OT172 Assessment of Joint Mobility and Stability PDF

Assessment of Joint Mobility & Stability OT 172: Assessment of Person Factors for Occupational Performance in Adults (Motor & Sensory Functions) First Semester, AY 2024-2025 BS Occupational Therapy Co...

Assessment of Joint Mobility & Stability OT 172: Assessment of Person Factors for Occupational Performance in Adults (Motor & Sensory Functions) First Semester, AY 2024-2025 BS Occupational Therapy College of Allied Medical Professions Lecturer: Kizha Marie S. Gabutan, OTRP August 29, 2024 OUTLINE II. JOINT MOBILITY I. Joint Stability Available range of motion on the joints A. Assessment II. Joint Mobility Closely related to joint stability A. Range of Motion ↑=Mobility ↓=Stability & vice versa B. Causes of LOM ○ The MORE STABLE a joint is, the LESS MOBILE it C. Evaluating ROM D. Types of ROM is. III. Joint-End Feel ○ The MORE MOBILE it is, the LESS STABLE it is A. Types of Joint-End Feel IV. Principles of Joint Measurement V. Measurement A. RANGE OF MOTION A. Informal Assessments 1. Functional Assessment Amount of movement possible at a joint a) Procedure Personal factors influence joint motion (e.g. age, b) Documentation c) WNL vs. WFL obesity, developmental conditions, B. Formal Assessments injuries/illnesses). 1. Goniometer Different body structures affect ROM a) Precautions b) Contraindications c) Procedure: AROM & PROM LIMITATIONS OF MOTION (LOM) can occur due to d) Documentation injury, diseases, trauma, or disuse. VI. Factors Affecting ROM Assessment A. Implications of LOM VII. Sample Case B. CAUSES OF LOM VIII. ROM Values Joint Diseases Injuries I. JOINT STABILITY Pain Ability of the joint to withstand mechanical shocks Edema and movements without becoming dislocated. Spasticity (e.g. d/t stroke) Enables mobility without pain. Muscle Weakness Determined by several key factors: Skin Contractures (e.g. d/t burns) ○ Shape of bones (e.g., Hip: Femoral Head + Bony obstructions or destructions Glenoid Fossa) Displacement of fibrocartilage ○ Ligaments and joint capsule (e.g., Soft tissue contractures Sternoclavicular joint) ○ Muscles (e.g., Shoulder) C. EVALUATING ROM Assessment determines: 1. Extent of limitation 2. Intervention Approaches (Remediate or Compensate) 3. Effectiveness of an intervention A. ASSESSMENT Laxity or Immobility “Is the ROM adequate to perform necessary and Apply stress to joints in different directions desired occupations?” ○ Check for pain or immobility Types of ROM Deformities a. Passive ROM (PROM) Observation and/or palpation Another person or machine (outside force) ○ Including dislocation (completely detached), moves the joint. subluxation (contact remains), nodules. It is normal to have slightly more PROM than Stroke px commonly experiences spasticity AROM. on one side of the body → may lead to subluxation b. Active ROM (AROM) Client themselves move the joint, controls the Assess the gap in the acromion process desired motion through how many fingers width BAGNES, BELLEZA, DE LEON, M., DE VERA, MICLAT, SALAS, TAYAO | GROUP 4 | BS OT 2026 1  ASSESSMENT OF JOINT MOBILITY AND STABILITY c. Active Assisted ROM V. PRINCIPLES OF MEASUREMENT Other types (use during Intervention) Therapist/caregiver provides support during 1. Knowledge of: active motion. a. Average normal ROM of joints Client moves first, then assisted by therapist, b. Anatomy of joints providing support. c. Palpation (bony landmarks, end-feel) 2. Appropriate stabilization and handling. d. Self ROM When asked to do elbow extension, px should Other types (use during Intervention) only be moving the elbow joint. Other joints Client performs ROM on the affected side using should remain stable. the non-affected side Helps avoid substitution and no compensatory movements III. JOINT-END FEEL 3. Proper positioning of client and therapist. Sensation felt by the examiner when a joint is moved to its maximum PROM. IV. MEASUREMENT Normal resistance to further joint motion. The following can limit movement at the end of A. INFORMAL & FORMAL ASSESSMENT each motion of each joint: ○ Anatomical structures such as muscles, bones, Informal Assessments ligaments, etc. Functional assessment ○ Condition of the structures Occupation-based activity analysis ○ Or DPA; can compare extremities and determine any Types of Joint-End Feel LOM in certain actions. a. Hard Photographs or videos Bone-to-bone contact Ex. action: Elbow extension Formal Assessments b. Soft Goniometer Soft tissue approximation Inclinometer Muscle on muscle ○ Usually for Spine ROM (e.g. cervical, thoracic, lumbar) Ex. actions: Knee flexion, elbow flexion Ruler/tape measure c. Firm Firm and springy sensation, with slight give B. FUNCTIONAL ASSESSMENT (Informal) towards the end of ROM Ex. actions: Forearm supination, ankle Functional screening or functional AROM scan dorsiflexion. MCP extension Preliminary assessment to identify if further d. Empty evaluation is needed. No LOM, (+) pain upon PROM Procedure 1. Position the client appropriately. Normal if… Abnormal if… 2. Assess both extremities together OR assess the unimpaired side first. Achieved full ROM Not full/partial ROM Appropriate end-feel Inappropriate 3. Provide verbal instructions and/or demonstration. of a joint end-feel of a joint 4. Observe completeness, symmetry, and timing. (e.g. Soft end-feel 5. Estimate AROM. Determine if it is functional or it during elbow merits further assessment. extension d/t edema) *UE