Joint Range Of Motion Lecture Notes PDF

# JOINT RANGE OF MOTION ## DR.MOHAMMED ELSAYED PhD. ### Movement of a Body Segment - Movements of a body segment take place as muscles or external forces move the bones. - Bones move with respect to each other at the connecting joints. - Range of motion activities are described in terms of join...

# JOINT RANGE OF MOTION ## DR.MOHAMMED ELSAYED PhD. ### Movement of a Body Segment - Movements of a body segment take place as muscles or external forces move the bones. - Bones move with respect to each other at the connecting joints. - Range of motion activities are described in terms of joint range. - To describe joint range, terms as flexion, extension, abduction, adduction, and rotation are used. - Range of available joint motion are usually measured with a goniometer and recorded in degrees. ### Types of Range of Motion - **Passive ROM**: movement within the unrestricted ROM for a segment that is produced entirely by an external force. There is no voluntary muscle contraction. The external force may be from gravity, a machine, another individual, or another part of the individual's own body. - **Active ROM**: movement within the unrestricted ROM for a segment that is produced by an active contraction of the muscles crossing the joint. - **Physiological ROM**: controlled voluntary motion, that occurs between the different body segments. - **Functional ROM**: range of motion available for conduction of activities of daily living. ### Purpose of Joint Range of Motion Evaluation 1. To establish the existing range of motion available in a joint and to compare it to the normal range for that subject. 2. To aid in diagnosing and determining the patient's joint function. Goniometry reveals joint limitations in the arc of motion but does not identify the dysfunction. - **Hypermobility** or **hypomobility** of joints affects a patient's function in activities of daily living. 3. To reassess the patient's status after treatment and compare it to that at the time of the initial evaluation. 4. To develop the patient's interest in and motivation and enthusiasm for the treatment program. - **Hyper-mobility**: laxity in the joint or structures surrounding the joint allows motion to exceed the normal range. - **Hypo-mobility**: joint tightness or a less than normal range of motion. ### Factors Affecting Range of Motion - **Age**: Generally, the younger the subject, the greater the range of motion. - **Sex**: Many studies have been performed to determine the difference of range of motion between men and women. - **Functional needs**: the upper limbs joints are known to be joints of mobility, while the lower limbs joints are joints of stability. - **Rotator cuff muscles stabilize the shoulder joint**: Supraspinatus, Infraspinatus, Subscapularis, Teres minor. - **Shoulder joint** - **The Hip Joint** ### Other Considerations - **Types of joints**: synovial joints have greater mobility than cartilaginous and fibrous joints. - **Type of motion**: passive range of motion has wider range than active one. - **Joint structures**: Some persons, because of genetics or posture, normally have hyper-mobile or hypo-mobile joints. Body type can influence joint mobility, as can flexibility of the tendon, and ligaments crossing the joint (hip & shoulder). - **Body build**: Mesomorph and the ectomorph usually have greater flexibility than endomorph. - **Personal exercise**. - **Neurologic or muscular diseases.** - **Surgical or traumatic insults.** - **Inactivity or immobilization from any reason.** ### N.B. - Active range of motion testing provides limited information regarding joint motion. - Active range grossly evaluates coordination of movement and functional ability. - Passive range of motion is usually evaluated in goniometry and is the amount of motion possible when the examiner moves a body part with no assistance from the subject. - A passive range of motion test gives the examiner information about the integrity of the joint. ### Instruments - The instruments practitioners use for measuring joint range of motion are called **gonio-meters** or **artho-meters**. - The tools, although varying in size, shape, and appearance, all possess the capabilities to provide specific information regarding joint motion. - The widely used universal goniometer is durable, washable, and can be applied to almost all joints. - The goniometer is basically a protractor with two long arms. One arm is considered movable and the other stationary. ### Goniometry **Aim:** 1. Determination of range of motion is a part of education process medical, physical therapy, and occupational therapy students. 2. The students and patients become aware of the changes in relation to age and occupation. 3. It determines the effects of the disease and injury. 4. It has a motivating effect on the patient, especially when they progress in a desirable direction. 5. The fundamentals of ADL and self-help activities are determined by range of motion. 