Mcveigh 2016

SCIENTIFIC ARTICLE
Accuracy and Validity of Goniometer and

Visual Assessments of Angular Joint Positions
of the Hand and Wrist
Kimberly H. McVeigh, MBA,* Peter M. Murray, MD,† Michael G. Heckman, MS,‡
Bhupendra Rawal, MS,‡ Jeffrey J. Peterson, MD§
Purpose To compare goniometric and visual assessments of angular hand joint and wrist joint
positions measured by board-certified hand surgeons and certified hand therapists. We hy-
pothesized that visual estimation would be similar to the goniometric measurement accuracy
of digital and wrist joint positions.
Methods The wrist, index finger metacarpophalangeal (MCP) joint, and index finger proximal
interphalangeal (PIP) joint were evaluated in different positions by 40 observers: 20 board-
certified hand surgeons and 20 certified hand therapists. Each observer estimated the position
of the wrist, index MCP joint, and index PIP joint of the same volunteer, who was positioned in
low-profile orthoses to reproduce predetermined positions. Following visual estimation, the
participants measured the same joint positions using a goniometer. The control measurement
was digitally determined by a radiologist who obtained radiographs of the hand and wrist po-
sitions in each orthosis. Observers were blinded to the results of control measurements.
Results When considering all joints at all positions, neither visual assessments nor goniometer
assessments were consistently within 5 of the measurements obtained on control radio-
graphs. When considering individual joints, goniometer measurements were significantly closer
to control radiograph measurements than the visual assessments for all 3 PIP joint positions.
There was no difference for the measurements at the wrist or for 2 of the 3 MCP joint positions.
Significant differences between surgeon and therapist joint angle measurements were not
observed when comparing visual and goniometer assessments to radiograph controls.
Conclusions Compared with radiograph measurements, neither visual nor goniometer assessment
displayed high levels of accuracy. On average, visual assessment of the angular positions of the index
MCP and wrist joint were as accurate as the goniometer assessment, whereas goniometer assessment
of the angular position of the PIP joint was more accurate than visual assessment. There was a
relatively high degree of between-observer variability in measurements, and therefore, no one
person’s measurements could be consistently relied upon to be accurate. (J Hand Surg Am. 2015;-
(-):-e-. Copyright Ó 2015 by the American Society for Surgery of the Hand. All rights reserved.)
Type of study/level of evidence Diagnostic II.
Key words Goniometer, hand, wrist, metacarpophalangeal joint, proximal interphalangeal joints.
From the *Department of Physical Medicine and Rehabilitation; the †Department of Ortho- Corresponding author: Peter M. Murray, MD, Department of Orthopedic Surgery, Mayo Clinic,
pedic Surgery; the ‡Division of Biomedical Statistics and Informatics; and the §Department of 4500 San Pablo Rd. South, Jacksonville, FL 32224; e-mail: murray.peter@mayo.edu.
Radiology, Mayo Clinic, Jacksonville, FL. 0363-5023/15/---0001$36.00/0
Received for publication April 26, 2015; accepted in revised form December 9, 2015. http://dx.doi.org/10.1016/j.jhsa.2015.12.014
No benefits in any form have been received or will be received related directly or indirectly
to the subject of this article.
Ó 2015 ASSH r Published by Elsevier, Inc. All rights reserved. r 1

