The primary aim of this study was to design and then test the intrarater reliability of a torque-controlled method of measuring passive abduction of the thumb carpometacarpal (CMC) joint. A secondary aim was to quantify passive CMC abduction in patients with and without contracture. Initially, clinicians used subjective feel (without range of motion measurements) to identify 52 people with loss of passive thumb CMC abduction. All subjects had a neurological condition. Passive thumb CMC abduction was measured in both hands of these 52 people and the hands of another 20 healthy able-bodied individuals (total of 72 people and 144 hands). Passive thumb CMC abduction was measured using a newly designed torque-controlled device and the previously recommended caliper method. Repeat measurements were taken with both devices, two to three days later, by blinded assessors on a subgroup of 12 patients (24 hands). Median (interquartile range) CMC angle of thumbs deemed by clinicians to have contracture was 45° (41–52°) and that of subjects without contractures was 56° (53–60°). The intraclass correlation coefficient for the repeat measures attained with the torque-controlled device was 0.78 (95% confidence interval, 0.56–0.90). The torque-controlled device provides a way of standardizing torque when measuring passive thumb CMC abduction. The clear difference between passive CMC abduction of subjects with and without contracture confirms the ability of clinicians to use feel and subjective assessment to identify patients with contracture.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Therapy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Adduction contracture thumb.Eur J Plast Surg. 1991; 14: 265-270
- Revision of the first web space: technics and results.South Med J. 1981; 74: 1204-1208
- Management of the thumb-index web space contracture.Am J Occup Ther. 1976; 30: 543-550
- Documentation of the first web space angle.J Hand Surg [Br]. 1989; 14: 298-300
- Reliability of thumb web measurements.J Hand Ther. 2004; 17: 58-63
- Brief or new: Measuring cone for thumb abduction/extension.Am J Occup Ther. 1984; 38: 263-264
- Reconstructive surgery in treatment of deformities of the hand.in: Dharmendra Leprosy. Kothari Medical Publishing House, Bombay1978: 567-617
- Clinical Assessment and Recommendations.American Society of Hand Therapists, Chicago, IL1992 (65)
- Deformity in leprosy.in: Cochrane R. Leprosy in Theory and Practice. John Wright and Sons, Ltd., Bristol, UK1964: 485-496
- Thumb web contracture.Hand. 1972; 4: 236-246
- Trapeziometacarpal arthroplasty using the entire flexor carpi radialis tendon.Clin Orthop. 2000; 370: 164-170
- Long-term results of tendon shortening trapeziometacarpal arthroplasty.Clin Orthop. 2002; 405: 199-206
- First web space contracture and hand function.J Hand Surg. 1993; 18A: 516-520
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- Forming inferences about some intraclass correlation coefficients.Psychol Methods. 1996; 1: 30-46
- Torque range of motion in the hand clinic.J Hand Ther. 1990; : 7-13
- The use of torque angle curves in the assessment of digital joint stiffness.J Hand Ther. 1988; 1: 69-74
- Quantifying the magnitude of torque physiotherapists apply when stretching the hamstring muscles of people with a spinal cord injury.Arch Phys Med Rehabil. 2003; 84: 1072-1075
- Inter and intratherapist reliability of passive accessory movement technique.N Z J Physiother. 1991; 19: 22-24
- Variability of forces applied by experienced therapists during mobilization.Clin Biomech. 1997; 12: 393-399
- Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries?.Aust J Physiother. 2005; 51: 251-256
- Reliability of a device designed to measure ankle mobility.Spinal Cord. 2003; 41: 559-562
- Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in people with spinal cord injuries.Aust J Physiother. 2003; 49: 176-181
JHT Read for Credit
Quiz: Article #042
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
- #1.The primary purpose of the study was to devise a:
- a.valid method of measuring thumb CMC active abduction using standardized torque.
- b.reliable method of measuring thumb CMC active abduction using standardized torque.
- c.reliable method of measuring thumb CMC passive abduction using standardized torque.
- d.valid method of measuring thumb MP motion using standardized torque.
- #2.The arms of the goniometer were aligned with the:
- a.1st & 2nd metacarpals.
- b.1st & 2nd metacarpal heads
- c.thumb & index long axes.
- d.thumb & dorsal shaft of the 3rd metacarpal.
- #3.A focus of the study was:
- a.CMC vs. MCP reliability.
- b.cross-population reliability.
- c.interrater reliability.
- d.intrarater reliability.
- #4.The clinicians found the average thumb CMC adduction contracture of about:
- #5.The ICC of the torque-controlled devise when measuring thumb CMC abduction was about:
When submitting to the HTCC for recertification, please batch your JHT RFC certificates in groups of three or more to get full credit.
Financial support from: The Rehabilitation and Disability Research Foundation Research Grants of The Royal Rehabilitation Centre Sydney.
© 2006 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.