Range of Motion Assessment - Upper Extremity PDF

Range of Motion Assessment – Upper Extremity Çiçek Günday, PT, MSc Arthrokinematics ❑ Arthrokinematics is the term used to refer to the movement of joint surfaces. ❑ The movements of joint surfaces are described as slides (or glides), spins, and rolls. ❑ A slide (glide),...

Range of Motion Assessment – Upper Extremity Çiçek Günday, PT, MSc Arthrokinematics ❑ Arthrokinematics is the term used to refer to the movement of joint surfaces. ❑ The movements of joint surfaces are described as slides (or glides), spins, and rolls. ❑ A slide (glide), which is a translatory motion, is the sliding of one joint surface over another, as when a braked wheel skids. ❑ A spin is a rotary motion, similar to the spinning of a toy top. All points on the moving joint surface rotate around a fixed axis of motion. ❑ A roll is a rotary motion similar to the rolling of the bottom of a rocking chair on the floor or the rolling of a tire on the road Osteokinematics Osteokinematics refers to the gross movement of the shafts of bones rather than the movement of joint surfaces. The movements of the shafts of bones are usually described as taking place in one of the three cardinal planes of the body (sagittal, frontal, transverse) around three corresponding axes (medial–lateral, anterior–posterior, vertical). The term goniometry is derived from two Greek words, gonia, meaning angle, and metron, meaning measure. Therefore, goniometry refers to the measurement of angles. Range of motion (ROM) is the arc of motion that occurs at a joint or a series of joints. Range of motion (ROM) Universal Goniometer The universal goniometer is the instrument most commonly used to measure joint position and motion in the clinical setting. Universal goniometers may be constructed of plastic or metal and are produced in many sizes.  The body of a universal goniometer resembles a protractor and may form a half circle or a full circle. Traditionally, the arms of a universal goniometer are designated as moving or stationary according to how they are attached to the body of the goniometer. The stationary arm is a structural part of the body of the goniometer and cannot be moved independently from the body. The moving arm is attached to the center of the body of most plastic goniometers by a rivet that permits the arm to move freely on the body.  Gravity-Dependent Goniometers (Inclinometers) Gravity-dependent goniometers or inclinometers use gravity’s effect on pointers and fluid levels to measure joint position and motion. Electrogoniometers They are used primarily in research to obtain dynamic joint measurements. Most devices have two arms, similar to those of the universal goniometer, which are attached to the proximal and distal segments of the joint being measured.  Goniometer alignment refers to the alignment of the arms of the goniometer with the proximal and distal segments of the joint being evaluated. Instead of depending on soft tissue contour, the examiner should use bony anatomical landmarks to more accurately visualize the joint segments. These landmarks, which have been identified for all joint measurements, should be exposed so that they may be identified easily and also palpated. The stationary arm is often aligned parallel to the longitudinal axis of the proximal segment of the joint, and the moving arm is aligned parallel to the longitudinal axis of the distal segment of the joint. The fulcrum of the goniometer may be placed over the approximate location of the axis of motion of the joint being measured. ❖ Active range of motion (AROM) is the arc of motion attained by a subject during unassisted voluntary joint motion. ❖ If active ROM is limited, painful, or awkward, the physical examination should include additional testing to clarify the problem. ❖ Passive range of motion (PROM) is the arc of motion attained by an examiner without assistance from the subject. The subject remains relaxed and plays no active role in producing the motion. ❖ Normally passive ROM is slightly greater than active ROM because each joint has a small amount of available motion that is not under voluntary control. This additional passive ROM helps to protect joint structures because it allows the joint to absorb extrinsic forces.  If pain occurs during active ROM, it may be due to contracting or stretching of “contractile” tissues, such as muscles, tendons, and their attachments to bone. If pain occurs during passive ROM, it is often due to moving, stretching, or pinching of noncontractile (inert) structures. The examiner should test passive ROM prior to performing a manual muscle test of muscle strength because the grading of manual muscle tests is based on completion of the joint ROM. End-Feel: A type of structure that limits a ROM has a characteristic feel that may be detected by the examiner who is performing the passive ROM.  