2 VALIDITY OF GONIOMETER VS VISUAL ASSESSMENTS
A
CCURATE JOINT ANGULAR MEASUREMENTS are stan- and wrist joint position assessment among this group of
dard means by which hand therapists and hand evaluators. Specific regional practice locations among
surgeons document the progress of rehabili- evaluators were not recorded. Primary data collection
tation. Goniometric measurement is considered the occurred at a national meeting in Nevada and a state
reference standard and most accurate range of mo- meeting in Florida. A single volunteer, who did not
tion (ROM) measurement.1 When using goniometric have any wrist or hand deformity, previous joint injury,
measurements to determine joint angles, intrarater or restricted ROM, displayed the study joint positions
measurements have been more reliable than interrater for assessment by the observers. Each observer
measurements,1,2 and there have been no significant assessed the MCP, PIP, and wrist joint positions in the
difference in joint angle measurements when different same order. Three different static, low-profile forearm-
styles of goniometers are used.2,3 Other studies have based Polyform orthoses (Patterson Medical, War-
shown that the location of goniometer placement can renville, IL) were fabricated and custom-molded to fit
affect measurements.4e6 For example, Kato et al6 the volunteer’s hand and wrist. Orthoses were placed
found that placement of the goniometer on the on the wrist, the index MCP joint, and the index PIP
lateral aspect of the joint was more effective than other joint of the volunteer, creating 3 different positions for
placement methods when measuring the proximal each joint studied and providing a total of 9 measure-
interphalangeal (PIP) joint ROM. Despite this finding, ment assessments. The orthoses were applied to the
73% of surveyed therapists prefer the dorsal place- volunteer with self-adherent compression bandage.
ment of the goniometer for PIP joint measurement.4,5 The measurements of the joint angles were estimated
However, many clinicians rely on visual estimation of by each of the 40 observers in the same order: first by
joint angles rather than using a goniometer because a using visual assessment and then by measuring the
visual assessment can be done quickly and without joint positions using a standard finger and wrist goni-
equipment.7 ometer (Patterson Medical, Warrenville, IL). The
The purpose of this study was to compare gonio- method of goniometer measurement was left to the
metric and visual assessments of angular hand and preference of the individual observer, and the mea-
wrist joint positions measured by board-certified hand surement process for this study is detailed in Figure 1.
surgeons and certified hand therapists. We hypothe- Reference measurements for all joint angles were
sized that the visual estimation of angular joint po- determined by plain radiographs of the volunteer’s
sition was similar to the goniometric measurement of hand while wearing each of the 3 orthoses (Fig. 2).
PIP, MCP, and wrist joint positions. We also evalu- These reference angles were digitally assessed in the
ated the accuracy of visual and goniometer assess- true lateral projection by a musculoskeletal radiologist.
ments of MCP, PIP, and wrist joint positions between The resultant joint angles were also assessed for
hand surgeons and hand therapists. reproducibility by obtaining 3 different lateral radio-
graphs of the wrist and hand for each of the 3 orthoses.
There were no differences in digital control measure-
METHODS ments among the multiple trial radiographs. Extension
Study subjects and data collection joint angles were considered as negative values to
This study was approved by our local institutional re- accurately compare all extension joint angles sepa-
view board, and all participants provided their rately from flexion angles. All study observers, study
informed consent. Forty consecutive observers (20 volunteers, and study authors were blinded to the re-
board-certified hand surgeons and 20 certified hand sults of the reference radiographs.
therapists) were recruited through various state and
national hand surgery/hand therapy combined meet- Statistical analysis
ings. All volunteer observers were either board- The mean difference between visual measurement and
certified hand surgeons or certified hand therapists. goniometer measurement of the joint angle was
Hand therapy certification and hand surgery board calculated along with a 95% confidence interval for
certification reflect extensive experience with angular each joint and position. Goniometric reliability studies
joint measurements of the hand. Reliability with define 5 to 10 as common error for both intrarater and
goniometric measurement increases with observer interrater testing.8,9 Therefore, a predefined acceptable
experience.8 Given the board certification status of the difference between visual- and goniometer-assessed
hand surgeons and the certification status of the hand joint angles that would demonstrate clinical equiva-
therapists, we felt that a reasonable amount of lence was 5 , and we, therefore, calculated the pro-
goniometer-measurement reliability existed for hand portion of visual and goniometer measurements within
J Hand Surg Am. r Vol. -, - 2015

VALIDITY OF GONIOMETER VS VISUAL ASSESSMENTS 3
FIGURE 1: Flow chart demonstrates the evaluation procedure performed by the observers.
measurements of joint angle with measurements

