Hand Surgery Source

Range of Motion: Passive

Test, Exam and Signs

Historical Overview

Historically, physicians have used a metric ruler or goniometer to measure passive range of motion (ROM).1 By 2006, a new goniometer was developed, particularly for the measurement of small joints.2


  • For an examination of passive ROM, the physician moves the patient’s affected area(s) of the hand, wrist and/or elbow. This will show the passive range of strength for each joint.1
  • Typical degrees of motion for each joint in the hand and for the wrist and elbow are provided in the Table.3,4

Approximate Typical ROM, Active




Degrees (°)























Radial deviation


Ulnar deviation










  • Loss of passive ROM may be due to rheumatoid arthritis (RA), Dupuytren’s disease, cerebral palsy5 or a neurological injury.6
  • There will be a typical pattern of tenodesis when a patient loses motion from a neurological injury.6
  • In infants and children with cerebral palsy, it is helpful to exercise with passive ROM, so that the patient does not develop further fixed-joint stiffness.5


  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate on a scale from 1-10 how much pain s/he usually experiences at the affected area(s).
  2. Assist the patient to flex, extend, abduct, and adduct the affected area(s). Measure each joint separately with a goniometer.1
  3. If the patient experiences a change in passive motion from the previous examination, record the reason, if known.1
  4. Examine the contralateral area(s) in the affected hand, wrist and/or elbow.


  • Also check the ulnar deviation and radial deviation of the wrist.

Related Signs and Tests

  • Pulp-to-palm, passive
  • Passive stretch test
  • ROM, active
  • Grip strength
  • Neuromuscular testing1
  • Nerve conduction studies
  • Radiographs
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • To improve reliability in diagnosing RA, use plain radiographs to test joints for damage.

Presentation Photos and Related Diagrams
Measuring Range of Motion with Digital Goniometer
  • Digital Goniometer
    Digital Goniometer
  • Measuring digital range of motion with goniometer
    Measuring digital range of motion with goniometer
  • Measuring MP joint range of motion with the digital goniometer
    Measuring MP joint range of motion with the digital goniometer
  • Measuring PIP joint range of motion with the digital goniometer
    Measuring PIP joint range of motion with the digital goniometer
Definition of Positive Result

Measuring PIP joint range of motion with the digital goniometer

Definition of Negative Result
  • A negative result occurs when the patient does not achieve full ROM with assistance, within the typical ranges for each joint of the hand, wrist and/or elbow.
Comments and Pearls
  • If there is a difference between joint active and passive ROM, this is called active-passive mismatch. Tendon adhesions may cause this mismatch.1
  • After further studies, dynamic EMG/motion laboratory analysis may be an important tool for diagnosing cerebral palsy and measuring its severity. The arc of motion that a joint allows when it is normal can easily be measured and observed; therefore abnormalities in joints and joint function can be assessed by loss    of motion. Measuring this loss helps to quantify the patient’s deficits.
  • Range of motion can be assessed as either active or passive.  When doing a passive range of motion assessment, the examiner places the joint in the maximum position allowed by the soft tissue constraints of the joint without the patient’s muscle power.
  • The muscles around any given joint provide a range of flexion, extension, rotation, and deviation which is inherent to each particular joint. When measuring ROM, we measure by either visual assessment or by a goiniometer.
  • It is critical to compare measurements to the contralateral joint to determine a baseline and assess for deficits if any.
Diagnoses Associated with Tests, Exams and Signs
Demonstrating active vs passive range of motion
Demonstrating passive range of motion

Cited references:

  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. Rayan G, Akelman E. The Hand: Anatomy, Examination, and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
  4. Adams BD, Grosland NM, Murphy DM, et al. Impact of impaired wrist motion on hand and upper-extremity performance. J Hand Surg Am 2003;28:898-903. PMID: 14642503
  5. Bunata R, Icenogle K. Cerebral palsy of the elbow and forearm. J Hand Surg Am 2014;39(7):1425-32. PMID: 24969499
  6. Kenney RJ, Hammert WC. Physical Examination of the Hand. J Hand Surg Am 2014;39(11):2324-34. PMID: 25442747
  7. Dutton M. Orthopaedic Examination, Evaluation and Intervention. McGraw-Hill, 2004, pp. 537, 613-615
  8. Trumble, T., & Budoff, J. (2006). Anatomy and Physical Examination of the Hand. In Hand, elbow & shoulder core knowledge in orthopaedics (p. 3). Philadelphia, Pennsylvania: Mosby.