Clinical Skills Final - Goniometry Skills

Shoulder Flexion

Axis: Greater tubercle

Proximal Arm: Bisecting the trunk/thorax

Moving Arm: Bisecting the humerus

ROM: \~180 degrees

End-Feel: Firm

Shoulder Extension

Axis: Greater tubercle

Proximal Arm: Bisect the trunk

Moving Arm: Bisecting the humerus

ROM: 65-80 degrees

End-Feel: Firm

Shoulder Abduction

Axis: Anterior aspect of the acromion

Proximal Arm: Parallel to midline of the sternum

Moving Arm: Bisecting the humerus

ROM: \~180 degrees

End-Feel: Firm

Shoulder Internal Rotation

Axis: Olecranon process

Proximal Arm: Vertical to ground

Moving Arm: Ulnar styloid

ROM: 30-50 degrees

End-Feel: Firm

Shoulder External Rotation

Axis: Olecranon process

Proximal Arm: Completely vertical

Moving Arm: Ulnar styloid

ROM: \~ 90 degrees

End-Feel: Firm

Elbow Flexion

Axis: Lateral epicondyle

Proximal Arm: Bisect humerus laterally

Distal Arm: Radial styloid

ROM: 130-145 degrees

End-Feel: Soft

Notes - make sure to use a towel to support humerus

Elbow Extension

Axis: Lateral epicondyle

Proximal Arm: Bisect humerus laterally

Moving Arm: Radial styloid

ROM: 5 degrees hyperextension

End-Feel: Hard

Forearm Pronation

Axis: Lateral to ulnar styloid

Proximal Arm: Parallel to the shaft of the humerus

Distal Arm: Dorsal aspect of the forearm between the styloids

ROM: \~75 degrees

End-Feel: Firm

Notes - make sure elbow is at patients side

Forearm Supination

Axis: Medial to ulnar styloid

Proximal Arm: Parallel to the shaft of the humerus

Distal Arm: Dorsal aspect of the forearm between the styloids

ROM: \~85 degrees

End-Feel: Firm

Notes - make sure elbow is at patients side

Wrist Flexion

Axis: Triquetrum/Ulnar styloid

Proximal Arm: Bisect forearm by aiming for the lateral epicondyle

Moving Arm: 5th metacarpal

ROM: 70-85 degrees

End-Feel: Firm

Wrist Extension

Axis: Triquetrum / Ulnar Styloid

Proximal Arm: Bisect forearm by the aiming for the lateral epicondyle

Moving Arm: 5th metacarpal

ROM: 60-75 degrees

End-Feel: Firm

Radial Deviation

Axis: Capitate

Proximal Arm: Bisect forearm

Moving Arm: 3rd metacarpal

ROM: 15-20 degrees

End-Feel: Firm

Ulnar Deviation

Axis: Capitate

Proximal Arm: Bisect forearm

Moving Arm: 3rd metacarpal

ROM: 35-40 degrees

End-Feel: Firm

MCP Flexion/Extension

Axis: Dorsal surface of joint

Proximal Arm: Dorsal metacarpal

Moving Arm: Dorsal proximal phalanx

ROM

* Flexion: 90-115 degrees
* Extension: 30-45 degrees

End-Feel: Firm

PIP Flexion/Extension

Axis: Dorsal surface of joint

Proximal Arm: Dorsal proximal phalanx

Distal Arm: Dorsal middle phalanx

ROM

* Flexion: 100-120 degrees
* Extension: 0 degrees (N/A)

End-Feel: Firm

DIP Flexion/Extension

Axis: Dorsal surface of joint

Proximal Arm: Dorsal middle phalanx

Distal Arm: Dorsal distal phalanx

ROM:

* Flexion: 70-90 degrees
* Extension: \~30 degrees

End-Feel: Firm

CMC Flexion

Axis: Trapezium

Proximal Arm: Bisecting radius

Moving Arm: 1st metacarpal

ROM: 15-20 degrees

End-feel: Firm

CMC Extension

Axis: Trapezium

Proximal Arm: Bisect radius

Moving Arm: 1st metacarpal

ROM: 20-35 degrees

End-Feel: Firm

CMC Abduction

Axis: Radial styloid

Proximal Arm: 2nd metacarpal

Moving Arm: 1st metacarpal

ROM: 40-50 degrees

End-Feel: Firm

Opposition

* Move tip of thumb towards 5th MCP
* If they cannot touch, then use a ruler to measure distance from 5th MCP to tip of thumb

MCP Flexion (Thumb)

