9/20/16

Applied Anatomy 1 HSc-51124

Seminar 3.1: Range of Motion Examination

Carlos Ladeira PT, MSc, EdD, FAAOMPT, MTC, OCS

Associate Professor

Seminar Objectives
Define and Discuss Range of Motion (ROM) and
Associated Terminology
Discuss and Compare Passive ROM (PROM) and
Active ROM (AROM)
Compare tools utilized to measure ROM
Compare different ways to document ROM
Discuss factors affecting ROM
Describe and Discuss ROM Technique Procedures

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ROM Definitions
ROM: is the term that is used to describe the amount of
movement you have at each joint.
l AROM is performed by patient alone.
l PROM is performed by therapist without any patient help
Endfeel:
l The resistance to movement that the therapist perceives at
end-range of motion when testing PROM (more to come in
future lectures)
Goniometer
l An instrument that measures angles. In PT, it is the most
common instrument utilized to measure ROM

ROM Definitions
Hypomobility:
l significant decrease from the normal expected ROM for
subject age and gender.
Hypermobility:
l Significant increase in ROM from the normal expected for
subject age and gender
Joint ROM vs. Muscle Length Measurements
l For joint ROM tests, the motion is measured with bi-
articular muscles shortened. For muscle length tests, the bi-
articular muscles are lengthened to assess muscle tightness.
Axis of motion
l Imaginary point where the joints pivot to form the angles
that are recorded with goniometers.

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ROM Definitions
Physiological or osteokinematic motion :
l Refer to the gross movements of the shafts of bones
rather than joint surfaces (next slide)
Accessory or arthrokinematic motion :
l Refer to the small movements that occur
involuntarily between joint surfaces during
physiological motions
l They may also be used therapeutically in manual
therapy techniques
l Examples: approximation, separation, slide, glide,
spin.

Physiological Motions Norkin, pp. 6-7

Rotation Abduction/Adduction
Flexion/extension
Transverse Plane Frontal plane
Sagittal plane

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Accessory Movements or
Arthokinematic
B : Se paration C: Glid e
A : resting position

D: Approximation F : Spin
E: Roll

Instruments to measure ROM

Electrogoniometer
l Computer assisted ROM
assessment. Often used in research
and seldom in the clinic.
Tape Measure
Eye balling
l Visual estimation of ROM
measurement can be used to get an
overall overview of the ROM in a
quick screen of ROM. For
documentation of patient progress, it
is not acceptable.

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Instruments to measure ROM

Metal universal goniometer most
versatile. Often smaller and
used for the hand.

Plastic full circle transparent

universal goniometers. Most
popular goniometer.

Universal Transparent Goniometer

Stationary arm : placed parallel with the longitudinal axis of the

fixed part
Movable arm : along the longitudinal axis of the movable
segment
Axis of rotation(pin) : at the intersection of the stationary &
movable arms

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Fluid & Gravity Goniometer

Norkin p. 25 Fig. 2.7

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Factors affecting range of motion

Gender ( adult females > adult males)
Age (children > adults > elderly)
Muscle bulk
Ligaments and joint capsule laxity
Extensibility of the skin and subcutaneous tissue

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The ROM Exam

l Eyeballing performed before goniometry with AROM
followed by PROM
l During the AROM exam:
Note the ability and motivation to move without
hesitance. Hesitance may indicate an active
inflammation
Note if patient has full range against gravity

If the patient has a symptom during motion, take note of

the range, position, and direction of movement. Ask the
patient to grade the pain during motion vs. resting. A
small movement causing intense pain may imply a
serious (fracture) or reactive (inflamed) condition.

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The normal AROM

l Coordinated movement, no extraneous
body compensation
l No facial expression of pain or discomfort.
l Antagonists are relaxed and do not impair
movement
l No hesitance to move joint
l Normal range and without pain even at
end-range
l Able to move against gravity without any
difficulty

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The abnormal AROM

l Facial expression of pain or discomfort during motion
l Painful arc (pain noted during partial range of the
available motion) or pain at end-range
l Uncoordinated movement or compensatory movement
(associated joints)
l Abnormal sounds during motion (crepitus and others).
l Restricted range
l Excessive range
l AROM always slightly < than PROM. When AROM
much worse than PROM, suspect muscle tear or
neurological compromise.

