Accuracy and Reliability of Three Different Techniques for Manual Goniometry for Wrist Motion: A Cadaveric Study

The purpose of this study was to evaluate the accuracy and reliability (both inter- and intra-rater) in measuring wrist flexion and extension using 3 manual goniometric alignment techniques (ulnar, radial, and dorsal–volar) in cadaveric upper extremities, using fluoroscopic verification of posture as a gold standard.  External fixators were applied to 10 cadaveric wrists with intramedullary cannulated rods in the radius and third metacarpal for gold-standard fluoroscopic verification of posture. Manual goniometric measurements with each technique were captured by 2 raters (a hand surgeon and a hand therapist) for reliability measurements and by a single rater for accuracy. Wrists were positioned at angles of maximum flexion, extension, and radial and ulnar deviation for reliability testing and at preselected angles across the range of motion for accuracy testing. At each position, wrist angle was measured with a 1° increment goniometer, and fluoroscopic angles were measured digitally. Intraclass correlation coefficients and root mean square values were calculated for all combinations, and analysis of variance was used to test differences between technique.  No technique was statistically less accurate than any other (6° to 7°). Each method was found to have high intra-rater reliability. For measurement of wrist flexion and extension, the dorsal–volar technique demonstrated the greatest inter-rater reliability, as compared to ulnar and radial, respectively.

Although each measurement technique demonstrated a similar degree of accuracy and intra-rater reliability, the dorsal–volar technique demonstrates the greatest level of inter-rater reliability for measurement of wrist flexion and extension. This information is important clinically, as measurements are regularly exchanged between hand surgeons and therapists as a basis for decisions regarding patient care.

Timothy I. Carter, Brian Pansy, Aviva L. Wolff, Howard J. Hillstrom, Sherry I. Backus, Mark Lenhoff and Scott W. Wolfe. Accuracy and Reliability of Three Different Techniques for Manual Goniometry for Wrist Motion: A Cadaveric Study. The Journal of Hand Surgery, 2009, 34(8), 1422-1428