| Joint | Action | Active | Passive | Normal |
| Elbow | Extension/Flexion | ___/___ | ___/___ | 0/145 |
| Forearm | Pronation/Supination | ___/___ | ___/___ | 70/85 |
| Wrist | Extension/Flexion | ___/___ | ___/___ | 70/75 |
| Wrist | Radial/Ulnar | ___/___ | ___/___ | 20/35 |
| Thumb | Action | Active | Passive | Normal |
| CMC | Adduction/Abduction | ___/___ | ___/___ | 0(contact)/60 |
| MCP | Extension/Flexion | ___/___ | ___/___ | 10H(hyperextension)/55 |
| IP | Extension/Flexion | ___/___ | ___/___ | 15H(hyperextension)/80 |
| Finger |
MCP Extension/Flexion |
PIP Extension/Flexion |
DIP Extension/Flexion |
Tip to |
||||||
| Active | Passive | Normal | Active | Passive | Normal | Active | Passive | Normal | ||
| Index | ___/___ | ___/___ | 0/80 | ___/___ | ___/___ | 0/100 | ___/___ | ___/___ | 10H/90 | ____ |
| Middle | ___/___ | ___/___ | 0/80 | ___/___ | ___/___ | 0/100 | ___/___ | ___/___ | 10H/90 | ____ |
| Ring | ___/___ | ___/___ | 0/80 | ___/___ | ___/___ | 0/100 | ___/___ | ___/___ | 20H/90 | ____ |
| Small | ___/___ | ___/___ | 0/80 | ___/___ | ___/___ | 0/100 | ___/___ | ___/___ | 30H/90 | ____ |
*(Passive values entered only if different than active; otherwise = AROM)