A guide to Goniometry Chapter 1

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Questions and Answers

What is the maximum score possible on the Beighton Hypermobility Score?

9 (correct)

Which factor is NOT mentioned as influencing range of motion (ROM)?

Gender

Handedness (correct)

Age

Body mass index

For the Beighton Hypermobility Score, how many points can one achieve by hyperextending the elbow more than 10 degrees?

1 (correct)

Why is it important to compare ROM values with those of the same age and gender?

To determine if ROM is impaired Signup and view all the answers

Which of these components is included in the Beighton Score for assessing generalized joint mobility?

Palms touching the floor Signup and view all the answers

Which demographic showed over 35% scoring greater than 5/9 on the Beighton score?

Children aged 8 to 12 years Signup and view all the answers

Which aspect is crucial for the validity of the Beighton score measurement?

Comparison with age and gender norms Signup and view all the answers

What should be avoided when making comparisons for range of motion measurements?

Using different measurement methods Signup and view all the answers

What is the primary association of hypomobility?

Orthopedic and metabolic conditions Signup and view all the answers

What contributes to hypomobility in neurological conditions?

Loss of voluntary movement and increased muscle tone Signup and view all the answers

What is referred to as a capsular pattern?

A specific pattern of restriction in joint motion Signup and view all the answers

According to Cyriax, how is joint motion restricted when capsular involvement occurs?

In fixed proportions relative to each other Signup and view all the answers

Which of the following is an example of a capsular pattern restriction in the elbow joint?

Greater limitation of flexion than extension Signup and view all the answers

What type of studies are needed to further understand capsular patterns?

Studies testing hypotheses regarding their causes Signup and view all the answers

Which condition is NOT mentioned as being associated with hypomobility?

Asthma Signup and view all the answers

What is one consequence of immobilization after an injury?

Decreased range of motion Signup and view all the answers

At what position is the ROM for flexion and extension measured in the 0- to 180-degree notation system?

At 0 degrees Signup and view all the answers

Which of the following is true about hyperextension?

It describes a greater than normal extension ROM. Signup and view all the answers

Which of the following terms best describes the 0- to 180-degree notation system?

Known as the neutral zero method Signup and view all the answers

What is active range of motion (Active ROM)?

The arc of motion produced by voluntary unassisted muscle contraction Signup and view all the answers

Which of the following describes the starting position for the 180- to 0-degree notation system?

The anatomical position is at 180 degrees. Signup and view all the answers

Why is the 0- to 180-degree notation system more widely used than the 180- to 0-degree and 360-degree systems?

It is simpler and easier to interpret. Signup and view all the answers

What happens to the measurement of the extension ROM when returning from full shoulder flexion to the zero starting position?

It does not need to be measured. Signup and view all the answers

Which authority first described the 0- to 180-degree notation system?

Silver Signup and view all the answers

Which statement is true regarding gender differences in joint motions in older adults?

Older women exhibit greater active range of motion in certain joint motions compared to older men. Signup and view all the answers

What is considered the maximal muscle length?

The greatest extensibility of a muscle-tendon unit. Signup and view all the answers

How is muscle length typically assessed clinically?

By determining the maximal passive range of motion of the joint crossed by the muscle. Signup and view all the answers

What determines whether hypomobility or hypermobility is present?

The length of the inactive antagonist muscle or other structures. Signup and view all the answers

What defines a one-joint muscle?

A muscle that influences the motion of only one joint. Signup and view all the answers

What effect does a shorter than normal one-joint muscle have on joint range of motion?

It decreases passive range of motion in the opposite direction. Signup and view all the answers

Which factor does NOT influence the amount of passive range of motion of a joint?

The age of the individual. Signup and view all the answers

In which age group was no significant influence of gender found on cervical range of motion?

70 to 79 years Signup and view all the answers

What position should the shoulder be in during elbow flexion ROM measurement to avoid passive insufficiency of the triceps?

