Goniometry of Wrist Joint

WRIST JOINT
Radiocarpal and Midcarpal Joints
 The wrist is composed of two joints, the radiocarpal and midcarpal joints, both of which
are important to function.
 The radiocarpal joint lies closer to the forearm, whereas the midcarpal joint is closer to the
hand.
 The proximal joint surface of the radiocarpal joint consists of the distal radius and
radioulnar articular disc
 The distal joint surface includes three bones from the proximal carpal row—the scaphoid,
lunate, and triquetrum—which are connected by interosseous ligaments to form a convex
surface
An anterior (palmar) view of An anterior (palmar) view of the A posterior view of the
the right wrist showing the right wrist showing the palmar right wrist showing the
radiocarpal and midcarpal radiocarpal, ulnocarpal, and dorsal radiocarpal and
joints. collateral collateral ligaments.
ligaments.
 Muscles responsible for Flexion

• Flexor carpi radialis: Flexes and abducts

the hand
• Flexor carpi ulnaris: The most powerful
wrist flexor, it also adducts the hand
• Palmaris longus: Resists shearing forces
of the palmar aponeurosis
• Flexor digitorum superficialis: Helps
bend the index, middle, ring, and small
fingers at the middle finger joint
• Flexor digitorum profundus: Flexes the
wrist, hand, and finger joints
 Muscles responsible for Extension

Extensor carpi radialis brevis: Stabilizes the wrist

during a strong grip or fist, and extends and abducts it
Extensor carpi ulnaris : Extends and adducts the
wrist, and is located in the posterior compartment of
the forearm
Extensor carpi radialis longus: One of the primary
wrist extensors, and is most effective when the elbow
is extended
Extensor digiti minimi : Extends the wrist and the
little finger
WRIST FLEXION

• This motion occurs in the sagittal plane around a medial–lateral axis.

• Wrist flexion is sometimes referred to as volar or palmar flexion.
• Normal ROM values for adults vary from about 60 to 80 degrees
[Acc to American Academy of orthopedics surgeons and American Medical Association]

Testing Position

• Sitting next to a supporting surface

• Shoulder abducted to 90 degrees,
• The elbow flexed to 90 degrees,
• And the palm of the hand facing the ground
• In this position the forearm will be midway between supination and pronation. Rest the
forearm on the supporting surface, but leave the hand free to move.
• Avoid radial or ulnar deviation of the wrist and flexion of the fingers.
Stabilization
Stabilize the radius and ulna to prevent supination or pronation of the forearm and motion of the
elbow.

Testing Motion
Flex the wrist by pushing on the dorsal surface of the
third metacarpal, moving the hand toward the floor
Maintain the wrist in 0 degrees of radial and ulnar
deviation, being careful not to twist the hand.
The end of flexion ROM occurs when resistance to
further motion is felt and attempts to overcome the
resistance cause the forearm to lift off the supporting
surface.

Normal End-Feel
The end-feel is firm because of tension in the dorsal radiocarpal ligament and the dorsal joint
capsule. Tension in the extensor carpi radialis brevis and longus and extensor carpi ulnaris muscles
may also contribute to the firm end-feel.
Goniometer Alignment

1. Center fulcrum on the lateral aspect of the wrist over the triquetrum.
2. Align proximal arm with the lateral midline of the ulna, using the olecranon and ulnar styloid processes
for reference.
3. Align distal arm with the lateral midline of the fifth metacarpal
WRIST EXTENSION

Motion occurs in the sagittal plane around a medial– lateral axis.

Wrist extension is sometimes referred to as dorsal flexion. Normal ROM values for adults vary from about
60 to 75 degrees

Testing Position

• Position the individual sitting next to a supporting surface with the shoulder abducted to 90 degrees,
• The elbow flexed to 90 degrees,
• The palm of the hand facing the ground.
• In this position the forearm will be midway between supination and pronation.
• Rest the forearm on the supporting surface, but leave the hand free to move.
• Avoid radial or ulnar deviation of the wrist and extension of the fingers
Stabilization
Stabilize the radius and ulna to prevent supination or pronation of the forearm and motion of the elbow.

