Range of Motion (ROM) Assessment

• When assessing range of motion, muscle tone and strength should support each movement with minimal effort.

Range of Motion (ROM)

• Active ROM is when the patient can move a joint without help.
• Passive ROM (PROM) involves the examiner moving the muscle for the client to assess joint flexibility and identify any restrictions.
• Crepitation is a crunching sound/feel caused by air in tissues, air in lungs, or bone rubbing on bone/cartilage.

Movements Associated with ROM

• Flexion decreases the angle of a joint.
• Extension increases the angle of a joint.
• Hyperextension excessively moves a joint beyond its normal range.
• Dorsiflexion bends the ankle upward.
• Plantar flexion bends the ankle downward.
• Lateral flexion bends a body part to the side.
• Abduction moves a body part away from the body's midline.
• Adduction moves a body part toward the body's midline.
• Pronation rotates the forearm so the palm faces down, or involves foot eversion and abduction.
• Supination rotates the forearm so the palm faces up, or involves foot inversion and adduction.
• Circumduction is circular movement of a limb or body part.
• Inversion turns the soles of the feet inward.
• Eversion turns the soles of the feet outward.
• Internal rotation moves a limb toward the body's midline.
• External rotation moves a limb away from the body's midline.
• Retraction shortens a tendon.
• Protraction lengthens a tendon.

Joints & ROM

• Flexion and extension occur at the neck, shoulder, elbow, wrist, fingers, thumb, hip, knee, and toes.
• Hyperextension occurs at the neck, shoulder, wrist, and fingers.
• Dorsiflexion and plantar flexion occur at the ankle.
• Lateral flexion occurs at the neck.
• Abduction and adduction occur at the shoulders, wrists, fingers, thumbs, hips, and toes.
• Opposition occurs at the thumbs.
• Pronation and supination occur at the forearm.
• Circumduction occurs at the shoulders and hips.
• Inversion and eversion occur at the feet.
• Rotation (internal and external) occurs at the neck, shoulders, wrists, thumbs, and hips.
• Retraction and protraction occur at the jaw.

Head/Neck Assessment - Inspection

• Expected findings: equal movement, full ROM without pain, neck muscle symmetry.
• Unexpected findings: muscle asymmetry.

Head/Neck Assessment - Palpation

• Expected findings: no masses/deformities, possible jaw clicking (TMJ), full firm muscle tone and strength.
• Unexpected findings: pain, muscle spasms, atrophic/hypertrophic tone.

Spine Assessment - Inspection

• Expected findings: equal movement, extremity length, steady gait, alignment, full ROM without pain, spinal curve.
• Unexpected findings: masses, deformity, asymmetry, pain, unsteady gait.

Spine Assessment - Palpation

• Expected findings: full, firm, equal tone and strength, no pain, symmetrical muscles.
• Unexpected findings: mass or deformity, joint warmth (inflammation), abnormal spinal curvature.
• Abnormal spinal curvatures include kyphosis, lordosis, and scoliosis.

Shoulders/Upper Extremities - Inspection

• Expected findings: symmetry in contour and height.
• Unexpected findings: erythema, atrophy, deformities, swelling.

Shoulders/Upper Extremities - Palpation

• Expected findings: equal firmness and fullness, dominant arm may be larger/stronger.
• Unexpected findings: heat, tenderness, swelling.

Hips/Lower Extremities - Inspection

• Expected findings: steady gait, smooth, even movements.
• Unexpected findings: asymmetry, erythema, swelling, deformities.

Hips/Lower Extremities - Palpation

• Expected findings: stable and symmetrical without pain.
• Unexpected findings: pain, tenderness, swelling, crepitus.

Range of Motion (ROM) - Expected

• Crepitus without pain or limitations is normal (knees).
• Full ROM.
• Active vs. passive ROM.

Range of Motion (ROM) - Unexpected

• Painful crepitus.
• Limited movement.