Axis: MCP joint of thumb

Proximal Arm: 1st metacarpal

Moving Arm: proximal phalanx of thumb

ROM: 50-60 degrees

End-Feel: Firm

MCP Extension (Thumb)

Axis: MCP joint of thumb

Proximal Arm: 1st metacarpal

Moving Arm: Proximal phalanx of thumb

ROM: 0-5 degrees

End-Feel: Firm

IP Flexion (Thumb)

Axis: IP joint of thumb

Proximal Arm: Proximal phalanx of thumb

Moving Arm: Distal phalanx of thumb

ROM: 80-90 degrees

End-Feel: Firm

IP Extension (Thumb)

Axis: IP joint of thumb

Proximal Arm: Proximal phalanx of thumb

Moving Arm: Distal phalanx of thumb

ROM: 20-30 degrees

End-Feel: Firm

Capital Flexion

Retraction (no measurement)

Capital Extension

Protraction (no measurement)

Cervical Flexion

(make sure to tuck in chin) (no measurement)

Cervical Extension

(no measurement)

Cervical Sidebending

(no measurement)

Cervical Rotation

(no measurement)

Trunk Flexion

(no measurement)

Trunk Extension

(no measurement)

Trunk Side-Bending

(no measurement) (have them follow hands down their sides)

Trunk Rotation

(no measurement)

Hip Flexion

Axis: Greater trochanter of femur

Proximal Arm: Bisecting trunk (assuming trunk is flat)

Moving Arm: Bisecting thigh and aiming for lateral epicondyle of knee

ROM: \~120 degrees

End-Feel: Firm

Hip Extension

Axis: Greater trochanter of femur

Proximal Arm: Bisecting trunk (assuming trunk is flat)

Moving Arm: Bisecting thigh and aiming for lateral epicondyle of knee

ROM: \~20 degrees

End-Feel: Firm

Hip Abduction

Axis: ASIS of the leg you are measuring

Proximal Arm: Aligned with contralateral ASIS (horizontal across hip)

Moving Arm: Center of femur, aiming for center of patella

ROM: \~40 degrees

End-Feel: Firm

Hip Adduction

Axis: ASIS of leg you are measuring

Proximal Arm: Directly aligned with contralateral ASIS (horizontal across hip)

Moving Arm: Center of femur, aiming for center of patella

ROM: \~20 degrees

End-Feel: Firm

Hip Internal Rotation

Axis: Center of patella

Proximal Arm: perpendicular to ground

Distal Arm: Center of lower leg, aiming for middle of the ankle (between malleoli)

ROM: \~35 degrees

End-Feel: Firm

Hip External Rotation

Axis: Center of patella

Proximal Arm: Perpendicular to ground

Moving Arm: Center of lower leg; aiming for middle of ankle (between malleoli)

ROM: \~ 40-45 degrees

End-Feel: Firm

Knee Flexion

* Axis: Lateral femoral epicondyle
* Proximal Arm: Greater trochanter
* Moving Arm: Lateral malleolus
* ROM: 130-150 degrees
* End-Feel: Soft to Firm

Knee Extension

Axis: Lateral femoral epicondyle

Proximal Arm: Greater trochanter

Moving Arm: Lateral malleolus

ROM: 0-5 hyperextension

Notes - patient is supine with towel under the “bulk” of gastroc; heel should be off table; apply pressure proximal and distal to patella

Ankle Dorsiflexion

* Axis: Lateral malleolus
* Proximal Arm: Head of fibula
* Moving Arm: Parallel to 5th metatarsal
* ROM: 15-25 degrees
* End-Feel: Firm
* Notes - legs are hanging off table (allowed to dangle); neutral position is 90 degrees

Ankle Plantarflexion

* Axis: Lateral malleolus
* Proximal Arm: Head of fibula
* Moving Arm: Parallel to 5th metatarsal
* ROM: 40-55 degrees
* End-Feel: Firm

Ankle Inversion

Axis: Talar dome between malleoli

Proximal Arm: Midline of the tibia

Moving Arm: 2nd metatarsal

ROM: 20-30 degrees

End-Feel: Firm

Ankle Eversion

Axis: Talar dome between malleoli

Proximal Arm: Midline of the tibia

Moving Arm: 2nd metatarsal

ROM: 10-15 degrees

End-Feel: Firm

Great Toe MTP Flexion/Extension

Axis: MTP Joint

Proximal Arm: 1st metatarsal

Moving Arm: Proximal phalanx

ROM:

* Flexion: 30-40 degrees
* Extension: 80-90 degrees

End-Feel: Firm

Note - ensure to apply any pressure at the proximal phalanx