obtained by radiograph were performed in the same
manner as described previously, with the mean of the 3
joint/orthosis-specific radiograph measures used for
the analysis. Absolute differences of the visual- and
goniometer-measured joint angles with measurements
obtained on radiograph were compared using a paired
Wilcoxon signed rank test. The differences bet-
ween visual- and goniometer-measured joint angles,
visual- and radiograph-measured joint angles, and
goniometer- and radiograph-measured joint angles
and the measurement differences between surgeons
and hand therapists were also compared using a Wil-
coxon rank sum test.
FIGURE 2: Demonstration of 1 of the 3 thermoplastic orthoses to
simulate index PIP, MCP, and wrist joint positions while refer- RESULTS
ence radiographs were obtained.
A summary of all visual and goniometer measure-
ments is provided in Appendix A (available on the
5 of one another. The SDs of the differences and the Journal’s Web site at www.jhandsurg.org).
median absolute differences between visual- and Appendix B (available on the Journal’s Web site at
goniometer-assessed joint angles were calculated. www.jhandsurg.org) displays a summary of differ-
Bland-Altman plots were constructed.10 Comparisons ences between visual- and goniometer-measured joint
of the joint angle measurements between visual and angles for all observers and also separately for sur-
goniometer assessments were made using a paired geons and hand therapists. There was noticeable
Wilcoxon signed rank test to evaluate whether one variability in the differences between visual- and
method was systematically higher or lower than goniometer-measured joint angles; more variability
the other. Comparisons of the visual and goniometer was seen in the PIP and MCP joint measurements

FIGURE 3: Bland-Altman plot of joint angle measures by visual assessment and goniometer for PIP joint orthosis 1.
(Figs. 3e11). When comparing visual- and goniometer- and radiographic measures for surgeons compared
measured joint angles to evaluate whether one method with hand therapists (Appendix C; available on the
predictably read higher or lower than the other, sig- Journal’s Web site at www.jhandsurg.org).
nificant differences were identified for PIP joint angle Differences between goniometer- and radiograph-
orthosis 1 (P ¼ .001), PIP joint angle orthosis 3 measured joint angles for all observers are recorded in
(P < .001), and MCP joint angle orthosis 2 (P < .001). Appendix D (available on the Journal’s Web site at
There were no statistically significant differences bet- www.jhandsurg.org) for surgeons and hand therapists
ween visual- and goniometer-measured joint angles separately. Similar to visual versus radiograph com-
(Appendix B; available on the Journal’s Web site at parisons, there was variability in the differences be-
www.jhandsurg.org) between surgeons and hand tween goniometer- and radiograph-measured joint
therapists (all P .18). angles. There were no statistically significant differ-
When examining mean and median differences to ences between surgeons and hand therapists regard-
assess bias and accuracy, visual assessments of joint ing absolute differences between goniometer- and
angles provided slight to moderate biased measures of radiograph-measured joint angles (all P .11).
radiographic assessments as evidence by the lack of In order to evaluate whether visual- or goniometer-
differences close to zero (Appendix C; available on the assessed joint angles were closer to radiograph-
Journal’s Web site at www.jhandsurg.org). Further- assessed joint angles, we compared absolute differ-
more, there was a substantial amount of variability in ences comparing radiograph-measured joint angles
the differences between visual- and radiograph- with visual and goniometer assessments (Appendix E;
measured joint angles. The highest proportion of vi- available on the Journal’s Web site at www.
sual and radiograph measures that were within 5 of jhandsurg.org). Median differences compared with
one another were wrist joint angle orthosis 2 and wrist radiographs were generally smaller for goniometer
joint angle orthosis 3. The proportion of visual and assessments than for visual assessments. Significant
radiographic measures that were within 5 of one differences were identified for PIP joint angle
another varied in a range from 5% to 38%. There were orthosis 1, PIP joint angle orthosis 2, PIP joint angle
no statistically significant differences between sur- orthosis 3, and MCP joint angle orthosis 3, where
geons and hand therapists regarding absolute differ- radiographic measures were closer to goniometer
ences comparing visual- and radiograph-measured measures than to visual measures (all P .015).
joint angles, except for MCP joint angle orthosis 3 There were no other statistically significant differ-
(P ¼ .020) and wrist joint angle orthosis 2 (P ¼ .04), ences between visual assessments and goniometer
both of which had smaller differences between visual assessments in comparison with radiographic control

measurements (all P .08), (Appendix F; available measurements that were within 5 of radiograph
on the Journal’s Web site at www.jhandsurg.org). measures was low, and there was a relatively high
degree of interobserver variability. Acknowledging
DISCUSSION this relative lack of accuracy, our findings suggest
The results of this study suggest that neither goni- that, on average, the goniometer continues to be more
ometer nor visual assessment of the PIP, MCP, and accurate than visual assessments for measuring PIP
wrist joint angles is consistently accurate when joint angles. However, there was no significant
compared with radiograph measurements. For both advantage to using a goniometer for assessment
methods of assessment, the proportion of joint angle of the MCP or wrist joint positions compared with