Neutral Signup and view all the answers

How is the length of a two-joint muscle assessed according to the content provided?

By measuring passive ROM while one joint is held in full ROM Signup and view all the answers

What type of end-feel is encountered when measuring the length of a two-joint muscle?

Firm Signup and view all the answers

When assessing the triceps, what should the position of the elbow be while the shoulder is in flexion?

Flexed until tension is felt Signup and view all the answers

How is the length of a multi-joint muscle determined?

By measuring passive ROM in the direction opposite to the action at the last joint moved Signup and view all the answers

What is an essential factor when positioning a patient for the assessment of two-joint muscles?

One joint should be in full ROM while the muscle is lengthened Signup and view all the answers

What happens to the passive tension in the muscle during the measurement of elbow flexion with the shoulder in flexion?

It increases until a firm end-feel is reached Signup and view all the answers

What is the role of the examiner during the measurement of muscle length?

To hold the joint in a full ROM position while measuring Signup and view all the answers

What factors are identified as influences on range of motion (ROM)?

Age, gender, and testing conditions Signup and view all the answers

In what specific situation should the Beighton score be validated for accuracy?

By comparing results to age and gender-specific norms Signup and view all the answers

Why is it challenging to assess range of motion in generalized populations?

Research on specific demographic norms is lacking Signup and view all the answers

Which component is NOT included in the evaluation of the Beighton Hypermobility Score?

Measurement of hand grip strength Signup and view all the answers

What characteristic is most likely to have an under-explored impact on ROM according to the content?

Body mass index and lifestyle choices Signup and view all the answers

How is the validity of the Beighton score further enhanced according to the findings?

By comparing to other localized assessments of hypermobility Signup and view all the answers

To what extent did the study highlight children's performance on the Beighton score?

Over 35% achieved a score greater than 5/9 Signup and view all the answers

Which external factor is mentioned as potentially influencing range of motion measurements?

Time of day the assessment is conducted Signup and view all the answers

In the study of joint motions among older adults, how many motions were reported greater in males compared to females?

4 Signup and view all the answers

What is the primary purpose of measuring muscle length in a clinical setting?

To identify the cause of hypomobility or hypermobility Signup and view all the answers

Which factor does NOT influence the passive range of motion of a joint?

Proximity of attachments to skin Signup and view all the answers

In the analysis by Kalscheur and associates, what was observed regarding older women compared to older men?

Women had greater active ROM in all analyzed motions Signup and view all the answers

What distinguishes one-joint muscles from two-joint and multi-joint muscles?

One-joint muscles only affect the joint they cross Signup and view all the answers

What is a significant characteristic of individuals diagnosed with hypermobility syndrome (HMS)?

They experience musculoskeletal symptoms despite being otherwise healthy. Signup and view all the answers

In which age group was no significant influence of gender on three-dimensional cervical range of motion found?

70 to 79 years Signup and view all the answers

Which statement about maximal muscle length is true?

It refers to the maximal distance between muscle's proximal and distal attachments Signup and view all the answers

What modification to the Beighton score cutoff did some researchers suggest for children?

Adopting a cutoff score of 7 for all pediatric assessments. Signup and view all the answers

Which additional joint motions are recommended by Grahame for assessing hypermobility?

Cervical spine lateral flexion greater than 60 degrees. Signup and view all the answers

What is indicated when a one-joint muscle is shorter than normal during assessment?

Decreased passive ROM in the opposite direction Signup and view all the answers

What is a primary criticism regarding the Beighton score when assessing children?

It lacks a comprehensive assessment of all possible joint motions. Signup and view all the answers

Which measurement technique was utilized in the study of Dutch children to evaluate hypermobility?

Goniometry to measure passive range of motion. Signup and view all the answers

What is a commonly noted outcome for individuals with benign joint hypermobility syndrome (BJHS) in terms of joint position sense?

They exhibit significantly poor joint position sense. Signup and view all the answers

What factor contributes to joint laxity in individuals with hypermobility syndromes?

