Range of Motion — Upper Extremities (Shoulder, Elbow, Wrist, Fingers)

1Step-by-Step Procedure

1. 1

   Wash hands.

2. 2

   Identify the resident and explain the procedure.

3. 3

   Raise the bed to a comfortable working height; lower the side rail on the working side.

4. 4

   Position the resident in supine (on their back) position.

5. 5

   Expose only the arm you are working on; keep the rest of the resident draped for warmth and privacy.

6. 6

   Shoulder flexion/extension: support the arm at the elbow and wrist; raise the arm straight forward and overhead (flexion), then lower it back to the side (extension). Perform 3–5 repetitions.

7. 7

   Shoulder abduction/adduction: move the arm out to the side and overhead (abduction), then return it to the side of the body (adduction). Perform 3–5 repetitions.

8. 8

   Shoulder internal/external rotation: with the elbow bent to 90°, rotate the forearm down (internal rotation) then up (external rotation). Perform 3–5 repetitions.

9. 9

   Elbow flexion/extension: bend the elbow, bringing the hand toward the shoulder (flexion), then straighten the arm (extension). Perform 3–5 repetitions.

10. 10

    Wrist flexion/extension: support the forearm; bend the hand downward (flexion) and upward (extension). Perform 3–5 repetitions.

11. 11

    Wrist radial/ulnar deviation: move the hand toward the thumb side (radial deviation) then toward the little-finger side (ulnar deviation). Perform 3–5 repetitions.

12. 12

    Finger flexion/extension: gently close the fingers into a fist (flexion), then straighten (extension). Perform 3–5 repetitions.

13. 13

    Thumb opposition: touch the thumb to each fingertip in sequence.

14. 14

    Support all joints above and below the joint being exercised throughout.

15. 15

    Move each joint through its full range of motion — never force a joint.

16. 16

    Stop and report immediately if the resident expresses pain.

17. 17

    Cover and reposition the resident comfortably after completing the exercises.

18. 18

    Lower the bed and raise the side rail.

19. 19

    Wash hands and document.

What the Examiner Is Watching For

• ✓

  All joints are supported above and below during each movement.

• ✓

  Movements are smooth, slow, and controlled — never forced.

• ✓

  Each joint is moved through full range of motion.

• ✓

  Candidate stops immediately if the resident reports pain.

• ✓

  All required joints are exercised: shoulder, elbow, wrist, and fingers.

Common Mistakes That Cause Failure

• ⚠

  Supporting only one point on the extremity rather than above and below the joint.

• ⚠

  Moving joints too quickly or with jerky motions.

• ⚠

  Skipping one of the required joints (e.g., forgetting thumb opposition).

• ⚠

  Continuing past the point of pain or resistance — always stop and report.

• ⚠

  Not performing the minimum number of repetitions (typically 3–5).

Tips for Exam Day

• →

  Support above AND below each joint — this is the most commonly missed technique point.

• →

  Move slowly; ROM is not a race.

• →

  Count repetitions quietly — 3 to 5 per motion.

• →

  If you feel resistance or the resident grimaces, stop and tell the evaluator.