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The PROM test

l During the AROM testing, before or at the end-
range, the therapist checks PROM with
overpressure carefully
l When checking PROM, the therapist
feels for joint sounds with hands,
feels for excess or limitation of motion,

observes end-feel and compares with opposite side

l The therapist examines all primary AROM and

PROM on the joint with symptoms as well as the
primary AROM/PROM of the joint above and
below bilaterally.

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Goniometer Positioning and Stabilization

POSITIONING
Start with zero position - This is the reference point for the
measurement. If zero position can't be achieved, this must be
documented.
Permit complete range of motion
l If you are assessing joint ROM, be sure that some other
structure (e.g.. a tight muscle) doesn't interfere.
l If you are assessing some other structure (e.g. a tight muscle,
pain limiting the motion) document exactly what is limiting
the range of motion. (e.g. hamstring tightness at 65 of hip
flexion)
STABILIZATION
Poor stabilization is the most frequent cause of invalid

measurements. (e.g. observe a "normal" ROM of elbow extension
when movement of shoulder and arm masks a limitation - actually
measuring shoulder and arm movement)

GONIOMETRY PROCEDURE
position joint in zero position and stabilize proximal joint
component.
move joint to end of range of motion (to assess quality of
movement)
determine end-feel at point where measurement will be
taken (at the end of available range of motion)
identify and palpate bony landmarks
align goniometer with bony landmarks while holding joint
at end of range
read the goniometer
record measurement (e.g. elbow flexion = 130)

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GONIOMETRY
Validity and Reliability
VALIDITY
Goniometric measurements can be invalid; usually because of
poor stabilization (see positioning and stabilization ), but also
because the joint axis always moves during measurement.
With universal goniometer (not fluid or gravity goniometer)

RELIABILITY
Upper extremity measurements are more reliable than lower
extremity measurements.
to maximize reliability always use the same:
Instrument, positioning, procedure, examiner

Goniometric ROM recordings

For most recordings, the measurement starts at 00.
l Elbow Flexion: starts at full elbow extension or 0 degrees.
l Neck flexion starts at neutral position or 0 degrees (mid-
range between flexion and extension).
Some recordings the goniometer starts in an angle
different from 00.
l In hip abduction and adduction, the goniometer readings
starts at 900. In these cases, this reading at the beginning is
taken as 00 and the reading at the end of motion is added to or
subtracted from the 900. E.g.; the final reading at end of hip
abduction is 1200 minus 900 = 300; hence the score for hip
abduction is 300.

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Recording ROM measurements

Two main two methods.
l A single motion recorded at a time
Elbow flexion 1500 and Extension 00 (normal)

Elbow flexion 1300 and extension -5 (flexion missing 200

and extension missing 50)
Elbow flexion 1500 and Extension +50 (flexion normal and
extension with 50 hypermobility)
l Two movements recorded together with a zero degree
between motions to denote neutral position when applicable.
0 0 0
90 -0 -70 Shoulder External and internal rotation
(normal)
450-00-600 Shoulder External and internal rotation
(external missing 450 and internal missing 100)

Recording ROM measurements cont.

l A single joint motion recorded at a time
Shoulder external rotation 900 and internal 700 (normal)
Shoulder external rotation 450 and internal 600 (ER
missing 450 and IR missing 100)
l Two movements recorded together with a zero
degree between motions to denote neutral position
when applicable.
00-1500 Elbow Extension and Flexion (normal). No zero
needed to denote neutral position.
50-1300 Elbow Extension and Flexion (Extension missing
50 and flexion 200)

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Key points to remember

There are different tools to measure ROM. We will use
mostly a goniometer.
ROM readings may indicate normal, reduced, or
increased motion.
There are two methods to record ROM, we will use the
single joint method.
Standardized procedures to take ROM are important
for good measurement validity and reliability.
Even when the patient has ROM within the normal
expected values; pain, movement compensation, or
crepitus may indicate abnormality.

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