Inherited abnormalities in collagen. Signup and view all the answers

What is one proposed criterion for improving the diagnosis of hypermobility in pediatric patients?

Using a higher age-adjusted Beighton score. Signup and view all the answers

Which joint exhibited no consistent loss of motion with increasing age according to the findings?

MCP joint of the thumb Signup and view all the answers

How much active motion do individuals lose in neck extension for each decade of life?

5 degrees Signup and view all the answers

Which age group demonstrated a mean active hip and knee motion decrease of 3 to 5 degrees?

60 to 74 years Signup and view all the answers

Which study reported a decrease of between 4% and 30% in 11 of 23 joints in men aged 25 to 54 years?

Stubbs, Fernandez, and Glenn Signup and view all the answers

In dancers, which specific joint motion did not change with increasing age, according to the findings?

Ankle plantar flexion Signup and view all the answers

What is the systematic decrease of active and passive lower-extremity motions in individuals aged 70 to 92 years described by James and Parker?

Decreases in 10 specific motions Signup and view all the answers

What was the conclusion about cervical spine range of motion according to Chen and colleagues?

Active cervical ROM decreased by 4 degrees per decade Signup and view all the answers

What specific area of joint motion did Youdas and associates find to decline with aging?

Cervical spine extension Signup and view all the answers

What was the average decrease in cervical range of motion (ROM) per decade according to Lansade and associates?

0.55 to 0.79 degrees Signup and view all the answers

What specific age interval did Intolo and colleagues' meta-analysis identify as primarily contributing to age-related reductions in lumbar range of motion?

40 to 50 years Signup and view all the answers

In the study comparing ROM between groups of women of different ages, what finding was significant regarding lumbar spine extension?

Extension ROM decreased significantly from the middle to older groups Signup and view all the answers

What factor is indicated to influence gender differences in joint motion, particularly in adults?

Differences in joint structure Signup and view all the answers

According to the content, what percentage of women tested were reported to have more flexibility than males across various joint motions?

82% Signup and view all the answers

What general trend was observed regarding lumbar flexion and extension in both racial groups studied?

Decreases in both flexion and extension with age Signup and view all the answers

Which of the following findings contrasts with the results of Fitzgerald regarding age-related lumbar range of motion?

Age-related reductions primarily found in older adults Signup and view all the answers

Which statement accurately reflects the effects of gender on range of motion (ROM) based on the content provided?

Females display greater ROM than males typically Signup and view all the answers

Study Notes

0- to 180-Degree Notation System

Used for measuring range of motion (ROM) of upper and lower extremity joints
Anatomical position is 0 degrees for flexion-extension and abduction-adduction
Neutral position is 0 degrees for rotation
ROM starts at 0 degrees and proceeds towards 180 degrees
Also referred to as the neutral zero method
Widely used globally

Hyperextension

Defined as greater than normal extension ROM beyond the starting position of 0 degrees

Active ROM

Arc of motion produced by individual's voluntary unassisted muscle contraction

Capsular Patterns of Restricted Motion

Pathological conditions involving the entire joint capsule cause a specific pattern of restriction in passive motions
Restriction involves a fixed proportion of one motion relative to another
Example: Elbow joint - greater limitation of flexion than extension

Beighton Hypermobility Score

Valid instrument to measure generalized joint mobility in children aged 8 to 12 years
Assesses ability to:
- Passively oppose thumb to forearm
- Passively extend fifth MCP joint beyond 90 degrees
- Hyperextend elbow more than 10 degrees
- Hyperextend knee more than 10 degrees
- Place palms on floor by flexing trunk with knees straight
Each item contributes 1 point for each side/action
Total score ranges from 0 to 9

Factors Affecting ROM

Age: Significant differences exist between age groups for both upper and lower extremities, as well as spine
Gender: Women typically have greater knee and upper extremity ROM than men
Other factors: BMI, occupation, recreational activities, testing position, instrument used, examiner experience, and time of day

