6. ROM

What does ROM assess?

• Measurement of arc of motion

• Assessment of the arthrokinematics of the joint itself

  • Is the joint rolling, gliding, etc. as you would expect?

• Symmetry between limbs

• Assessing for use of compensatory motions

• Body posture

• Muscle contour and proportion

• Palpation to determine bony landmarks, soft tissue contours, skin temperature etc.

AROM

Assesses the amount of movement produced at a joint volitionally (voluntarily and unassisted)

• Willingness to move, coordination, muscle strength, pain

• If limited, painful, or awkward -> investigate further

Used to screen whether further testing is warranted

Screening of AROM provides focus for quantitative ROM testing

Not appropriate for SCI, cognitive impairments, protocols

PROM

• Assesses amount of motion possible at a joint

• Normally slightly greater than AROM due to stretch of soft tissues and reduced muscle bulk during passive range

• Assesses integrity of joint structures, extensibility of capsule, and soft tissues (e.g. ligaments, muscles, etc)

AAROM

Active Assist ROM

• Person initiates motion, but movement through end of range is completed with assistance

• Assistance can be from therapists, robotics, arm skate, etc.

FROM

Functional ROM

• Amount of motion necessary for ADL without adaptations or equipment

WNL vs WFL

Within Normal vs Functional Limits

• WFL is more important/relevant

  • Pretty large FROM is needed to complete all ADLs

NT

AROM vs PROM Differences

Potential causes of large differences between AROM and PROM

• Tendon tear/laceration

• Muscle weakness, deconditioning

• Pain due to edema or injury

• Scar tissue limiting range of motion

• Neurological conditions (stroke, SCI, MS)

Factors Influencing ROM

• Patient factors

• Psychological/psychosocial factors

• Environment

• Skeletal Factors

  • Methodological & Measurement Factors

ROM Contraindications

• Dislocation or unhealed fracture

• Immediately following surgery involving tendons, ligaments, joint capsule, skin

• Heterotopic Ossification

  • Myositis Ossificans

Heterotopic Ossification

Formation of bones at an abnormal anatomical site, typically in soft tissue

• Can impact functional ROM after SCI

• Benign, conservative treatment includes rest and immobilization in early stages

Myositis Ossificans

Form of heterotopic ossification where bone forms in muscle

• Osteoblasts form in muscle after injury or trauma

• Edema after injury proceeds to calcification and ossifications; seen in young adults

ROM Precautions

Use extra care:

• In presence of infectious or inflamed joint

• Client is on pain meds or muscle relaxants

• In areas of marked osteoporosis

• When assessing hypermobile or subluxed joints

• When ROM may increase painful conditions

• In person with hemophilia

• In regions of hematomas, esp. elbow, hip, knee

• If bony ankylosis is suspected (Rheumatoid Arthritis)

• Immediately after soft tissue injury

Normal Soft End Feel

Soft tissue	Elbow FL CMC thumb FL Knee FL

Normal Firm End Feel

Muscular, capsular, and ligamentous stretch	Scapular EL Shoulder AB, EX, IR, ER Forearm SUP PIP EX DIP FL/EX

Normal Hard End Feel

Bone against bone	Elbow EX Forearm PRO MCP FL of thumb

Pathological Soft End Feel

Occurs sooner or later in ROM Occurs in joint normally firm or hard Feels “boggy”	Synovitis Edema

Pathological Firm End Feel

Occurs sooner or later in joints  Occurs in joints normally soft or hard	Increased muscle tone/spasticity Capsular, muscular, or ligamentous shortening

Pathological Hard End Feel

Occurs sooner or later in joint  Occurs in joints normally soft or firm Bony grating or block	Osteoarthritis Chondromalacia Myositis Ossificans Fractures

Pathological Empty End Feel

ROM never reached due to pain No resistance felt	Bursitis, abscesses, fractures, or psychogenic disorders

Capsular Patterns

• Pathological conditions of joint capsule leads to patterns of ROM restriction at the joint

  • Can lose PROM and AROM at ends of range in all motions

Frozen Shoulder/Adhesive Capsulitis

Type of capsular pattern

• Inflammation of joint capsule (synovitis), autoimmune reactions, post surgery or immobilization after fracture

• Can be painful, ROM, mild to severe

Goniometry

• Parts: Distal/Move; Proximal/Still; Protractor; Fulcrum/Axis 

• Place: Palpate to align correctly

• Read: Put yourself at eye-level with the goniometer; avoid parallax