6. The estimation of the necessary strength, coordination, and endurance depend on the range of motion. ### Construction of the universal goniometer A) a full circle or half circle protractor numbered in each direction from zero to 180 degrees and from 180 degrees to zero. B) The protractor has one axis that joins two arms - 1- stationary arm. - 2- movable arm. ### End Feel - The "End Feel" is a type of **sensation** or **feeling** which the examiner experienced when the joint is at the end of its available passive range of motion in assessment. - There are multiple types of joint end-feels all of which are different for each individual. It may be normal (physiological) or abnormal (pathological). ### Normal (Physiologic) end feel: | End feel | Description | |---|---| | Hard (Bony) | hard stop to movement when bone contacts bone; for ex.: passive elbow extension. The olecranon process contacts the olecranon fossa. | | Soft (Soft tissue opposition) | When two body surfaces come together a soft compression of tissue is felt, for ex.: in passive knee flexion, | | Firm (Soft tissue stretch) | A firm sensation that has some give when muscle is stretched for ex.: passive ankle dorsi flexion performed with the knee in extension is stopped due to tension in the gastrocnemius muscle. | | (Capsular stretch) | A hard arrest to movement with some give when the joint capsule or ligaments are stretched. The feel is similar to stretching a piece of leather, for ex.: passive shoulder external rotation. | ### Abnormal Pathologic end feel: | End feel | Description | |---|---| | Hard | hard stop to movement, when bone contacts bone, or a bony grating sensation, when rough articular surfaces move past one another, for ex.: in a joint that contains loose bodies, degenerative joint disease, dislocation, or a fracture. | | Soft | A boggy sensation that indicates the presence of synovitis or soft tissue edema. | | Firm | A firm sensation or a hard arrest to movement with some give, indicating muscular, capsular, or ligamentous shortening. | | Springy block | A rebound is seen or felt and indicates the presence of an internal derangement, for Ex. the knee with a torn meniscus. | | Empty | If considerable pain is present there is no sensation felt before the extreme of passive ROM as the patient requests the movement be stopped. This indicates pathology such as an extra articular abscess, acute bursitis or joint inflammation, | | Spasm | A hard sudden stop to passive movement that is often accompanied by pain, is indicative of an acute or subacute arthritis, the presence of a sever active lesion of fracture. If pain is absent a spasm end feel may indicate a lesion of the control ner system with resultant increased muscular tonus. e.g spacticity | ### The Patient May Not Be Able to Perform Full Active Range of Motion Because of 1. muscle weakness. 2. soft tissue contractures (in joint capsule or ligaments). 3. muscle contractures. 4. bony blockage (bony fusion). ### Dominance - It has been reported that there is essentially no difference for corresponding joints between the left and right sides of the body. - Comparative goniometry is done when a joint is involved unilaterally, the contralateral limb can then be used as the standard for normal range of motion for that subject. ### Basic Elements for Reliable Goniometric Measurements - Demonstrate to the patient simply and clearly what to do. - Each joint is measured from a specific starting position. - All extremity movements should be measured in degrees from specific starting or 0° position. - The goniometer is applied to the lateral side except for few motions. - The instrument should be held in light contact with the patient's body. - Any tight or restrict clothing should be removed. - Comparison between the two limbs are conducted. ### Different Methods of Measuring Range of Motion 1. **Universal goniometer**: - It consists of a full circle or half circle protractor (180° or 360°), numbered in each direction from zero to 180° and from 180° to zero. - The protractor has one axis (fulcrum) that joins two arms. - The size of the universal goniometer differs according to the joint being assessed - Image of universal goniometers 2. **Electro-goniometer**: - It has the same construction as the universal goniometer, but, is connected to a potentiometer, which is very sensitive to the movement. 3. **Inclinometer**: - It contains a unique fluid-based design, which makes it easy and accurately measure ranges of motion which are not easily obtained with the conventional goniometers 4. **Spinogram**: - It used to measure spinal motion. Reflective dots are placed on the spinous processes of each vertebra. - A video camera connected to a computer with special program is then used to photo the spine as a whole or the joints between two vertebrae. 5. **pleurical caliper**: - A pleurical caliper, a symmetry graph are tools which may be used to determine the tilting of the pelvis from anterior or posterior views. - Image of pleurical caliper - Pleurical caliper: It used for measuring: - 1- Pelvic tilt with leg shortening. - 2-Shortening of a) femur b) tibia 3-forefoot supination. - 4- Tibial torsion. - 5-Upper thigh diameter. - 6-Level of (ASIS&PSIS) - 7- Shoe lift. - 8- Measuring rib hump. - 9- Inside diameter of prosthetic socket. - Images of various measurements using a pleurical caliper. 6. **Tempro-mandibular joint measurement** (**Therabite scale**) - The tempro-mandibular joint is a complex synovial joint. - It's movements takes place in rotational and transnational components, which is difficult to be measured. It permits six movements (opening, closing, deviation to the right, to the left, protrusion and retrusion). - It may be measured by a regular ruler, caliper, therabite scale. - Image of therabite scale ### Image of a baby in a white hooded garment - The image contains a baby in a white hooded garment smiling - The background is blue and contains the words "THANK YOU" in blue and with a reflection.