Screening: Upper extremity ROM screen *LE Screening: Lower Extremity ROM Screen BAGNES, BELLEZA, DE LEON, M., DE VERA, MICLAT, SALAS, TAYAO | GROUP 4 | BS OT 2026 2  ASSESSMENT OF JOINT MOBILITY AND STABILITY ACTION INSTRUCTION C. GONIOMETRY (Formal) Shoulder flexion Lift your arms straight up as Most common objective measurement of ROM if reaching toward the ceiling Provides a system for the other disciplines to understand and interpret the condition of the Shoulder extension Move your arms back, as if client. reaching behind Shoulder Move arms out to the side abduction and over your head Shoulder Raise arms forward to horizontal shoulder height, move arm to abduction and the side and back in again adduction External rotation Touch the back of your head with your hand *Axis/Body = Aligned to the respective bony landmark Internal rotation Touch the small of your back of joint with your hand *Stationary arm = Proximal to joint Elbow flexion and Start with arms straight down *Moveable arm = Distal to joint extension on the side. Touch shoulder with hand Forearm Move your arms back, as if supination and reaching behind pronation Wrist flexion and Move your wrist up and down extension Finger flexion and Make a fist, then spread your extension fingers out *How to use Goniometer: ROM Videos Finger opposition Touch each finger with your Precautions thumb one at a time Joint inflammation Pain medications or muscle relaxants Documentation of Functional Assessment Osteoporosis, osteoarthritis, rheumatoid arthritis Describe your observations of the client’s Hypermobility or joint subluxations movement. Hemophilia Multiple joint movements are assessed → use Hematoma tables Soft tissue injury Examples: Newly united fracture ○ Client can fully flex (B) shoulders independently. Prolonged immobilization ○ (B) SH flexion WFL upon functional screening Bony ankylosis ○ (L) SH flexion WFL, LOM on (R) SH flexion upon Fragile bone condition functional screening. Recommended for ROM (+) Resistance upon PROM assessment on (R) SH flexion. Contraindications WNL WFL (+) Joint dislocation Within normal limits Within functional Unhealed fractures The range is within limits Immediate post-surgery the norms/average Can perform ADLs Myositis ossificans normal ROM values and IADLs Ectopic ossification BAGNES, BELLEZA, DE LEON, M., DE VERA, MICLAT, SALAS, TAYAO | GROUP 4 | BS OT 2026 3  ASSESSMENT OF JOINT MOBILITY AND STABILITY Procedure of Goniometry Assessment AROM Ax 1. Both sides must be assessed. 2. Instruct/demonstrate the desired motion. 3. Note the starting range. 4. Reposition moveable arm at the end range, parallel to longitudinal axis distal to jt assessed. 5. Repeat active motion and measurement, as necessary. 6. Record AROM. Compare both sides. a. Indicate/describe pain, swelling, or Note: spasticity if present. WNL = Normal ROM value (e.g. measurement b. Indicate testing position and use the same bet. 0-170° in SH FLX). for retesting. WFL = Not necessarily be within normal ROM but enough to allow the person to do their PROM Ax occupations; WFL is usually used initially in 1. Both sides must be assessed. subjective/informal assessments, like during 2. Note the starting range. observation and OBAA. → More commonly 3. Move jt passively. used. 4. Reposition moveable arm at end range, parallel WNL = Formal assessment would only be used to longitudinal acis distal to jt assessed. 5. Repeat passive motion and measurement, as for affected joint movements (LOM detected). necessary. Active Motion/AROM = Check for muscle 6. Record PROM. Compare both sides. strength a. Indicate/describe pain, swelling, or Passive Motion/PROM = Check for joint spasticity, if present. stability/mobility b. Indicate abnormal end-feel, if present. c. Indicate testing position and use the same for retesting. GENERAL AX 1. Explain purpose and procedure to the client. Documentation of Goniometry Assessment 2. Conduct functional screening of ROM. Stated as a range (from start to end position) To determine the need to proceed to formal Include joint motion tested and laterality AROM/PROM Ax Common format: “[ROM type] of 3. Position the client correctly. [laterality][motion tested][angle range]” Use anatomic and neutral position of jt as ○ Ex. AROM of R elbow flexion WNL 0-150º starting position. Regarded as 0° 4. Place goniometer (axis) on appropriate bony Other details: landmark. ○ Hyperextension 5. Stabilize area proximal to the jt to prevent Recorded separately from 0 starting point or substitution. as a negative. Ex. 0-20º of R Elbow hyperextension upon PROM Ex. -20 to 0 to 150º of abnormal hyperextension ○ Fused joints Start and end positions are the same. “Fused at [angle] of [motion]ˮ Ex. Fused at 15º of wrist flexion ○ MUST document: Abnormal end feels When a joint that should have a soft end feel has a hard end feel instead and vice versa. Spasticity BAGNES, BELLEZA, DE LEON, M., DE VERA, MICLAT, SALAS, TAYAO | GROUP 4 | BS OT 2026 4  ASSESSMENT OF JOINT MOBILITY AND STABILITY Edema VI. FACTORS AFFECTING ROM ASSESSMENT Position of joints when the client feels pain or discomfort Pain, fear, fatigue, feelings of tension, and stress of Appearance of protective muscle spasm client Whether AROM or PROM was measured Experience and knowledge of therapist EXAMPLES A. IMPLICATIONS OF LOM ○ All joints of L UE are WNL/WFL upon PROM and AROM except for the following secondary to If AROM is significantly less than PROM [cause]. (AROM