611 - Kate - AROM & PROM of the elbow (flexion + extension)

Client

Kate, 70-year-old female.

Injury

Radial fracture, post above-elbow cast (6 weeks immobilisation).

Stage of Recovery

Just out of cast, cleared to begin range of motion exercises.

Affected Arm

Left arm.

Lifestyle

Retired, enjoys reading and cooking, lives with husband.

Greeting

"Hi Kate, welcome. I understand you've just had your cast removed—how's the arm feeling? Today I'd like to check how your elbow is moving to see how we can safely start some exercises and get you back to cooking and reading comfortably."

Assessment Explanation

"I'll be guiding your elbow through some bending and straightening movements—first you'll move it yourself, and then I'll gently move it for you. This will help us understand how your elbow is recovering and where to begin your rehab."

Clothing Instructions

Remove clothing that restricts visibility of shoulder, elbow, and forearm.

Positioning

Supine lying, comfortable and supported, towel under upper arm, clear of elbow joint line.

AROM Instruction

"Can you bend and straighten your elbow as far as you can? Show me how far you can go."

AROM Observations

Movement quality, range, compensatory patterns, pain or guarding.

AROM Measurement

Use goniometer; axis: lateral epicondyle of humerus, stationary arm: along humerus towards acromion, moveable arm: along radius towards radial styloid.

AROM for Left Elbow

Flexion: ___° (normal ~0-150°), Extension: ___° (normal ~0°).

PROM Instruction

"Now I'll move your arm for you. Just relax and let me know if anything feels uncomfortable."

PROM Observations

End feel, resistance, discomfort, guarding.

Normal End Feels

Flexion: soft (muscle bulk), Extension: hard (bony contact).

Comparison for PROM

Right (unaffected) arm.

Sample Documentation

AROM: Flexion 105°, Extension -10°; PROM: Flexion 120° (soft end feel, mild discomfort), Extension -5° (firm end feel, no pain); Right elbow AROM: Flexion 150°, Extension 0°; Comments: Mild stiffness and reduced range due to immobilisation. No acute pain.

Clinical Reasoning

Expected loss of elbow ROM post-casting, PROM > AROM indicates potential recovery, no red flags or instability.

Next Steps

Gentle active-assisted and active ROM exercises, incorporate into meaningful tasks, review progress in 1-2 weeks, consider strengthening once ROM improves.

Example Conversation

"Kate, you've got a good starting range, and there's more movement when I assist, which means the joint itself is capable. We'll start with some simple stretching and movement exercises, and I'll teach you ways to do them at home—nothing too painful, but just enough to slowly get you back to normal."