In principle, ‘passively’ examine movements which are painful and/or limited during the active movement examination. Or movements with an abnormal course, or if hypermobility or a mild musculotendinous injury is suspected.
Procedure
- The patient sits at a table or an examination table and, if required, lean on their elbows.
- The examiner is seated opposite the patient.
- The patient should relax the hand and wrist as much as possible.
- It is essential here that one of the examiner’s hands is fixed and the other hand carries out the movement.
- For movements in the distal radio-ulnar joint: Offer the patient a hand, and with the other hand grasp the wrist proximally. It will now be possible to palpate the distal joint between radius and ulna using the fingertips [Figure 117].
Figure 117
- For movements in the wrist joint: With one hand grasp the four fingers and middle hand, and with the other hand grasp the wrist. The fingertips can be used to palpate the radio-carpal joint at the anatomical snuff box (e.g. passive ulnar abduction) [Figure 118].
Figure 118
- For movements in the finger joints: Palpate the relevant joint spaces using the thumb and index finger of one hand, whilst using the other hand to carry out the movement in the distal part [Figures 119, 120].
Figure 119
Figure 120
- For movements in the CMC I joint: Palpate the CMC I joint using thumb and index finger, and take hold of the 1st metacarpal bone with thumb and index finger of the other hand, whilst carrying out a passive opposition and reposition movement [Figure 121].
Figure 121
- When conducting these movements, assess:
- The course of the movement.
- The maximum range of motion.
- Occurrence of pain.
- The presence or disappearance of crepitations.