FIGURE 6: Bland-Altman plot of joint angle measures by visual assessment and goniometer for MCP joint orthosis 1.
conducting a visual assessment of the same joint Several studies have assessed the effectiveness of
position. This is in line with previous studies of the visual estimation for angle measurements of large
finger, knee, elbow, wrist, and ankle joints.7,11,12 joints.12,13 It has been previously demonstrated that
Williams and Callaghan13 found that visual estima- visual estimation is an inaccurate method for obtaining
tion of joint position in the shoulder was a valid knee, ankle, elbow, and wrist joints angular measure-
technique and that the use of the goniometer may ments.13 To test the accuracy of visual assessment of
have been redundant. These authors suggested that the MCP and PIP joints, one study used a resin cast to
visual estimation of shoulder joint positions were also avoid any movement of the joint during measurement.7
more accurate than the goniometer owing to interrater Rose et al7 discovered a 25% inaccuracy rate among
variability.13 therapists and plastic surgeons when performing visual

FIGURE 9: Bland-Altman plot of joint angle measures by visual assessment and goniometer for wrist orthosis 1.
estimation of MCP, PIP, and distal interphalangeal goniometer assessment of the hand joints were the
joint ROM. The highest visual estimation accuracy in most reliable.7 In our study, the greatest visual
the Rose et al study7 was for the thumb interphalangeal assessment accuracy was demonstrated for the wrist
and PIP/distal interphalangeal of the digits; but of the joint (Appendix C; available on the Journal’s Web site
digits, the measurements for the small finger were the at www.jhandsurg.org), and there was not a significant
most accurate. This suggests that the more distal and difference between measurements taken by hand sur-
border joints are easier to assess. The visual measure- geons and those taken by hand therapists (Appendix C;
ments of the MCP joints of the digits were the least available on the Journal’s Web site at www.jhandsurg.
accurate. These authors concluded that, although vi- org). For goniometer measurements, the measurement
sual estimation improved with time and practice, the of the PIP joint was the most accurate (Appendix D;

available on the Journal’s Web site at www.jhandsurg. clinical practice. None of the participants relied solely
org). Similar to visual estimation, no significant dif- on visual assessment of joint angular positions, and
ference was shown at the PIP joint between the mea- all were open to the idea of assessing the usefulness
surements of the hand surgeons and those of the hand of the concept. A potential source of bias in the study
therapists (Appendix D; available on the Journal’s could have been that the evaluators measured the
Web site at www.jhandsurg.org). joints using visual assessment first and then assessed
At baseline, each of the study participants was the joints with a goniometer. However, we felt that
very familiar with and routinely used goniometer this was mitigated by the multiple measured angles at
assessments of hand and wrist joint positions in their each joint such that, by the time the evaluators went

back to measure the joint position using the goni- immediately after each study participant’s estimation
ometer, he or she would likely have forgotten the of the different hand and wrist positions. This was
details of the prior visual measurements. The evalu- impractical owing to the design of this study, and it
ators were also blinded from the results of all of their would have led to a sizable increase in radiation
prior measurements and the measurements of the exposure for the sole volunteer who donned the or-
other evaluators. Limitations of this study include the thoses for every evaluation.
orthosis, strapping, and soft tissue barriers, which
could have interfered with visual estimation and ACKNOWLEDGMENTS
goniometric measurements of all of the joint angles.
The authors would like to thank Kelly Viola, ELS, for
Future studies may be improved by creating a
her assistance with this manuscript.
different model of hand and wrist positioning and the
inclusion of other hand joints beyond the index finger
PIP and MCP joints. In addition, the sample size was REFERENCES
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3. Hamilton GF, Lachenbruch PA. Reliability of goniometers in
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Evidence shows that intrarater reliability has interphalangeal joints, part I: a survey of instrumentation and
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5. Groth GN, VanDeven KM, Phillips EC, Ehretsman RL. Goniometry
Future studies could evaluate the intrarater reli- of the proximal and distal interphalangeal joints, part II: placement
ability of each observer over multiple trials rather prefereces, interrater reliability, and concurrent validity. J Hand Ther.
than comparing multiple individuals with each other 2001;14(1):23e29.
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to determine accuracy of visual estimation of angular measurements of proximal interphalangeal joints in fresh cadavers:
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and interobserver reliability was not a focus of this and fingers. J Hand Ther. 2007;20(1):12e18; quiz 19.
7. Rose V, Nduka CC, Pereira JA, Pickford MA, Belcher HJ. Visual
study, and individual measurement accuracy among estimation of finger angles: do we need goniometers? J Hand Surg
the hand surgeons or the hand therapists was not Br. 2002;27(4):382e384.
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Verstappen FT. Variability and reliability of joint measurements. Am
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10. Bland JM, Altman DG. Statistical methods for assessing agreement
therapists, the visual assessments of the MCP and between two methods of clinical measurement. Lancet.
wrist joint angular positions were as accurate as the 1986;1(8476):307e310.
goniometer assessments. 11. Low JL. The reliability of joint measurement. Physiotherapy.
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Another limitation of the study was that the various 12. Youdas JW, Bogard CL, Suman VJ. Reliability of goniometric
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9.e1 VALIDITY OF GONIOMETER VS VISUAL ASSESSMENTS
APPENDIX A. Descriptive Summary of Visual and Goniometer Estimations for PIP, MCP, and Wrist Joint
Angles
All Observers (n ¼ 40) Surgeons (n ¼ 20) Hand Therapists (n ¼ 20)
Joint Angle
Measure ( ) Mean (SD) Mean (SD) Mean (SD)
Visual estimation PIP joint angle

