Upper Limb Assessment and Evaluation
What you must know
Assessment of the upper limb is a hypothesis-driven process, not a checklist. Be able to describe observation (posture, swelling, wasting, skin changes), active and passive range of motion (AROM/PROM), manual muscle testing (MMT, 0–5 scale), goniometry landmarks, sensation testing (light touch, two-point discrimination, monofilament), grip and pinch dynamometry, and functional/outcome measures (e.g., DASH, QuickDASH, PRWE, Michigan Hand Questionnaire). Know the difference between impairment measures and activity/participation measures.
Traps in questions
- AROM vs PROM: a painful arc with preserved PROM suggests a contractile or impingement problem, whereas a true capsular restriction limits both. A large AROM–PROM gap signals tendon rupture or neurologic deficit.
- Goniometry conventions: shoulder flexion measured supine vs standing; wrist measured with forearm pronated; always state the reference position. Zero-position and axis placement are common distractors.
- MMT grading: grade 3 = full ROM against gravity only; grade 2 = full ROM with gravity eliminated. Questions love to swap these.
- Dynamometry: grip strength varies with elbow position and handle setting; compare to the uninvolved side and to normative data, not an absolute number alone.
- Provocative tests (e.g., Phalen, Tinel, Finkelstein, apprehension) are screening tools with modest accuracy - a positive test alone does not confirm diagnosis.
Rule of thumb
Assess proximal before distal and active before passive, then compare sides. If a finding does not change your working hypothesis, it probably does not belong in the reassessment.
Worked example
A patient has painful shoulder elevation to 90° but full passive elevation. The AROM–PROM gap points to a contractile or subacromial source (e.g., rotator cuff tendinopathy/impingement) rather than adhesive capsulitis, which would restrict both. Document the arc, the gap, and the pain level.