goniometry and manual muscle testing of the ue
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TRANSCRIPT
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Range of Motion AssessmentUpper Extremity
OT 3760
Neurokinesiology Lab
Created by Ben Atchison, PhD, OTR, FAOTA
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Factors to Consider
• Norms are only guidelines. Measure non-affected extremity for intra subject comparison.
• Tableside manner is critical. Make every effort to comfort and inform. ALWAYS obtain permission to perform the procedure after you have comforted and informed
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Factors to Consider
Know the biomechanics/pathomechanics of the condition that the person is diagnosed with. Ask about recent/past surgeries.
This is necessary to know to avoid unnecessary pain, discomfort and potential for structural damage.
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Factors to Consider
• Perform a functional assessment first that starts from proximal and proceeds to distal.
• This enables you to observe variation between the affected vs non affected extremity AND..
• It saves time!
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Factors to Consider
• ALWAYS: AROM before PROM
• ALWAYS: Follow up with PROM when a limitation is noted so you can assess restrictions through motion and “joint end feel” (firm, hard, soft)
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Factors to Consider
• When a difference exists between PROM and AROM in the same joint, this is due to muscle weakness
• Prevent subsitution or compensation by positioning and stabilizing the joint proximal to the joint being measured
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Factors to Consider
• Align the stationary bar parallel to the long axis of the stationary bone
• Align the moveable bar parallel to the long axis of the moveable bone
• The axis of the goniometer is aligned with the joint axis
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Factors to Consider
• Measure both the starting position and the end position, or maximum range. This indicates the freedom of motion at the joint.
• Place the goniometer at the starting point and then replace at the end point. (video demo shows movement of goniometer as person moves for demo of total range)
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Factors to Consider
• Indicate whether the measure is active or passive ROM
• If person cannot reach 0 degrees starting position,indicate that by stating number of degrees of motion from zero (example: 10-145 for elbow flexion)
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Factors to Consider
• Record signs and symptoms that interfered with full AROM/PROM assessment that may be unrelated to the primary diagnosis.
• Examples: Old fractures resulting in joint limitations, secondary dx resulting in weakness, pain, inability to follow directions, etc…..
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Factors to Consider
• Record all measures on a form, leave nothing blank (indicate NT if not tested), date, and sign the form.
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VIEWING VIDEO CLIPS
Click on the picture to start the videos for each slide…
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Scapular Depression/Elevation
• Not measured with a goniometer
• Compared with movement on non affected side
• Recorded as less than half/half/more than half/ or full range
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Scapular Adduction
• Not measured with a goniometer
• Compared with opposite side
• Record as less than half/ half/ more than half/ or full range
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Scapular Abduction
• Not measured with a goniometer
• Compared with movement on the opposite side
• Recorded as < half, half, more than half or full range
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Shoulder Flexion: 0-170
• Start: Arm at side, elbow extended
• Axis: Shoulder joint below acromium
• Stationary Arm: parallel to mid axillary line of trunk
• moveable Arm: parallel to longitudinal axis of the humerus
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Shoulder Extension 0-60
• Start: Arm at side with elbow extended
• Axis is shoulder joint laterally below acromium
• Stationary arm parallel to mid axillary line of trunk
• moveable arm parallel to longitudinal axis of the humerus
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Shoulder Abduction: 0-170
• Start: Arm at side and elbow extended
• Axis: center of shoulder jt posterior
• Stationary arm: Parallel with midline of body
• moveable arm: Parallel with longitudinal axis of the humerus
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Shoulder Adduction
• Start: Arm at side, elbow extended
• Axis: center of the shoulder jt. posterior
• Stationary arm is parallel to midline
• moveable arm is parallel to longitudinal axis of the humerus
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Shoulder Horizontal Abduction 0-130
• Start: seated and shoulder flexed to 90
• Axis: Top of acromiom
• Stationary arm parallel to longitudinal axis of humerus and remains
• moveable arm parallel to longitudinal axis of humerus
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Shoulder Horizontal Adduction: 0-40
• Start: seated and shoulder flexed to 90
• Axis: Top of acromiom
• Stationary arm parallel to longitudinal axis of humerus and remains
• moveable arm parallel to longitudinal axis of humerus
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Shoulder Internal Rotation: 0-70
• Start: arm abducted 90 and elbow flexed 90
• Axis: center of elbow jt
• Stationary arm: parallel to mid axillary line of the thorax
• moveable arm: parallel to the longitudinal axis of the ulna
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Shoulder External Rotation: 0-90
• Start: arm abducted 90 and elbow flexed 90
• Axis: center of elbow jt
• Stationary arm: parallel to mid axillary line of the thorax
• moveable arm: parallel to the longitudinal axis of the ulna
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Elbow Flexion: 0-145
• Start with arm at side• Axis: center of lateral