Hypermobility refers to an increase in passive ROM that exceeds normal values for that joint, given the subject’s age and gender. Hypomobility refers to a decrease in passive ROM that is substantially less than normal values for that joint, given the subject’s age and gender. Capsular Patterns: Cyriax has proposed that pathological conditions involving the entire joint capsule cause a particular pattern of restriction involving all or most of the passive motions of the joint.  Upper Extremity Range of Motion Assessment  Shoulder Flexion Place the subject supine, with the knees flexed to flatten the lumbar spine. Place the elbow in extension. Position the forearm in 0 degrees of supination and pronation so that the palm of the hand faces the body. 1. Center fulcrum of the goniometer over the lateral aspect of the greater tubercle. 2. Align stationary arm parallel to the midaxillary line of the thorax. 3. Align moving arm with the lateral midline of the humerus. (through the lateral epicondyle of the humerus) Kendall: 180 AAOS: 180  Shoulder Extension Position the subject prone, with the face turned away from the shoulder being tested. A pillow is not used under the head. Position the elbow in slight. Place the forearm in 0 degrees of supination and pronation so that the palm of the hand faces the body. 1. Center fulcrum of the goniometer over the lateral aspect of the greater tubercle. 2. Align stationary arm parallel to the midaxillary line of the thorax. 3. Align moving arm with the lateral midline of the humerus. (through the lateral epicondyle of the humerus). Kendall: 45 AAOS: 60  Shoulder Abduction Position the subject supine, with the shoulder in lateral rotation and 0 degrees of flexion and extension so that the palm of the hand faces anteriorly. The elbow should be extended so that tension in the long head of the triceps does not restrict the motion. 1. Center fulcrum of the goniometer close to the anterior aspect of the acromial process. 2. Align stationary arm so that it is parallel to the midline of the anterior aspect of the sternum. 3. Align moving arm with the anterior midline of the humerus. Kendall: 180 AAOS: 180  Shoulder Adduction Position the subject supine, with the shoulder in lateral rotation and 0 degrees of flexion and extension so that the palm of the hand faces anteriorly. The elbow should be extended so that tension in the long head of the triceps does not restrict the motion. 1. Center fulcrum of the goniometer close to the anterior aspect of the acromial process. 2. Align stationary arm so that it is parallel to the midline of the anterior aspect of the sternum. 3. Align moving arm with the anterior midline of the humerus. not normally measured  Shoulder IR/ER Position the subject supine, with the arm being tested in 90 degrees of shoulder abduction. Place the forearm perpendicular to the supporting surface. Rest the full length of the humerus on the examining table. The elbow is not supported by the examining table. Place a pad under the humerus so that the humerus is level with the acromion process. 1. Center fulcrum of the goniometer over the olecranon process. 2. Align stationary arm perpendicular to the floor. 3. Align moving arm with the ulna, using the olecranon process and ulnar styloid for reference. Int. Rot. Ext. Rot. Kendall: 70-90 Kendall: 90 AAOS: 70 AAOS: 90  Elbow Flexion Position the subject supine, with the arm is close to the side of the body. Place a pad under the distal end of the humerus to allow full elbow extension. Position the forearm in full supination with the palm of the hand facing the ceiling. 1. Center fulcrum of the goniometer over the lateral epicondyle of the humerus. 2. Align stationary arm with the lateral midline of the humerus, using the center of the acromion process for reference. 3. Align moving arm with the lateral midline of the radius, using the radial styloid process for reference. Kendall: 145 AAOS: 150  Elbow Supination Position the subject sitting, with the upper arm is close to the side of the body. Flex the elbow to 90 degrees. Initially position the forearm midway between supination and pronation so that the thumb points toward the ceiling. 1. Center fulcrum of the goniometer to the volar side of the ulnar styloid process. 2. Align stationary arm perpendicular to the ground. 