient.
During the examination, the doctor can have the patient perform active movements or place the patient in a relaxed state without muscle contraction, moving the patient around various axes in the anatomical area (passive movement).
After taking the medical history, if no contraindications (severe trauma, loss of consciousness, etc.) are found, it is best to start with the “active movement” examination because, during active movement, the patient will voluntarily stop or refuse further activity if symptoms worsen. In contrast, during passive movement, the range of motion is significantly increased. Through these two methods of examination, the doctor can clearly understand the status of joint range of motion (e.g., severity, fractures, dislocations, somatization symptoms, symptom exaggeration, etc.).
MCP or PIP/DIP Joint Extension
1. The patient sits; forearm is pronated; upper limb supported on the treatment table; wrist and hand are in a neutral position.
Measure the starting position for MCP extension. The red line and dots indicate the alignment markers for the goniometer (the dorsal midline of the metacarpal, the dorsal side of the MCP joint, and the dorsal midline of the proximal phalanx).
2. Stabilize the metacarpal.
3. Instruct the patient to perform the required movement, checking the MCP joint extension through the achievable ROM.
MCP extension ROM completion, showing proper hand placement to stabilize the metacarpal and flex the MCP joint. The red line and dots indicate the alignment markers for the goniometer (the dorsal midline of the metacarpal, the dorsal side of the MCP joint, and the dorsal midline of the proximal phalanx).
4. After completion, return the limb to the starting position.
Normal ROM: MCP = 20°～25°
[Course Guide] Pain Physical Examination and Anatomical Analysis
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