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Questions and Answers
What is the main difference between passive range of motion (ROM) and active ROM?
What is the main difference between passive range of motion (ROM) and active ROM?
- Active ROM can only be measured with a goniometer while passive ROM cannot.
- Passive ROM is produced entirely by external forces while active ROM is produced by muscle contraction. (correct)
- Active ROM involves no external force while passive ROM always involves gravity.
- Passive ROM requires muscle contraction while active ROM does not.
Which term best describes the limited range of motion due to tightness in a joint?
Which term best describes the limited range of motion due to tightness in a joint?
- Physiological ROM
- Functional ROM
- Hypermobility
- Hypomobility (correct)
In evaluating joint range of motion, why is it important to reassess a patient's status after treatment?
In evaluating joint range of motion, why is it important to reassess a patient's status after treatment?
- To measure changes in joint function compared to prior evaluations. (correct)
- To determine if the joint has become hypermobile.
- To assess the effectiveness of the goniometer used in measurement.
- To establish the patient's age-related changes in ROM.
Which of the following factors is NOT typically associated with affecting range of motion?
Which of the following factors is NOT typically associated with affecting range of motion?
What does functional range of motion allow an individual to do?
What does functional range of motion allow an individual to do?
Which muscle is NOT part of the rotator cuff that stabilizes the shoulder joint?
Which muscle is NOT part of the rotator cuff that stabilizes the shoulder joint?
What tool is commonly used to measure the range of motion of joints?
What tool is commonly used to measure the range of motion of joints?
How does age generally affect range of motion?
How does age generally affect range of motion?
What is the primary difference between passive and active range of motion testing?
What is the primary difference between passive and active range of motion testing?
Which type of joint is characterized by greater mobility?
Which type of joint is characterized by greater mobility?
What is the purpose of using a goniometer in joint measurement?
What is the purpose of using a goniometer in joint measurement?
Which group of body types is generally associated with greater joint flexibility?
Which group of body types is generally associated with greater joint flexibility?
What effect does range of motion testing have on a patient?
What effect does range of motion testing have on a patient?
What is the basic structure of a universal goniometer?
What is the basic structure of a universal goniometer?
What external factors may influence an individual's joint mobility?
What external factors may influence an individual's joint mobility?
What does the passive range of motion testing primarily assess?
What does the passive range of motion testing primarily assess?
What type of end feel involves a hard stop to movement when bone contacts bone, such as in passive elbow extension?
What type of end feel involves a hard stop to movement when bone contacts bone, such as in passive elbow extension?
Which abnormal end feel may indicate the presence of synovitis or soft tissue edema?
Which abnormal end feel may indicate the presence of synovitis or soft tissue edema?
What does a 'springy block' end feel indicate?
What does a 'springy block' end feel indicate?
Which end feel is characterized by a firm sensation with give, indicating muscle or ligament shortening?
Which end feel is characterized by a firm sensation with give, indicating muscle or ligament shortening?
What type of end feel might be described as a hard sudden stop to passive movement and is often associated with pain?
What type of end feel might be described as a hard sudden stop to passive movement and is often associated with pain?
In what situation might an 'empty' end feel be present?
In what situation might an 'empty' end feel be present?
What distinguishes a 'hard' abnormal end feel?
What distinguishes a 'hard' abnormal end feel?
Which end feel is described as a hard arrest with some give, similar to stretching leather?
Which end feel is described as a hard arrest with some give, similar to stretching leather?
What may cause a patient to be unable to perform full active range of motion?
What may cause a patient to be unable to perform full active range of motion?
Which goniometric measurement tool uses reflective dots to assess spinal motion?
Which goniometric measurement tool uses reflective dots to assess spinal motion?
What is the primary purpose of comparative goniometry?
What is the primary purpose of comparative goniometry?
Which method is specifically designed to measure pelvic tilt?
Which method is specifically designed to measure pelvic tilt?
What is a key requirement for reliable goniometric measurements?
What is a key requirement for reliable goniometric measurements?
How is the universal goniometer structured?
How is the universal goniometer structured?
Which device is known for being sensitive to movement due to its connection to a potentiometer?
Which device is known for being sensitive to movement due to its connection to a potentiometer?
What starting position should extremity movements be measured from?
What starting position should extremity movements be measured from?
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Study Notes
Movement of a Body Segment
- Movements of a body segment occur when muscles or external forces move bones.