Testing Motion
Extend the wrist by pushing evenly across the palmar surface
of the metacarpals, moving the hand in a dorsal direction
toward the ceiling.
Maintain the wrist in 0 degrees of radial and ulnar deviation.
The end of extension ROM occurs when resistance to
further motion is felt and attempts to overcome the
resistance cause the forearm to lift off the supporting
surface.

Normal End-Feel
Usually the end-feel is firm because of tension in the palmar radiocarpal ligament, ulnocarpal ligament, and
palmar joint capsule. Tension in the palmaris longus, flexor carpi radialis, and flexor carpi ulnaris muscles
may also contribute to the firm end-feel. Sometimes the end-feel is hard because of contact between the
radius and the carpal bones.
Goniometer Alignment

1. Center fulcrum on the lateral aspect of the wrist over the triquetrum.
2. Align proximal arm with the lateral midline of the ulna, using the olecranon and ulnar styloid process.
3. Align distal arm with the lateral midline of the fifth metacarpal.
WRIST RADIAL DEVIATION
Motion occurs in the frontal plane around an anterior– posterior axis. Radial deviation is sometimes
referred to as radial flexion or abduction.
Normal ROM values for adults vary from about 20 to 25 degrees.

Testing Position
• Position the individual sitting next to a supporting surface with the shoulder abducted to 90
degrees,
• The elbow flexed to 90 degrees,
• The palm of the hand facing the ground.

Stabilization

Stabilize the radius and ulna to prevent pronation or supination of the forearm and elbow flexion
beyond 90 degrees.
Testing Motion

Radially deviate the wrist by moving the hand

toward the thumb. Maintain the wrist in 0 degrees
of flexion and extension, and avoid rotating the
hand.
The end of radial deviation ROM occurs when
resistance to further motion is felt and attempts to
overcome the resistance cause the elbow to flex

Normal End-Feel

Usually the end-feel is hard because of contact between the radial styloid process and the scaphoid or
trapezium, but it may be firm because of tension in the ulnar collateral ligament, the ulnocarpal ligament,
and the ulnar portion of the joint capsule. Tension in the extensor carpi ulnaris and flexor carpi ulnaris
muscles may also contribute to the firm end-feel..
Goniometer Alignment

1. Center fulcrum on the dorsal aspect of the wrist over the capitate .
2. Align proximal arm with the dorsal midline of the forearm , If the shoulder is in 90 degrees of abduction
and the elbow is in 90 degrees of flexion, the lateral epicondyle of the humerus can be used for reference.
3. Align distal arm with the lateral midline of the third metacarpal. Do not use the third phalanx for
reference.
Wrist Ulnar Deviation
Motion occurs in the frontal plane around an anterior– posterior axis. Ulnar deviation is sometimes
referred to
as ulnar flexion or adduction.
Normal ROM values for adults vary from about 30 to 40 degrees.

Testing Position

• Position the individual sitting next to a supporting surface with the shoulder abducted to 90
degrees,
• The elbow flexed to 90 degrees,
• The palm of the hand facing the ground.

Stabilization

Stabilize the radius and ulna to prevent pronation or supination of the forearm and less than 90
degrees of elbow flexion
Testing Motion

Deviate the wrist in the ulnar direction by moving the

hand toward the little finger. Maintain the wrist in 0
degrees of fl exion and extension, and avoid rotating
the hand.
The end of ulnar deviation ROM occurs when resistance
to further motion is felt and attempts to overcome the
resistance cause the elbow to extend.

Normal End-Feel

The end-feel is firm because of tension in the radial collateral ligament and the radial portion of the joint
capsule. Tension in the extensor pollicis brevis and abductor pollicis longus muscles may contribute to the
firm end-feel.
Goniometer Alignment

1. Center fulcrum on the dorsal aspect of the wrist over the capitate .
2. Align proximal arm with the dorsal midline of the forearm , If the shoulder is in 90 degrees of abduction
and the elbow is in 90 degrees of flexion, the lateral epicondyle of the humerus can be used for reference.
3. Align distal arm with the lateral midline of the third metacarpal. Do not use the third phalanx for
reference.