3. Moving arm should be parallel to the styloid processes of the radius and ulna. Kendall: 90 AAOS: 80  Elbow Pronation Position the subject sitting, with the upper arm is close to the side of the body. Flex the elbow to 90 degrees. Initially position the forearm midway between supination and pronation so that the thumb points toward the ceiling. 1. Center fulcrum of the goniometer to the dorsal side of the ulnar styloid process. 2. Align stationary arm perpendicular to the ground. 3. Moving arm should be parallel to the styloid processes of the radius and ulna. Kendall: 90 AAOS: 80  Wrist Flexion/Extension Position the subject sitting next to a supporting surface with the shoulder abducted to 90 degrees, the elbow flexed to 90 degrees, and the palm of the hand facing the ground. Rest the forearm on the supporting surface but leave the hand free to move. 1. Center fulcrum on the lateral aspect of the wrist over the triquetrum. 2. Align stationary arm with the lateral midline of the ulna (ulnar styloid). 3. Align moving arm with the lateral midline of the fifth metacarpal. Flexion Extension Kendall: 90 Kendall: 70 AAOS: 80 AAOS: 70  Wrist Ulnar and Radial Deviation Position the subject sitting next to a supporting surface with the shoulder abducted to 90 degrees, the elbow flexed to 90 degrees, and the palm of the hand facing the ground. Rest the forearm and hand on the supporting surface. 1. Center fulcrum on the dorsal aspect of the wrist over the capitate. 2. Align stationary arm with the dorsal midline of the forearm. 3. Align moving arm with the dorsal midline of the third metacarpal. Do not use the third phalanx for reference. Ulnar Dev. Radial Dev. Kendall: 35-45 Kendall: 20 AAOS: 30 AAOS: 20  METACARPOPHALANGEAL FLEXION / EXTENSION Position the subject sitting, with the forearm and hand resting on a supporting surface. Place the forearm midway between pronation and supination 1. Center fulcrum of the goniometer over the dorsal aspect of the MCP joint. 2. Align stationary arm over the dorsal midline of the metacarpal. 3. Align moving arm over the dorsal midline of the proximal phalanx. Flexion Kendall: 90 AAOS: 90 Extension Kendall: 25 AAOS: 45  FINGERS: METACARPOPHALANGEAL ABDUCTION Position the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the dorsal aspect of the MCP joint. 2. Align stationary arm over the dorsal midline of the metacarpal. 3. Align moving arm over the dorsal midline of the proximal phalanx. Kendall: 45 AAOS: -  FINGERS: PROXIMAL INTERPHALANGEAL FLEXION / EXTENSION Place the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the dorsal aspect of the PIP joint. 2. Align stationary arm over the dorsal midline of the proximal phalanx. 3. Align moving arm over the dorsal midline of the middle phalanx. Flexion Extension Kendall: 120 Kendall: 0 AAOS: 100 AAOS: 0  FINGERS: DISTAL INTERPHALANGEAL FLEXION / EXTENSION Position the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the dorsal aspect of the DIP joint. 2. Align stationary arm over the dorsal midline of the middle phalanx. 3. Align moving arm over the dorsal midline of the distal phalanx. Flexion Extension Kendall: 75 Kendall: 0 AAOS: 90 AAOS: 0  THUMB: CARPOMETACARPAL FLEXION Position the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the palmar aspect of the first CMC joint. 2. Align stationary arm with the ventral midline of the radius using the ventral surface of the radial head and radial styloid process for reference. 3. Align moving arm with the ventral midline of the first metacarpal. Kendall: 45 AAOS: 15  THUMB: CARPOMETACARPAL ABDUCTION Position the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the lateral aspect of the radial styloid process. 2. Align stationary arm with the lateral midline of the second metacarpal, using the center of the second MCP joint for reference. 3. Align moving arm with the lateral midline of the first metacarpal, using the center of the first MCP joint for reference. Kendall: 80 AAOS: 70  THUMB: METACARPOPHALANGEAL FLEXION Position the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the dorsal aspect of the MCP joint. 2. Align stationary arm over the dorsal midline of the metacarpal. 3. Align moving arm with the dorsal midline of the proximal phalanx. Kendall: 60 AAOS: 50  THUMB: INTERPHALANGEAL FLEXION Position the subject sitting, with the forearm and hand resting on a supporting surface. 1. Center fulcrum of the goniometer over the dorsal surface of the IP joint. 2. Align stationary arm with the dorsal midline of the proximal phalanx. 3. Align moving arm with the dorsal midline of the distal phalanx. Kendall: 80-90 AAOS: 80