Knee and Talocrural Joint Flexion Assessment

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Questions and Answers

What is the expected range of motion (ROM) for hip adduction?

45°

30° (correct)

60°

90°

In which position is the goniometer axis placed at the mid-patella during hip internal and external rotation testing?

Sitting with the hip and knee flexed 90° (correct)

Prone with knees flexed 90°

Supine with hips and knees in neutral rotation

Standing with legs straight

What is a common substitution movement that may occur during the hip adduction measurement?

Knee flexion

Ankle dorsiflexion

Hip external rotation

Lateral pelvic tilt (correct)

What is the stabilization required when measuring knee extension?

Trunk and pelvis stabilization Signup and view all the answers

What might indicate soft tissue tightness of the hip flexors or extensors during hip rotation testing?

Different amounts of motion in each position Signup and view all the answers

What does a noncapsular pattern indicate regarding joint movement?

There is limitation of movement but not in the capsular pattern. Signup and view all the answers

Which of the following is NOT a contraindication to ROM testing?

Patient's consent to the assessment. Signup and view all the answers

What instrument is used to measure spinal active range of motion (AROM)?

Universal goniometer Signup and view all the answers

Which step is essential before performing a ROM assessment on the patient?

Position the patient in anatomical position. Signup and view all the answers

What is the purpose of assessing the uninvolved limb before testing the involved limb?

To determine the normal range of motion. Signup and view all the answers

Which of these is a proper tool for measuring AROM of temporomandibular joints (TMJs)?

Ruler or calipers Signup and view all the answers

What should be ensured about the movement when assessing and measuring AROM and PROM?

Only the desired movement occurs at the joint being assessed. Signup and view all the answers

Why is it important to properly expose the area to be assessed before a ROM evaluation?

To facilitate proper measurement. Signup and view all the answers

What primarily limits elbow flexion during movement?

Muscle bulk of the arm against the forearm Signup and view all the answers

Which of the following tissues can affect joint motion?

Tendons and ligaments Signup and view all the answers

What does the term 'accessory motions' refer to in joint evaluation?

Small movements that are not under voluntary control Signup and view all the answers

Why is passive range of motion (PROM) typically greater than active range of motion (AROM)?

Relaxed muscles allow for slight elastic stretch of tissues Signup and view all the answers

What factors can alter the shape of joint surfaces?

Posture, disease, or trauma Signup and view all the answers

Active range of motion (AROM) evaluation provides information about all of the following EXCEPT:

Joint laxity levels Signup and view all the answers

Which of the following may lead to a decrease in active range of motion?

Injury causing joint swelling Signup and view all the answers

What should be considered during goniometric measurements of a joint?

The 'end feel' of the joint Signup and view all the answers

What is the expected range of motion (ROM) for knee flexion?

0° to 120-135° Signup and view all the answers

In which position should the patient be for testing talocrural dorsiflexion with the knee extended?

Supine with ankle off the edge of the table Signup and view all the answers

What should be monitored to prevent substitutions during the knee flexion test?

Hip abduction and/or hip flexion Signup and view all the answers

What is the role of the goniometer's fixed (stationary) arm during the talocrural dorsiflexion measurement?

To remain parallel to the long axis of the fibula Signup and view all the answers

How much increase in range of motion is expected in talocrural dorsiflexion when testing with the knee flexed?

Increase to 20° Signup and view all the answers

What is the expected range of motion (ROM) for talocrural plantar flexion?

0° to 40-50° Signup and view all the answers

What position should the patient be in when testing knee flexion alternately in a prone position?

Prone with femur stabilized Signup and view all the answers

What is the purpose of the therapist's stabilization during the talocrural plantar flexion measurement?

To ensure the lower leg remains immobile Signup and view all the answers

Where is the preferred placement of the goniometer?

Lateral to the joint, off the limb surface Signup and view all the answers

What should the axis of the goniometer align with during measurements?

The axis of movement of the joint Signup and view all the answers

What does the stationary arm of the goniometer typically align with?

Parallel to the fixed proximal joint segment Signup and view all the answers

When measuring active range of motion (AROM), what should be done with the movable arm of the goniometer?

It should move along with the limb throughout the range of motion Signup and view all the answers

What is an essential factor to ensure accurate goniometer readings during joint movement?

Maintaining proper positioning of both goniometer arms Signup and view all the answers

What is the final step in measuring passive range of motion (PROM)?

Read and record the measurement Signup and view all the answers

Which technique is NOT used to measure passive range of motion (PROM) at a joint?

Having the patient perform isometric exercises Signup and view all the answers

What does the movable arm of the goniometer usually lie parallel to?