Orthosis 1 20 (10) 17 (7) 23 (11)
Orthosis 2 41 (13) 39 (13) 42 (13)
Orthosis 3 72 (9) 74 (7) 71 (10)
Goniometer PIP joint angle
Orthosis 1 24 (7.9) 22 (9) 25 (7)
Orthosis 2 42 (11) 41 (13) 43 (8)
Orthosis 3 65 (6) 65 (6) 66 (5)
Visual estimation MCP joint angle
Orthosis 1 41 (10) 40 (9) 42 (10)
Orthosis 2 84 (5) 83 (5) 85 (6)
Orthosis 3 14 (10) 17 (9) 12 (10)
Goniometer MCP joint angle
Orthosis 1 44 (9) 44 (9) 43 (10)
Orthosis 2 78 (11) 78 (13) 77 (10)
Orthosis 3 14 (6) 14 (6) 13 (6)
Visual estimation wrist joint angle
Orthosis 1 7 (15) 12 (10) 1 (16)
Orthosis 2 18 (10) 14 (6) 22 (11)
Orthosis 3 13 (9) 15 (6) 12 (11)
Goniometer wrist joint angle
Orthosis 1 9 (10) 7 (10) 10 (9)
Orthosis 2 19 (10) 15 (6) 22 (12)
Orthosis 3 11 (9) 10 (10) 13 (8)

VALIDITY OF GONIOMETER VS VISUAL ASSESSMENTS 9.e2
APPENDIX B. Comparison of Visual- and Goniometer-Measured Joint Angles for All Observers, Surgeons,
and Hand Therapists
Visual Measurement Minus Goniometer Measurement ( )
Number (%)
Joint Angle Mean Difference SD of Median (Range) of Absolute
Measure (95% CI) Differences Absolute Difference Differences 5 P Value*
All observers (n ¼ 40)

PIP joint angle orthosis 1 4 (7, 0) 11 5 (0, 42) 31 (78) .001
PIP joint angle orthosis 3 7 (4, 10) 10 10 (0, 25) 17 (43) < .001
MCP joint angle orthosis 1 2 (6, 1) 11 5 (0, 42) 26 (65) .35
MCP joint angle orthosis 2 6 (3, 9) 10 5 (0, 50) 22 (55) < .001
Wrist joint angle orthosis 1 2 (3, 6) 14 4 (0, 50) 25 (63) .63
Surgeons (n ¼ 20)
Hand therapists (n ¼ 20)
CI, confidence interval.

*P values result from a paired Wilcoxon signed rank test comparing visual- and goniometer-measured joint angles; this test examines whether
visual measurements were systematically higher or lower than goniometer measurements.

APPENDIX C. Comparison of Visual- and Radiograph-Measured Joint Angles for All Observers, Surgeons,
and Hand Therapists
Visual Measurement Minus Radiograph Measurement ( ) (n ¼ 40)
Number (%)

Wrist joint angle orthosis 3 6 (3, 8) 9 7 (0, 28) 19 (48) < .001
Surgeons (n ¼ 20)

*P values result from a paired Wilcoxon signed rank test comparing visual and radiographic measured joint angles; this test examines whether
visual measurements were systematically higher or lower than radiographic measurements.

