Measurement of finger stiffness in algodystrophy

Using a single, simple goniometer measuring the range of joint movement at each joint in the hand, the author has developed a simple method of assessing joint stiffness and algodystrophy. This not only involves testing all joints in the fingers but also is a simple technique that can be performed in the outpatient clinic. Arthrography has been used to measure resistance of passive motion of joints, finding that stiffness is worse in the morning and improves after physiotherapy and after injection with steroids. The author's method does not actively measure the resistance to passive motion in a joint, as does the arthrograph. As the patient recovers with time, however (see Fig. 2), the range of movement increases and this may be equivalent to the improvement seen in Bramley et al. Goniometry has been found to be a sensitive test for diagnosing algodystrophy. Together with dolorimetry, however, the specificity of the two tests combined increases significantly while maintaining adequate sensitivity to use as a diagnostic tool. Consequently, it is possible to diagnose algodystrophy at 1 week following Colles' fracture. This finding has important implications in that it probably means the initial injury is responsible for the disease causation rather than anything constitutional or psychological.