Range of Motion

ROM

- the arc of motion in degrees between the beginning and end of a motion in a specific plane

types of ROM

- AROM

- Active Assisted ROM (AAROM)

- PROM

- Functional Range of Motion

AROM

- arc of motion produced by voluntarily unassisted muscle contraction

- tests the amount of movement voluntarily obtained by the pt

what does AROM provide info on

- willingness to move

- coordination

- quality of motion

- muscle strength

- joint ROM

- pain

- crepitus

if AROM is WNL & Pain-free

- no further ROM testing

limited, awkward and/or painful

- do PROM

active assisted ROM

- arc of motion produced by voluntary muscle contraction assisted by an external force

- most often performed as an intervention (exercise)

functional ROM

- amount of motion required for or the ability to perform functional activities

PROM

- arc of motion completely produced by an external force

- tests the amount of movement obtained from the pt w/o assistance from the pt

- normally, PROM is slightly greater than AROM

- determine end-feels

information from PROM

- is the motion:

- normal?

- hypomobile?

- hypermobile?

- painful?

- symmetrical?

- end-feel?

end-feels

- distinctive feeling or sensation experienced by the therapist that is the barrier to further motion; what stops the motion from going further?

- helps determine the tissue involved (dx & px)

- normal (physiological)

- abnormal (pathological)

normal end-feels

- soft: soft tissue approximation

- firm: muscle stretch, capsular stretch, ligamentous stretch

- hard: bone on bone

pathological end-feel soft

- occurs sooner or later than is usual OR in a joint that normally has a firm or hard end-feel, feels boggy

- swelling, inflammation, tumor, tissue edema, synovitis

pathological end-feel firm

- occurs sooner or later than is usual OR in a joint that normally has a soft or hard end-feel

- contracture, capsular tightness, scarring, increase muscular tone, fascial shortening

pathological end-feel hard

- occurs sooner or later than is usual OR in a joint that normally has a soft or firm end-feel

- osteophyte

- fx

- loose body

- osteochondral defect

- avascular necrosis

- chondromalacia

- OA

- myositis ossificans

pathological end feel empty

- no real end-feel because pain or apprehension prevents reaching end ROM

- PROM is limited but you feel nothing

- acute inflammation jt, bursitis, abscess, fx, psyhological

pathological end feel springy

- bouncy, rebound sensation

- meniscal tear, loose body (cartilage)

goniometry

- derived from two greek words

- goina: angle

- metron: measure

- goniometry: the measurement of angles, in particular the measurement of angle created at human joints by the bones of the body

purposes of goniometry

- identify impairments

- determine pts functional level

- develop dx, px, goals, POC

- evaluate pt's progress

types

- electrogoniometers

- gravity dependent: pendulum, fluid

- universal

parts of a goniometer

- body: center axis

- stationary arm: goes with proximal segment/ non moving

- moving arm: distal segment/moving

methods of measuring for goniometry

- 180 degree system

- all motions are from 0" towards 180 degrees at anatomical position

method of recording goniometry

- 2 number system

- "0" is the midrange

- 0 to 180 for example

for a contracture in goniometry

- start the range in the position of the contractured limb

arthrodesis

- use one number system

- example: (R) wrist fused in 45º extension

is goniometry reliable?

- generally, good to excellent for peripheral joints

- intratester > intertester

how can we improve reliability

- follow the standard testing protocol

- same position

- consistent landmarks

- PROM: should be passive & other body parts supported by exam table or PT

- method of applying force: OP should be gentle & amount of force should be applied consistently

- consider the size of the goniometer in relation to the size of the joint being measured & use the same device for successive measurement

- provide consistent instructions

- conduct same time of day, by same therapist, in same environment

normal values for ROM

- wide variation

- wrist flexion AAOS 0-80

- AMA 0-60

- green and wolf 0-73

factors that can affect ROM

- age

- sex

- limb dominance

age and ROM

- ROM tends to decrease with aging

- infants and children may demo > ROM patterns than adults

sex and ROM

- females generally demonstrate greater ROM than males, although differences vary by joint movement, and individual

limb dominance and ROM

- dominant and non-dominant limbs may have different ROM d/t habitual activities and movement demands

shoulder external rot. ROM

- pt is supine w/ shoulder abducted and elbow flexed to 90º

- towel under humerus to position parallel to table

- axis is at olecranon process and moving arm is at ulnar styloid process, stationary arm is perpendicular to floor

- passively ext. rot. and then bring joint back and then do with goniometer

- end feel: firm

- normal range: 0-90º

shoulder internal rotation ROM

- pt is supine, w/ shouder abd to 90º, and elbow flexed to 90º

- towel under humerus

- passively move into int. rot and then bring joint back and then do with goniometer

- axis is at olecranon, moving arm is at styloid process, stationary arm is perpendicular to floor

- end feel: firm

- normal range: 0-70º

shoulder abduction ROM

- pt is supine

- move pt through ROM, stabilize at shoulder, release from end range and redo with goniometer

- moving arm bisect condyles of elbows, axis on acromion, stationary arm is parallel to thorax

- end feel: firm

- normal range: 0-180º

shoulder extension ROM

- pt is prone

- passively move into end range

- elbow is slightly flexed, stabilize through rib cage, and move them into extension

- axis at greater tubercle, moving arm at lateral epicondyle, stationary arm is parallel to midaxillary region

- end feel: firm

- normal range: 0-60º

shoulder flexion ROM

- pt is supine

- passively move them into end range, relax, and redo with goniometer

- axis at greater tubercle, moving arm at lateral epicondyle, stationary arm is parallel to midaxillary region

- end feel: firm

- normal range: 0-180º