Hand Surgery Source

Pulp-to-Palm Distance Active

Test, Exam and Signs

Historical Overview

  • Historically, the pulp-to-palm distance has been measured efficiently with a metric ruler. This measurement provides an approximate assessment of total finger range of motion (ROM). Pulp-to-palm distance can also be measured with a digital goniometer.1
  • By 2006, a new goniometer with ergonomic advantages was developed, especially for the measurement of small joints.2


  • The pulp-to-palm distance is the measurement (cm) from the tip of a finger to its distal palmar crease, for the index, long, ring and little fingers.
  • This measurement is useful when assessing a patient over time for changes in flexion, particularly when multiple joints or digits are involved.1
    • Goniometry is considered the “gold standard” for measuring finger ROM.3 However, using a digital goniometer is more time consuming than using a metric ruler.


  • A positive result for active pulp-to-palm distance may arise from flexor tendon injury, joint injuries, paralysis, flexor tenosynovitis and rheumatoid arthritis (RA).
  • In rare cases, a positive result can also be caused by systemic sclerosis or brachial plexus palsy in children.3


  1. Ask the patient to flex the fingers of the affected hand and bring the tips of the affected fingers as close to the palm as possible.
  2. Measure and record the pulp-to-palm distance with a metric ruler or goniometer.
  3. Observe whether the patient experiences pain or crepitus with this measurement.
  4. Examine the patient’s contralateral hand for comparison.


  • If the patient has been examined before, record whether there is a loss or gain in active motion. Motion may be limited by pain, tendon dysfunction or joint stiffness.1
  • The distance can be measured repeatedly over time to determine the results of exercise and/or hand therapy.4

Related Signs and Tests

  • Pulp-to-palm distance, passive
  • Muscle testing
  • Neurovascular examination
  • Plain radiographies to assess joints for damage such as arthritis

Diagnostic Performance Characteristics

  • Using a metric ruler or goniometer will improve the reliability of the pulp-to-palm distance measurement.
  • Joint swelling and deformation may decrease the accuracy of joint angle measurement.2
  • Because of inconsistency by different testers, pulp-to-palm measurements should not be used to compare measurements between patients.4
Definition of Positive Result
  • A positive result occurs when the active pulp-to-palm distance is greater than 0.
Definition of Negative Result
  • A negative result occurs when the active pulp-to-palm distance is 0.
Comments and Pearls
  • If there is a difference between joint active and passive motion, it should be recorded as “active-passive mismatch.”1 This result may occur if joints are flexing and extending with passive motion, but the damaged tendons cannot flex the joints actively.
  • If pulp-to-palm active results are positive, the patient may need occupational therapy and/or surgery.  
Diagnoses Associated with Tests, Exams and Signs
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Stam HJ, Ardon MS, den Ouden AC, et al. The compangle: a new goniometer for joint angle measurements of the hand. A technical note. Eura Medicophys 2006;42(1):37-40. PMID: 16565684
  3. Torok KS, Baker NA, Lucas M, et al. Reliability and validity of the delta finger-to-palm (FTP), a new measure of finger range of motion in systemic sclerosis. Clin Exp Rheumatol 2010;28(58):S28-36. PMID: 20576211
  4. Macdermid JC, Fox E, Richards RS, et al. Validity of pulp-to-palm distance as a measure of finger flexion.  J Hand Surg Br 2001;26(5):432-5. PMID: 11560424