aspect of the elbow jt• Stationary arm:
parallel to longitudinal axis of the humerus
• moveable arm: parallel to longitudinal axis of the radius
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Elbow Extension: 145-0
• Start with arm at side• Axis: center of lateral
aspect of the elbow jt• Stationary arm:
parallel to longitudinal axis of the humerus
• Stationary arm: parallel to longitudinal axis of the radius
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Forearm Supination: 0-90
• Start: arm adducted and elbow flexed to 90. The forearm is midway between pronation and supination
• Axis: centered at the ulnar styloid
• Stationary arm parallel to longitudinal axis of humerus
• moveable arm is on volar surface of the wrist
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Forearm Pronation: 0-90
• Start: arm adducted and elbow flexed to 90 forearm midway between pronation and supination
• Axis: centered at the ulnar styloid
• Stationary arm parallel to longitudinal axis of humerus
• moveable arm is on dorsal surface of the wrist
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Wrist Flexion: 0-80
• Start: Arm at side, elbow flexed and forearm neutral
• Axis: midcarpal joint• Stationary arm: dorsal
and parallel to longitudinal axis of radius
• Moveable arm dorsal and parallel to longitudinal axis of the 3rd metacarpal
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Wrist Extension: 0-70
• Start: Arm at side, elbow flexed and forearm neutral
• Axis: radiocarpal joint• Stationary arm: volar
and parallel to longitudinal axis of radius
• moveable arm volar and parallel to longitudinal axis of the 3rd metacarpal
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Wrist Radial Deviation: 0-20
• Start: Elbow flexed, forearm pronated and wrist neutral
• Axis: intercarpal jt
• Stationary arm is dorsal and parallel to midline of forearm
• moveable arm is parallel to midline of the 3rd metacarpal
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Wrist Ulnar Deviation: 0-30
• Start: Elbow flexed, forearm pronated and wrist neutral
• Axis: intercarpal jt
• Stationary arm is dorsal and parallel to midline of forearm
• moveable arm is parallel to midline of the 3rd metacarpal
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Finger MP Flexion: 0-90
• Start with wrist and forearm in neutral
• Axis is MP joint• Stationary arm is
dorsal and parallel to metacarpal
• moveable arm is dorsal and parallel to proximal phalynx
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Finger PIP Flexion: 0-110
• Start with wrist and forearm in neutral
• Axis is PIP joint• Stationary arm is
dorsal and parallel to proximal phalynx
• moveable arm is dorsal and parallel to middle phalynx
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Finger DIP Flexion: 0-80
• Start with wrist and forearm in neutral
• Axis is DIP joint• Stationary arm is
dorsal and parallel to middle phalynx
• moveable arm is dorsal and parallel to distal phalynx
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Finger MP Extension
• Start with wrist and forearm in neutral
• Axis is MP joint• Stationary arm is
dorsal and parallel to metacarpal
• moveable arm is dorsal and parallel to proximal phalynx
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Finger IP Extension
• Start with wrist and forearm in neutral
• Axis is IP joint• Stationary arm is dorsal
and parallel to proximal phalynx to the joint tested
• moveable arm is dorsal and parallel to the phalynx distal to the joint tested
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Finger Abduction
• Start with wrist neutral, forearm pronated and IP’s extended
• Use a ruler to measure distance between fingertips
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Finger Adduction
• Start with wrist neutral, forearm pronated and IP’s extended
• Use a ruler to measure distance between fingertips
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Small (5th) Finger Opposition
May be done with a ruler to measure distance between thumb tip to small finger tip
This is an overall assessment of opposition and not a specific test of small finger opposition
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Thumb MP Flexion: 0-50
• Start with forearm and wrist in neutral
• Axis is MP joint
• Stationary arm is dorsal and parallel to first metacarpal
• moveable arm is dorsal and parallel to the proximal phalynx of the thumb
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Thumb IP Flexion: 0-90
• Start with forearm and wrist in neutral
• Axis is the IP joint• Stationary arm is
dorsal parallel to the proximal phalynx
• moveable arm is dorsal parallel to the distal phalynx
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Thumb MP Extension
• Start with forearm and wrist in neutral
• Axis is MP joint
• Stationary arm is dorsal and parallel to first metacarpal
• moveable arm is dorsal and parallel to the proximal phalynx of the thumb
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Thumb IP Extension
• Start with forearm and wrist in neutral
• Axis is the IP joint• Stationary arm is
dorsal parallel to the proximal phalynx
• moveable arm is dorsal parallel to the distal phalynx
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Thumb Palmar Abduction
• Start with wrist and forearm in neutral
• Axis is the intersection of lines parallel to 1st and 2nd metacarpal
• Stationary arm is parallel to 2nd metacarpal along radial aspect
• moveable arm is parallel to 1st metacarpal along the radial aspect
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Thumb Radial Abduction
• Start with forearm pronated and wrist neutral
• Axis is the intersection of lines parallel to 1st and 2nd metacarpal
• Stationary arm is parallel to 2nd metacarpal along dorsal aspect
• Moveable arm is parallel to 1st metacarpal along the dorsal aspect
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Thumb Opposition
A ruler is used to measure the distance between IP jt of volar surface of the thumb to third metacarpal at the distal palmar crease
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Competency Assessment
• Final step in this ROM Assessment Unit is to complete a Competency Evaluation.
