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Thumb Measurements
391 Plays30 days ago
Miranda and Josh discuss key thumb measurements used to track progress, including calipers, goniometers, and the Kapandji score for thumb opposition.
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Transcript
Introduction to Hand Therapy Academy and Thumb Mobility Measurement
00:00:05
josh MacDonald
Hi, I'm Josh McDonald.
00:00:06
Miranda Materi
I'm random material and we are Hand Therapy Academy.
00:00:10
josh MacDonald
Let's talk a little bit today about how we do measurements on the thumb. It can be kind of a challenging one to get good standardized measurements. So let's talk about some of the ways that may be standard and some of the newer ways to that might be a little more interesting.
Transitioning from Goniometer to Calipers for Abduction Measurement
00:00:22
Miranda Materi
Yeah, so I know um just from being a part of Pan Therapy Academy, we read a lot of articles and we're always trying to stay up to date. And I think one thing that changed my clinical practice was how we measure radial and palmar abduction, abduction, because I used to do it with a goniometer, but now I'll switch to the calipers. um And from the research studies, they said that's a little bit more accurate than going doing the goniometric.
Challenges with Calipers and Preference for Goniometer
00:00:50
Miranda Materi
And so what about you? are you doing The calipers, are you doing the goniometric for that one?
00:00:56
josh MacDonald
So we're doing the goniometry. We're doing kind of a standard. Now we have our little pocket goniometer that we use that we um that we line up on the axis of pivot on the scapho trapezial trapezoid joint um with the mobile and the static arms on first and second metacarpals, all that. I tried the um the calipers and I tried it with another therapist and we tried to like, when we first read this article and thought, oh, that sounds kind of cool. I even had calipers I brought in and we tried it.
00:01:25
josh MacDonald
He and I struggled to find a standardization about where we were putting the points of the calipers. Was it on like like we didn't always see eye to eye in the moment on our testing about where the apex of those two joints were. And so I found there was some variation where we didn't have variation with the goniometer like we laid things right where they like We matched each other.
Standardization Issues with Caliper Measurements
00:01:50
josh MacDonald
And I think that intra-rater or inter-rater reliability was more consistent with the goniometer than it was with the calipers. I don't know the wrong with the calipers. We just didn couldn't seem to match.
00:01:58
Miranda Materi
Oh, that's interesting. I felt like at least for my intra-raider, so intra-relator reliability is basically you measuring it yourself right over and over how consistent you are.
00:02:11
josh MacDonald
yeah
00:02:12
Miranda Materi
I feel like that is much better for me. um But I can't say I went as far as you did and did the inter-raider reliability where I tested it with my peers.
00:02:22
josh MacDonald
And I know where I feel like the apex of those joints is the um the first and second MCP joints, but I had him do it. And we would do it like on our front desk gal. We do it on patients and caregivers that came in for people and a spouse or girlfriend or whatever. And we found that we were putting them in different spots. And we're like, well, how come you got a bigger measurement than I did? And we're like, well,
Different Goniometer Types in Clinical Settings
00:02:44
josh MacDonald
here's the apex. i'm like Well, if there's a two millimeter difference on both metacarpal heads,
00:02:49
josh MacDonald
that can look like a significant difference on your progress report measurement if he does it after I did the eval or something like that.
00:02:57
Miranda Materi
Yeah, that's interesting.
00:02:59
josh MacDonald
But I like the idea, if if you haven't seen what a caliper is, it's this sliding measurement tool that measures distance between two points. So instead of measuring an angle of that first to second metacarpal angle, you're measuring the distance between the first and so second metacarpal flangeal heads, just a different number that represents the same the same change from eval to progress report. But you've got to have consistency between your yourself your own measurements and across other therapists as well.
Kapanji Score for Thumb Functionality and Patient Empowerment
00:03:28
Miranda Materi
Yeah, that's interesting. I felt like, well, at least for the godeometer are using the like half moon one or using the ones with the longer windows.
00:03:35
josh MacDonald
we're using We're using our pocket goniometer. I feel like I'm, honestly, from a sense of convenience, I feel like the longer but skinny goniometer works well. But I have to grab it out if I wouldn't otherwise need it. like I use that one for wrist flexion extension and radial ulnar deviation. But if I'm not doing that, I don't have that out. And so I feel like I can still be consistent with a pocket goniometer that's that half moon shape.
00:03:59
Miranda Materi
Yeah.
00:03:59
josh MacDonald
um but
00:04:01
Miranda Materi
Well, that's interesting. I think that would be an interesting study to compare the pocket goniometer with the longer handles, just because I feel like with the longer one, you're more likely to account for some of their hypermobility.
00:04:07
josh MacDonald
Yeah.
00:04:13
Miranda Materi
If they have any, you know, what you have to be like really, I think more precise and accurate with how you line it up. So almost feel like the pocket one, and this is just kind of my theory, is that it might be actually a little better than the longer one.
00:04:27
josh MacDonald
Yeah, I feel like the longer one, if they've got that hypermobile extension at MCP and IP, you're right. The goniometer is more likely to run into those, and it pushes it offline of that center axis of the first metacarpal.
Tools for Various Patient Types: Goniometer and Kapanji
00:04:40
Miranda Materi
right?