Muscle Length Testing

Maximal muscle length is the greatest extensibility of a muscle-tendon unit
Assessed indirectly by determining the maximal passive ROM of the joint(s) crossed by the muscle
Purpose: To determine if hypomobility or hypermobility is caused by the length of the inactive antagonist muscle or other structures
Muscles are categorized by the number of joints they cross:
- One-joint muscles
- Two-joint muscles
- Multi-joint muscles
One-joint muscle length testing is assessed by measuring passive ROM in the opposite direction of the muscle's action
Two-joint muscle length testing:
- The muscle is lengthened over both its proximal and distal joints
- One joint is held in full ROM while the examiner attempts to further lengthen the muscle by moving the second joint through full ROM
- Length is indirectly assessed by measuring passive ROM at the second joint
Multi-joint muscle length testing:
- Similar to two-joint muscle testing
- The muscle is lengthened over all joints except for one last joint
- Passive ROM is measured at the last joint to be moved

Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) affects all major body systems in addition to joint hypermobility and musculoskeletal pain.

Hypermobility Syndrome

Hypermobility syndrome (HMS) or benign joint hypermobility syndrome (BJHS) describes healthy individuals with generalized hypermobility and musculoskeletal symptoms.
Joint laxity in individuals with HMS is thought to be caused by inherited collagen abnormalities and regular physical exercise.

Diagnosing Hypermobility Syndrome

Traditionally, HMS diagnosis involves excluding other conditions, a Beighton score of at least 4, and arthralgia in 4+ joints for over 3 months.
Beighton score criteria may be inadequate for children because 65% of children aged 4-7 years scored above 4 on the Beighton scale.
Higher Beighton score cutoffs (7 for 3-9 year olds, 4 for 10-16 year olds) may be needed for children.
There is a need for international agreement on firm cutoff points and standardized measurement for the Beighton mobility tasks.

Additional Criteria for Diagnosing Hypermobility Syndrome

Additional criteria for HMS diagnosis include specific joint motions and extra-articular signs.
Specific joint motions to consider:
- Shoulder lateral rotation > 90 degrees
- Cervical spine lateral flexion > 60 degrees
- Distal interphalangeal joint hyperextension > 60 degrees
- First metatarsophalangeal joint extension > 90 degrees
Individuals with HMS have significantly poor joint position sense compared to people without HMS.

Beighton Score as a Measure of Hypermobility

Beighton score is a valid measure of generalized joint mobility in children aged 8-12 years when goniometry is used.
Additional items suggested by Grahame for the Beighton score are not needed.

Factors Affecting Range of Motion

Factors affecting range of motion (ROM) include: age, gender, active vs. passive motion, body mass index, occupational activities, recreational activities, testing position, type of instrument, examiner experience, and time of day.

Age Effects on Range of Motion

Older adults generally have less ROM in the extremities compared to younger adults.
Age-related ROM changes are joint and motion specific and may affect males and females differently.
Wrist flexion-extension, hip rotation, and shoulder rotation ROM decrease with increasing age, while thumb MCP joint flexion ROM remains consistent.
There is a small (3-5 degree) decrease in mean active hip and knee motions between the youngest (25-39 years) and oldest (60-74 years) age groups.
Spinal ROM decreases with age, specifically in neck extension and flexion, lateral flexion, and rotation.
Cervical ROM decreases by approximately 4 degrees per decade.
Thoracolumbar spinal mobility decreases with age, with an average decrease of 8 degrees per decade in flexion-extension.
Lumbar flexion and extension decrease with increasing age, primarily between 40-50 years and after 60 years of age.

Gender Effects on Range of Motion

Gender differences in ROM are joint and motion specific.
Females often have slightly greater ROM than males, especially in adults.
Greater flexibility in females for 14 out of 17 tested joint motions.
Females generally have greater ROM than males in the knee, upper extremity, and cervical spine motions.
Gender has no significant influence on 3-dimensional cervical ROM, except in the 70-79 year old group.