• Competency requirements are provided in class.
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Manual Muscle Testing
OT 375
Fall 2004
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What is MMT?
Objective measure of the strength of muscle groups within grades of resistance from
antigravity through full, manual resistance
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Indications
• Persons with musculoskeletal disorders
• Persons with progressive neurological disorders
• Persons with spinal cord injuries
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Contraindications
• Persons with brain injury that results in hypertonicity/spasticity
• Persons with active state of pain such as arthritis (exacerbated state), myositis, cellulitis, etc.
• Severe cardiopulmonary conditions
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Limitations
• Tests only static strength vs dynamic
• Functional endurance
• Reliability/Validity
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Procedures
Start Position
Stabilize
Observe
Position
Palpate
Resist
Grade
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Start Position
• Beginning point of range of motion
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Stabilize
• Refers to method of supporting body part in assessment
• Often times by position, per se, of the body or specific handling by evaluator
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Observe
• Patient ability to understand directions
• Comfort…………………Apprehension
• Substitution patterns
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Position
• Your position is important for your own comfort and efficient handling
• Placement of hand proximal to joints vs on the joint or too distal
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Palpate
• Primarily for grades 0-3
• Assess for abnormalities as well
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Resistance
• Resistance of muscle against gravity to full resistance by gravity
• Refers to the amount of force applied to inhibit motion
• Is manually applied in opposite line of ms pull
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Grading
• Assign a term or numerical rating to indicate
• Use opposite extremity for “norms”
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MMT Grading
Normal 5
Good 4
Fair 3
Poor 2
Trace 1
Zero 0
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MMT Grade Criteria
• Normal (5): Holds test position against maximal resistance
• Good (4): Holds test position against moderate resistance
• Fair (3): Holds test position against gravity
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MMT Grade Criteria
• Poor (2) Able to move through full ROM with gravity eliminated
• Trace (1) No visible movement; palpable or observable tendon prominent/flicker
• Zero (0) No palpable or observable muscle
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Functional Motion Test
• Purpose
• Procedure
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Scapular Depression
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Scapular Elevation
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Scapular Adduction
(Retraction)
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Scapular Abduction
(Protraction)
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Shoulder Flexion
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Shoulder Extension
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Shoulder Abduction
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Shoulder Adduction
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Shoulder Horizontal Abduction
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Shoulder Horizontal Adduction
![Page 75: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/75.jpg)
Shoulder Internal Rotation
![Page 76: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/76.jpg)
Shoulder External Rotation
![Page 77: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/77.jpg)
Elbow Extension
![Page 78: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/78.jpg)
Elbow Flexion
![Page 79: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/79.jpg)
Forearm Supination
![Page 80: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/80.jpg)
Forearm Pronation
![Page 81: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/81.jpg)
Wrist Flexion
![Page 82: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/82.jpg)
Wrist Extension
![Page 83: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/83.jpg)
Radial and Ulnar Deviation not part of the
MMT protocol since those muscles are tested via Wrist Flexion and
Extension
![Page 84: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/84.jpg)
Finger MP Flexion
![Page 85: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/85.jpg)
Finger PIP Flexion
![Page 86: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/86.jpg)
Finger DIP Flexion
![Page 87: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/87.jpg)
Finger MP Extension
![Page 88: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/88.jpg)
Finger IP Extension
![Page 89: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/89.jpg)
Finger Abduction
![Page 90: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/90.jpg)
Finger Adduction
![Page 91: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/91.jpg)
Opposition of Thumb
and 5th Finger
![Page 92: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/92.jpg)
Thumb MP Flexion
![Page 93: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/93.jpg)
Thumb IP Flexion
![Page 94: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/94.jpg)
Thumb MP Extension
![Page 95: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/95.jpg)
Thumb IP Extension
![Page 96: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/96.jpg)
Thumber Palmar
Abduction
![Page 97: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/97.jpg)
Thumb Radial
Abduction
![Page 98: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/98.jpg)
Thumb Adduction
![Page 99: Goniometry and Manual Muscle Testing of the UE](https://reader034.vdocuments.net/reader034/viewer/2022051323/547ae628b4af9fed2f8b473e/html5/thumbnails/99.jpg)