APPENDIX D. Comparison of Goniometer- and Radiograph-Measured Joint Angles for All Observers,
Surgeons, and Hand Therapists
Goniometer Measurement Minus Radiograph Measurement ( )
Number (%)

Surgeons (n ¼ 20)

*P values result from a paired Wilcoxon signed rank test comparing visual and radiographic measured joint angles; this test examines whether
goniometer measurements were systematically higher or lower than radiographic measurements.

APPENDIX E. Comparison of Accuracy as Measured Radiograph Between Visual- and Goniometer-Measured

Joint Angles for All Observers
Visual Measurement vs Radiograph Goniometer Measurement vs Radiograph
Measurement Measurement
Median (Range) Number (%) Median (Range) Number (%)
Joint Angle Absolute of Absolute Absolute of Absolute
Measure Difference Differences 5 Difference Differences 5 P Value*
PIP joint angle orthosis 1 8 (2, 32) 9 (23) 3 (2, 25) 22 (55) < .001
PIP joint angle orthosis 2 11 (1, 41) 2 (5) 6 (0, 41) 10 (25) .005
PIP joint angle orthosis 3 8 (2, 23) 15 (38) 3 (2, 12) 23 (58) < .001
MCP joint angle orthosis 1 10 (0, 30) 14 (35) 15 (0, 45) 9 (23) .69
Wrist joint angle orthosis 1 10 (0, 45) 9 (23) 6 (0, 25) 11 (28) .084
*P values result from a Wilcoxon signed rank test.

APPENDIX F. Summary of Radiograph Data

Joint Angle Orthosis Trial Flexion/Extension Angle ( ) SD & Range
PIP 1 1 Flexion 30 SD, 2

PIP 1 2 Flexion 26 Range, 4
PIP 1 3 Flexion 28
PIP 2 3 Flexion 50
PIP 3 3 Flexion 67
MCP 1 1 Flexion 28 SD, 2
MCP 1 2 Flexion 32 Range, 4
MCP 1 3 Flexion 31
MCP 2 1 Flexion 77 SD, 1
MCP 2 2 Flexion 79 Range, 2
MCP 2 3 Flexion 78
MCP 3 1 Extension 20 SD, 1
MCP 3 2 Extension 21 Range, 2
MCP 3 3 Extension 22
Wrist 1 1 Extension 3 SD, 3
Wrist 1 2 Extension 4 Range, 5
Wrist 1 3 Extension 8
Wrist 2 1 Flexion 18 SD, 1
Wrist 2 2 Flexion 17 Range, 2
Wrist 2 3 Flexion 19
Wrist 3 1 Flexion 9 SD, 2
Wrist 3 2 Flexion 6 Range, 3
Wrist 3 3 Flexion 9

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SCIENTIFIC ARTICLE

Accuracy and Validity of Goniometer and

Ó 2015 ASSH r Published by Elsevier, Inc. All rights reserved. r 1

J Hand Surg Am. r Vol. -, - 2015

measurements of joint angle with measurements

J Hand Surg Am. r Vol. -, - 2015

J Hand Surg Am. r Vol. -, - 2015

J Hand Surg Am. r Vol. -, - 2015

J Hand Surg Am. r Vol. -, - 2015

J Hand Surg Am. r Vol. -, - 2015

J Hand Surg Am. r Vol. -, - 2015

J Hand Surg Am. r Vol. -, - 2015

Visual estimation PIP joint angle

J Hand Surg Am. r Vol. -, - 2015

All observers (n ¼ 40)

CI, conﬁdence interval.

J Hand Surg Am. r Vol. -, - 2015

All observers (n ¼ 40)

CI, conﬁdence interval.

J Hand Surg Am. r Vol. -, - 2015

All observers (n ¼ 40)

CI, conﬁdence interval.

J Hand Surg Am. r Vol. -, - 2015

APPENDIX E. Comparison of Accuracy as Measured Radiograph Between Visual- and Goniometer-Measured

*P values result from a Wilcoxon signed rank test.

J Hand Surg Am. r Vol. -, - 2015

APPENDIX F. Summary of Radiograph Data

PIP 1 1 Flexion 30 SD, 2

J Hand Surg Am. r Vol. -, - 2015

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