The longitudinal axis of the moving distal joint segment Signup and view all the answers

Study Notes

Knee Flexion

Testing occurs with the patient in a supine reclined position with the hip and knee in neutral rotation
The trunk and pelvis are stabilized by body weight and position: the goniometer axis is placed at the lateral epicondyle of the femur
The fixed arm of the goniometer is parallel to the long axis of the femur and points at the greater trochanter while; the distal arm is parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement occurs as the hip and knee are flexed, bringing the heel towards the buttock
Expected range of motion for knee flexion is 0° to 120-135°
An alternate position is prone lying with the femur stabilized. Knee flexion motion may be decreased due to the rectus femoris being stretched over two joints
Prevent substitute motion of hip abduction and/or hip flexion

Talocrural Dorsiflexion

Testing occurs with the patient supine, the ankle off the edge of the table, and the knee extended. A towel can be placed under the knee to flex it if necessary.
The tibia is manually stabilized against the supporting surface: the goniometer axis is placed at the lateral calcaneus, where the fibula meets the 5th metatarsal
The fixed arm of the goniometer is parallel to the long axis of the fibula and points towards the fibula head, while; the distal arm is parallel to the long axis of the 5th metatarsal
Ankle dorsiflexion occurs actively: the expected range of motion is 10° with the knee extended, increasing to 20° with the knee flexed
Therapists must monitor for subtalar pronation. Observing calcaneal eversion can monitor this.
An alternate test involves repeating the procedure with the knee flexed 90°—isolating soleus flexibility. A 10° increase in ROM to 20° is expected

Talocrural Plantar Flexion

Testing occurs with the patient prone or supine, with the knee in slight flexion
The lower leg is stabilized by the therapist: the goniometer axis is placed at the lateral calcaneus, where the fibula meets the 5th metatarsal
The fixed arm of the goniometer is parallel to the long axis of the fibula and points towards the fibula head, while; the distal arm is parallel to the long axis of the 5th metatarsal
Ankle plantar flexion occurs actively: the expected range of motion is 40-50°
The therapist stabilizes the ipsilateral pelvis
The goniometer axis is placed at the ASIS on the measured side
The fixed arm of the goniometer is along a line between the two ASIS, while the distal arm is parallel to the long axis of the femur
Hip adduction occurs during testing: the expected range of motion is 30°
Substitute motions to watch for include hip internal rotation or lateral pelvic tilt

Hip Internal and External Rotation

Testing occurs with the patient sitting with the hip and knee flexed 90°. The opposite extremity is abducted and resting on a footstool
Thigh abduction and adduction are prevented: the goniometer axis is placed in the middle of the patella
The fixed arm of the goniometer is perpendicular to the floor, while the distal arm is parallel to the long axis of the tibia
Internal and external ROM occur independently: the expected ROM is 45° for both internal and external rotation.
Substitute motions to watch for include thigh abduction/adduction

Alternate Test Position for Hip Internal/External Rotation

Testing occurs with the patient prone with the knees flexed 90°
The pelvis is either manually or using a strap for stabilization.
Diagnostic findings for this position are determined by comparing measurements of a patient with their hips flexed or extended. Similar measurements indicate structural limitations, while different amounts of motion indicate soft tissue tightness of the hip flexors/extensors

Knee Extension

Testing occurs with the patient supine with hips and knees in neutral rotation
The trunk and pelvis are stabilized by body weight and position: the goniometer axis is placed at the lateral epicondyle of the femur
The fixed arm of the goniometer is parallel to the long axis of the femur and points at the greater trochanter while; the distal arm is parallel to the long axis of the fibula and pointing at the lateral malleolus
Movement occurs as the knee extends, the expected range of motion for knee extension is 0°
Some motions are limited by soft tissue bulk of the segments: for example, elbow flexion is usually limited by the bulk of the arm muscles against the forearm.
Soft tissues such as ligaments, tendons, and capsules are dense, they may become tight or loose affecting joint motion

Goniometric Measurements for Upper Limb

Assess the uninvolved limb before measuring the involved limb to determine normal ROM and end-feel.
The goniometer axis is placed over the joint's axis of movement, using specific bony prominences or anatomical landmarks.
The stationary arm of the goniometer is parallel to the proximal segment's longitudinal axis or points towards a distant bony prominence.
The movable arm is parallel to the distal segment's longitudinal axis or points towards a distant bony prominence.
The goniometer is aligned to measure the defined zero position for the ROM at a joint

Measuring AROM And PROM

To measure AROM, the patient actively moves through the ROM, and either the goniometer's movable arm travels with the limb or the goniometer is realigned at the end of the ROM.
To measure PROM, passively move the goniometer or limb segment through the ROM or actively move through the ROM and passively move the final few degrees.

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Description

This quiz covers the assessment techniques for knee flexion and talocrural dorsiflexion. It details the proper positioning of the patient and the use of a goniometer for measuring range of motion. Learn the expected range of motion and important considerations for accurate testing.