00:04:40
josh MacDonald
Yeah, yeah. um Okay, so that's one option for measuring thumb mobility. Do you use Kapanji score pretty pretty consistently?
00:04:50
Miranda Materi
Um, I don't, but that's just because I think, you know, I haven't really adapted to that. And that was never part of my routine for the last, you know, 17, 18 years. But I do know if my team's doing it, I'll go in and report it. But that's definitely not my first um thing that I'll report. Do you guys use it quite a bit?
00:05:11
josh MacDonald
We do, I would say with all of our thumb relevant patients and even like our distal radius fractures that have that edema and they need to work through, I'll use it pretty consistently. I feel like it's something that gives the patient some power over their own sense of progress. They get a sense of like, oh, okay, now I can touch this fingertip and now I can touch this one.
00:05:30
josh MacDonald
It's supposed to be more functional measure. I feel like it's six to one half a dozen of the other. It's not like it gives me any better reading of their change in status, but it's super quick and easy to do. And it gives me a little bit more functional. You do have to kind of be careful, though, that they're not getting pad of the thumb, that it's supposed to be truly tip of the thumb to tip of each of the fingers or that crease on the on the index or small.
00:05:55
Miranda Materi
Yeah, I can understand how that would be, um where you have to be more careful with it. um Anything else for thumb measurements that you're doing? I usually, for the Kaponji one, I'll usually just tell the patient, like, oh look, you can touch your long finger tomorrow, or when I see you next week, let's make it a goal for me to touch your small finger, as opposed to saying, oh, that's a number seven, let's get to number nine, you know?
00:06:14
josh MacDonald
Yeah, yeah. And I have some patients that kind of get excited about the number system, but they're going to get excited. to be those are the may Those are the more type A patients who want
Measuring Thumb Strength and Different Grip Types
00:06:23
josh MacDonald
an objective measure, something specific.
00:06:23
Miranda Materi
yeah
00:06:24
josh MacDonald
so
00:06:25
Miranda Materi
those engineers, probably.
00:06:25
josh MacDonald
um Right, right. um As far as range of motion goes, those are kind of the main tools that I have. As far as strength measuring, how often do you go through all four of the grip strengths with a thumb relevant patient, general gross grasp strength on the on the dynamometer, and then key grip, two point and three point. Do you use all four of those pretty consistently?
00:06:52
Miranda Materi
I will if they're not like, of course, if they're like away of the CMC, I'm not going to be doing all those punches. But if it's we're measuring it, I usually do them every three to four weeks, depending upon the case. And then also, you know, I feel like sometimes those changes happen more dramatically early on. So I might do them more frequently and then less as they progress out. That's kind of standard for what we do. How about for you?
00:07:15
josh MacDonald
I find myself dropping the ones that are less relevant or give me less valuable information. like i'll if it Let's assume it's not an arthritis and it's not contraindicated. If it's a thumb relevant patient, I'm doing grip strength, I'll do lateral or a key grip and then I'll do tip or two point. But a lot of times I'm not also doing three point.
00:07:37
josh MacDonald
If they've got a long finger diagnosis or something, like a third metacarpal or something, then I for sure will. But I feel like I don't get that much more data and information by doing another round of pinch grip strength testing for three point than I did with two point. I feel like two point, accomplish what I needed.
00:07:55
Miranda Materi
Yeah, I think it just depends too, right? You can compensate a lot with the three point versus the two point. um If so, if you're, if it's an index finger, you know, you might want to see, I don't know, I just think it's interesting.
00:08:06
Miranda Materi
You might want to see if they're actually, cause I like to see the measure and see from those two points, are they compensating at all using their other digit as opposed to just their index?
00:08:16
josh MacDonald
Yeah.
00:08:16
Miranda Materi
And I feel like that data helps a little bit, but probably not necessary.
00:08:19
josh MacDonald
Yeah. I've never plotted it. I've never like grafted out, but I think it would be interesting to see across our you know orthopedic acute trauma patients, if their tip pinch follows this graph of improvement, how closely does the three point follow that same graph of improvement that it becomes a redundant measure?
00:08:41
josh MacDonald
Or it does it give me information because there's a split between the two? Like, how big of a split should there be between the two? And so its it would be interesting to track that and say, like, what does that tell me about their rehab if there isn't a difference, if it follows the same correlation, or if there's supposed to be a certain gap, like non-dominant hand strength is supposed to be a certain gap.
00:09:02
josh MacDonald
Are those supposed to be?
Listener Engagement: Sharing Tools and Thoughts
00:09:04
josh MacDonald
And I don't know if I've ever seen that.
00:09:05
Miranda Materi
Yeah, I think that would be interesting added to the list.
00:09:07
josh MacDonald
Yeah. All good things to do in research. Maybe we'll ask some ah capstone students from some of our universities to to trial that one out. That would be interesting.
00:09:14
Miranda Materi
Yeah, there you go. That's a good idea.
00:09:16
josh MacDonald
Yeah, yeah. All right, well, it'd be interesting if you guys have any other measurement tools you use for range of motion or for strength testing or any other thoughts. Certainly comment back here or you can reach out to us on our email info at handtherapyacademy.com or on our social media platforms, handtherapyacademy.