Special tests for hand and wrist injuries will be specific to the injured area. However all hand and wrist injuries will likely require assessment of range of motion.

One of the common methods of measuring joint range of motion is with the use of a goniometer. However, whilst this may be optimal for larger joints such as the knee, because of the small size and intricacy of the wrist, as well as the dual axis of movement around the capitate bone, at both the radiocarpal joint and the midcarpal joint, goniometer measurement can sometimes be difficult and inaccurate. 

An alternative measure is with the use of a spirit level, either as a separate device or using a level built in to a smartphone. For measuring flexion and extension, this is best done in side-lying (with the affected side down), with the level resting over the line of the 3rd metacarpal. We measure in side-lying so that we can keep the forearm in neutral pronation/supination. For radial/ulnar deviation we measure in supine with the level resting in the web of the hand, along the line of the 2nd metacarpal. For pronation and supination we measure in sitting or standing, with the elbow flexed to 90 degrees and the level resting on the palm, supported by the thumb. 


It is also important when measuring wrist flexion and extension to measure with both open and closed hand. When measuring extension with the hand open, we will be measuring more muscle length due to the finger flexors being on stretch, however when measuring with the hand closed, the restriction may be more related to joint movement. When measuring flexion with the hand closed, we will be measuring more muscle length due to the finger extensors being on stretch, however when measuring with the hand open, the restriction may be more related to joint movement.

About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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By Sam Gilbert