Joint Range of Motion

Introduction Joint flexibility is defined as the range of motion (ROM) allowed at a joint. A joint's ROM is usually measured by the number of degrees from the starting position of a segment to its position at the end of its full range of the movement. The most common way this is done is by using a double-armed goniometer. A stationary arm holding a protractor is placed parallel with a stationary body segment and a movable arm moves along a moveable body segment. The pin (axis of goniometer) is placed over the joint. When anatomical landmarks are well defined, the accuracy of measurement is greater. If there is more soft tissue surrounding the joint area, measurement error can be more frequent. Purposes The purpose of this Lab is to practice measuring the ROMs of the major joints in our body using a doublearmed goniometer. Students need to memorize the terms used to describe different joint motions allowed at the major joints of the body. Procedures Stage 1: Shoulder Girdle Movements & ROM Standing behind the subject, palpate the inferior angle and the vertebral border of the scapula (Figure 1). Have the subject slowly abduct his/her arm at the shoulder joint. 1. Record the degree of shoulder joint abduction at the point the scapula starts moving. 2. How many degrees will the scapula move if the arm continues in abduction (Figure 1)? 3. What is the name of this scapula movement?

Figure 1. Scapula Movements Now, have the subject slowly flex his/her arm at the shoulder joint to 90 flexion. 4. Record the number of degrees of shoulder joint flexion at the point the scapula starts moving. 5. Have the subject move to 90 of shoulder joint flexion. How many centimeters will the scapula (inferior edge) move laterally (Figure 2)? 6. What is the name of this scapula movement?

Figure 2. Lateral Motion of the Scapula

Stage 2: Shoulder Joint ROM 7. With the shoulder joint abducted to 90 and the elbow flexed, determine the ranges of internal and external rotations (Figure 3). 8. Determine the amount of hyperextension.

Figure 3. Internal & External Rotation / Forward Flexion & Hyperextension of the Shoulder

Stage 3: Elbow Joint ROM 9. Determine the range of motion (flexion) at the elbow (Figure 4). 10. How many degrees of hyperextension of the elbow?

Figure 4. Elbow Joint Motions

Stage 4: Wrist Joint ROM 11. How many degrees of 12. How many degrees of 13. How many degrees of 14. How many degrees of

wrist flexion (Figure 5)? wrist hyperextension? wrist radial deviation? ulnar deviation?

Figure 5. Wrist Joint Motions

Stage 5: Hip Joint ROM 15. Determine the amount of (right) hip flexion. You will place the goniometer pin on the greater trochanter of the femur (Figure 6). Measurement is most accurate with the subject lying supine and flexing the right hip by raising one leg in the air (both knees remains in extension). 16. Determine hip flexion when the moveable segment has 90 of knee flexion. 17. Determine the amount of hip hyperextension. The subject will assume a prone position for this measurement.

Figure 6. Hip Joint Motions

Stage 6: Knee Joint ROM 18. Determine the amount of knee flexion. The easiest measurement technique is to again have the subject be prone (Figure 7). 19. Determine the amount of knee hyperextension. Have the subject sitting on a bench with the legs out in front. Elevate the feet so that the leg is not resting on the surface.

Figure 7. Knee Joint Motions

Stage 7: Ankle Joint ROM 20. Determine the amount of dorsal flexion and plantar flexion (Figure 8).

Figure 8. Ankle Joint Motions Summary Improving joint flexibility is essential for injury prevention. One may increase joint flexibility (range of motion) by regular stretching. What are the factors affecting flexibility of a joint? Table 1 summarizes the average ROMs published. Compare your measurements with these values. Are they in similar ranges or not? If not, why?

Table 1. Average ROMs

Joint/Segment Elbow Forearm

Wrist

Shoulder

Shoulder w/ Abducted Arm

Hip

Extended Hip Knee Ankle

Cervical Spine

Lumbar-thoracic Spine

Movement Degree Flexion 145 Hyperextension 0-10 Pronation 80 Supination 85 Extension (Dorsiflexion) 70 Flexion (Palmar flexion) 80 Radial Deviation 20 Ulnar Deviation 30 Forward Flexion 180 Hyperextension 50 Abduction 180 Adduction 50 Internal Rotation 90 External Rotation 90 Horizontal Adduction 135 Horizontal Adduction 45 Flexion 125 Hyperextension 30 Abduction 45 Adduction 25 Internal Rotation 40 External Rotation 60 Flexion 135 Plantar flexion 45 Dorsiflexion 20 Flexion 60 Hyperextension 75 Lateral Flexion 45 Rotation 80 Flexion 45 Hyperextension 25 Lateral Flexion 25 Rotation 30