- Bones move relative to each other at their connecting joints.
- Joint range describes the extent of movement at a joint.
- Terms like flexion, extension, abduction, adduction, and rotation are used to describe joint motion.
- Goniometers measure range of motion and results are recorded in degrees.
Types of Range of Motion
- Passive ROM: Movement produced entirely by an external force without any voluntary muscle contraction.
- Active ROM: Movement produced by active muscle contraction.
- Physiological ROM: Controlled voluntary motion between body segments.
- Functional ROM: Range of motion needed for everyday activities.
Purpose of Joint Range of Motion Evaluation
- Determine existing joint range of motion and compare to normal range.
- Aid in diagnosis and determine joint function.
- Reassess patient status after treatment.
- Motivate patient interest in treatment program.
Factors Affecting Range of Motion
- Age: Younger individuals typically have greater range of motion.
- Sex: Differences in range of motion between men and women have been studied.
- Functional needs: Upper limb joints are designed for mobility while lower limb joints are designed for stability.
- Rotator cuff muscles: Stabilize the shoulder joint (Supraspinatus, Infraspinatus, Subscapularis, Teres minor).
- Shoulder joint:
- The Hip Joint:
Other Considerations
- Types of joints: Synovial joints have greater mobility than cartilaginous and fibrous joints.
- Type of motion: Passive range of motion is wider than active range of motion.
- Joint structures: Genetics, posture, and body type can influence joint mobility. Ligament and tendon flexibility also play a role.
- Body build: Mesomorphs and ectomorphs tend to have greater flexibility than endomorphs.
- Personal exercise:
- Neurologic or muscular diseases:
- Surgical or traumatic insults:
- Inactivity or immobilization:
Instruments
- Goniometers or arthro-meters: Tools to measure range of motion.
- Universal goniometer: Durable, washable, and applicable to most joints. It is a protractor with a stationary arm and a movable arm.
Goniometry
- Aim:
- Educate medical, physical therapy, and occupational therapy students.
- Raise awareness of age and occupational related motion changes.
- Assess the effects of disease and injury.
- Motivate patients through progress.
- Evaluate functional abilities and self-help activities.
- Estimate strength, coordination, and endurance needs.
Construction of the universal goniometer
- A: Circular or half-circle protractor with degrees.
- B: Two arms connected by an axis (fulcrum).
- 1: Stationary arm.
- 2: Movable arm.
End Feel
- End feel: Sensation experienced during passive range of motion at the end of its range.
- Types: Can be normal (physiological) or abnormal (pathological).
Normal (Physiologic) End Feel
| End feel | Description |
|---|---|
| Hard (Bony) | Hard stop when bone contacts bone. |
| Soft (Soft tissue opposition) | Compression of soft tissue felt when two surfaces come together. |
| Firm (Soft tissue stretch) | Firm sensation with give when muscle is stretched. |
| Capsular stretch | Hard arrest with some give when joint capsule/ligaments are stretched. |
Abnormal Pathologic End Feel
| End feel | Description |
|---|---|
| Hard | Hard stop with bony grating. |
| Soft | Boggy sensation indicating synovitis or soft tissue edema. |
| Firm | Firm sensation indicating muscular, capsular, or ligamentous shortening. |
| Springy block | Rebound indicating internal derangement. |
| Empty | Pain without sensation before end of ROM. |
| Spasm | Hard, sudden stop with pain indicating acute/subacute arthritis or fracture. |
Active Range of Motion Limitations
- Muscle weakness.
- Soft tissue contractures.
- Muscle contractures.
- Bony blockage (fusion).
Dominance
- Usually no significant difference in corresponding joints between left and right sides.
- Contralateral limb can be used as a standard for comparison.
Basic Elements for Reliable Goniometric Measurements
- Demonstrate instructions clearly.
- Measure from a specific starting position.
- Measure in degrees.
- Apply goniometer laterally (except for certain motions).
- Hold instrument lightly against the body.
- Remove restrictive clothing.
- Compare limbs bilaterally.
Different Methods of Measuring Range of Motion
- Universal goniometer: Protractor with two arms.
- Electro-goniometer: Universal goniometer connected to a potentiometer for more accurate reading.
- Inclinometer: Fluid-based design for ease of use.
- Spinogram: Measures spinal motion with reflective dots and video camera.
- Pleurical caliper: Used to measure pelvic tilt and leg shortening.
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