OOPS - PHYSICAL ASSESSMENT
HAND - FINGERS

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WARNING!! The thumbs and fingers are complex machines.

Only use these guidelines by yourself when there is no deformity of the fingers and you can straighten and bend the fingers actively, even if by a reduced amount. Any laceration (cut) that has left you with not being able to bend or straighten a finger should be taken seriously as a possible tendon injury that may need surgery. SEE A DOCTOR.

See the instructions for drawing your pain on devices.

You can also draw a pain chart / graph to show how the pain changes over the course of 24 hours.

Here is a spreadsheet table you can use online.
Enter the measurements, as percentage of full movement of ALL fingers, even if many are 100% i.e unaffected.
See measuring instructions with the images below.
The table will automatically calculate the functional range of your individual fingers and your whole hand. Make a copy of your results e.g. screenshot as they will disappear when you close the page. 
For each finger use the individual functional percentage to choose your rehabilitation starting guidelines for that finger(at the bottom of this page). 
You can return to the table when you need to re-assess your progress. 



Measuring finger range and function. Check your movements against your other hand to estimate how much of your range you have before you feel pain or stiffness. It's okay to make an estimate of the percentage compared to full range e.g 1/2 full range = 50%.

Calculating the function of fingers and thumb: Write the percentage of each movement of each affected joint in the table calculator. Just leave the score for any unaffected joints on the table, blank. It will give you the average of range of that joint (functional range).

Joints: Fingers have 3 joints: Knuckles (MCPs); Middle (Proximal joints PIPs) and; First (Distal joints DIPs). The Thumb joints are called: CMC (Thumb-Wrist joint), MCP (Knuckle), and DIP (First Joint). You will see the movement and ranges of each joint in the diagrams below.

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Hand Resting Posture 
Rest your hand and forearm face down on a table. You will notice that your hand will relax in approximately this position. If it is resting in a different position, make a note of that. 
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Neutral Position
Turn your hand and forearm on the side and then upward with straight fingers. If you are unable to straighten your fingers like the image, see finger extension. 
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Finger Flexion
Estimate each joint by curling the fingers down into a fist or as far as they can go. 

Write as: e.g
DIP = 80%
PIP = 80%
MCP = 100%
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Finger Extension
Resting hand palm down on table. Lift fingers up as far as can.
When the fingers can't straighten, estimate as % between straight and right angle (0%).

Write as Extension (E) = (e.g 100%)
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Thumb Neutral
With the hand palm down, the thumb sits nearly 90degrees (square) to the hand. With the hand palm upward, the thumb sits forward about 20 degrees. 

1. Distal Joint (DIP)
2. Metacarpal Joint (MCP)(Knuckle)
3. Wrist-Thumb Joint (CMC)
Measure the range of your other movements from this position. 
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Thumb Flexion
The thumb flexes across the palm about to the base of the fourth finger.
Full range:
1st (DiP) joint 90 degrees
2nd (MCP) joint 90 degrees
3rd (CMC) joint 20 degrees

Write as % of the above
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Thumb Extension
The thumb extends in line with the hand.
Full range: 
1st (DiP) joint straight or hyper = 100%. 90 degrees flexion = 0%
2nd (MCP) joint straight or hyper = 100% 90 degrees = 0%
3rd (CMC) joint 60 degrees = 100%
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Thumb Adduction
The thumb adducts at the CMC joint to next to the index finger. 
The thumb being able to sit against the index finger = 100%. 
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Thumb Abduction
The thumb abducts at the CMC joint forward away from the line of the hand. 
Measure from Thumb against hand = 0%
Full range = 60 degrees = 100%
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Thumb Opposition
The thumb circumducts to be able to pincer onto the tip of every finger.
Full range is touching the base of the fifth finger = 100%.
Touching tip of the 5th finger = 75%. Touching tip of the mid finger = 50%
Touching the tip of the index finger = 25%

Guide to commencing your self therapy from the Functional Range Table
Total average range less than 40% start your therapy here.
Total average range between 40 and 70% start your therapy here.
Total average range more than 70% start your therapy here.

OOPS First Aid

Acute Hand Recovery

Physical Assessment