Gerontologic Considerations

• Decline in speed, strength, resistance to fatigue, reaction, and coordination.
• Increased risk for falls.
• Changes in proprioception (awareness of self in relation to the environment).
• Decreased bone density, flexibility, ROM, and muscle mass.
• Increased risk for fractures, osteoarthritis, and osteoporosis.

Health Promotion - Ergonomics

• Injuries can result from improper lifting, bending, and computer positioning.
• Proper desk techniques include correct chair height, wrist support, eye-level monitors, and good posture.
• Proper lifting techniques include assessing weight, getting help if needed, spinal alignment, bending at the knees, and using thigh muscles.

Health Promotion - Injury Prevention

• Use seatbelts in cars.
• Wear helmets when riding motorcycles or bicycles.
• Avoid texting while driving.
• Remove hazards like loose rugs or cords.
• Take breaks during repetitive motion activities (golf, tennis).
• Lift with legs, not the back, using proper body mechanics.

Health Promotion - Exercise

• Regular exercise improves muscle strength, reduces bone loss, and promotes joint ROM.
• Ask about current exercise types, frequency, and duration.
• Warm-up with stretching and low-intensity aerobics to avoid injury.
• Exercise programs should include various muscle contractions.
• Wear supportive shoes and stay hydrated when exercising.

Health Promotion - Nutritional Considerations

• Calcium is essential for bone mass, found in dairy/non-dairy foods.
• 1,000-1,200 mg daily intake decreases the risk for bone loss and protects against fractures.
• Vitamin D, a fat-soluble vitamin, helps with calcium absorption.
• The adult recommended daily intake of vitamin D is 600-800 IU.
• Vitamin D is in egg yolks and fatty fish, and fortified foods like milk, orange juice, and margarine.
• Sunlight exposure can trigger vitamin D synthesis.

Abnormal Musculoskeletal Findings

• Kyphosis is an abnormal forward curvature of the upper back, also known as a hunchback.
• Lordosis is an excessive inward curvature of the spine.
• Scoliosis is a sideways curve of the spine.
• Crepitus is a popping, clicking, or crackling sound in the joint.

Physical Assessment Techniques - Inspection

• General observation: observe posture, gait, and ability to perform daily activities.
• Symmetry and alignment: check for symmetry in body parts, alignment of joints, and any deformities or swelling.
• Skin and tissue inspection: note changes in skin color, swelling, rash, or masses over joints.

Physical Assessment Techniques - Palpation

• Joint and muscle palpation: palpate bones, joints, muscles, and surrounding tissues for warmth, swelling, tenderness, or crepitus.
• Specific areas: palpate anatomical landmarks such as the spinous processes of the spine or the menisci in the knee.

Physical Assessment Techniques - Range of Motion

• Active ROM: ask the patient to move their joints through the full range of motion voluntarily.
• Passive ROM: assist the patient by moving their joints to assess full range of motion if necessary.
• Assessment of movement: note any pain, stiffness, or limitations during movement.

Physical Assessment Techniques - Muscle Strength and Tone

• Muscle strength testing: use scales like the Medical Research Council scale to grade muscle strength from 0 to 5.
• Muscle tone assessment: evaluate muscle tone for normalcy or abnormalities such as flaccidity or spasticity.

Physical Assessment Techniques - Special Maneuvers

• Stress tests: perform tests like the McMurray test for meniscal tears or the Spurling test for cervical spine issues.
• Specific joint tests: use tests like the Finkelstein test for de Quervain tenosynovitis or the Phalen sign for carpal tunnel syndrome.

Physical Assessment Techniques - Imaging and Diagnostic Tests

• X-rays: evaluate bone density and structure.
• CT scans: assess musculoskeletal trauma and bony abnormalities.
• MRI: examine soft tissue injuries like muscle or ligament tears.
• Bone densitometry: assess bone density and predict fracture risk.