Evaluation of Joint Motion by Dortha Esch

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EV LU TIONOFJOINTMOTION


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Evaluation

ofJoint Motion

Methods

of

Measurement

and

Recording

byDorthaEschandMarvin Lepley

Illustrations

by Jean Magney

Universityof

Minnesota

Press

Minneapolis

N

N

SO

T


5/53

Copyright 1971 by

Dortha

Esch and Marvin Lepley.

Copyright 1974

by the

University

of

Minnesota.

All

rights

reserved.

Published by theUniversityof MinnesotaPress

111 Third

Avenue

South, Suite 290, Minneapolis, MN 55401-2520

Printed in the United

States

o fAm ericaat

the University of MinnesotaPrintingDepartment.

Eighthprinting,

1997

LibraryofCongress Catalog Card Number: 73-93576

ISBN

0-8166-0714-1


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Preface

The

measurement

of the

motion produced

by an

individual

in any

given joint

of

the

body

is

done

to

determine

the

degree

an d

extent

of

loss

of

mobility

resulting from injury,

disease, o r

disuse.

The

record obtained from such

measurement provides

a

basis

for

patient treatment planning

by

therapists,

nurses, physicians,

an d

other members

of the

health care team.

The techniques ofmeasurement and the methodso frecording are not

diffi-

cult

to

learn.

To

ensure proper patient care each member

of the

health care

team, evenif he is notrequired to evaluate and

record,

should havean

appreciation

of the

problems faced

by a

person with joint impairment. Such

an understanding is enhancedby studyingthe techniques ofmeasuring joint

motion.

This manual presents

th e

most commonly accepted methods

ofmeasurement,

th e

full-circle

or

360 system

and the

half-circle

or

180 system.

A

special

unit

on

hand

evaluation

by use of

graphic means

is

included.

This manualhasbeen usedin the classroom fo r several years previousto

publication. W ehave

found

that students learn measurement techniquesand

recording witheasebecause each pagefollowingthe introductory material

provides

a guide to the techniquefor measuring ajointof the body. Direc-

tions

for the

testing position

and

placement

of the

measuring instrument

are

given. Illustrations

show

graphically correct instrument placement

and

give

th e normal

limits

ofmotionf or each joint. Aform is provided torecord th e

measurements obtained. Students

are

able

to

study

th e

manual quite inde-

pendently and learn techniques with minimal instructor assistance.

Sincethere

is

considerable variability

in

normal

limitsof

motion figures

given byvarious authors, w ehave arbitrarily selected one set: those used

by th ePhysical Medicine Departmentof theUniversity ofMinnesotawith

some modifications resulting from our ownobservations in the clinicand

classroom.

It

is our

belief that

the

manual presents

a

practical approach

to

learning

and

maybe successfully usedby students, therapists, andotherswho are re-

quired

to

evaluate joint mobility.

We would liketo express appreciation to all our colleagues w hohave will-

ingly consulted withu s during th e preparation ofthismanual. W e especially

want tothank JohnD . Allison, R.P,T. , andJames F. Pohtilla, R.P.T.,


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whoprovided information and valuable suggestions during th e earlydevelop-

ment of the manual. Special thank s go to Darlene Kriska and Barbara

Bartholomew

w ho

typed

th e

man uscript. The ir pleasant

an d

cooperative

attitude w as appreciated.

The preparation of the manualw as assisted financially, in

part,

by S . R .S.

Grant

N o.

16-P-56810, awarded

to the

Regional Rehabili tat ion R ese arch

an d

Training

Center,

RT-2, at the University of Minnesota Medical School.

Dor tha Esch,

B. S. ,

O . T . R .

Marvin

Lepley,

B. S. , O . T . R .

Universi ty ofMinnesota

October 1973

vi


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Contents

Introduction 3

The

180 System

6

The 360 System 7

Goniometers 8

General Procedures 10

Upper Extremity Measurement and Recording 14

Shoulder Flexion andExtension 15

ShoulderAbduction

an d

A dduction

16

Shoulder Rotation 17

Elbow Flexion andExtension 18

Pronation

and

Supination

19

Wrist Flexion andExtension 20

Radial

an d

Ulnar Deviation

21

Metacarpophalangeal Flexion andExtension 22

Proximal Interphalangeal FlexionandExtension 23

Distal Interphalangeal Flexion andExtension 24

Thumb Carpometacarpal Extension 25

Thumb

Metacarpophalangeal Flexion

and

Extension

26

T h u m b

Interphalangeal Flexion an dExtension 27

Abduction ofThumb 28

Optional Method:

Fingers an dThumb (Graphic Representation) 29


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Lower Extremity Measuremen t and Reco rding 32

H ip

Flexion an d

Extension

33

Alternate Method: H ipFlexion an d Extension 34

H ip

Abduction

and Addu ction 36

H ip

External

an d

Internal Rotation

37

Knee

Flexion and

Extension

38

Dorsiflexion

an d

Plantar

Flexion 39

Inversion and

Eversion

40

References 43

Index 43


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EV LU TION

OF JOINT MOTION


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Introduction

The

m e a sure m e n t

of

joint motion

is one of a

n u m b e r

of

evaluat ive proce-

dures

important

in

programs

for

rehabilitation

of the

physically handi-

capped.

Effective

rehabilitation planning requires con sideratio n

of all

aspects of

behavior ,

includingth e degree towhich an individualcanmove ,

for this influences

the

degree

to

which

he can

functionindependent ly .

The

following

are

some

of the

ways

in

wh ich physicians

an dtherapists

utilize

th e

evaluation

of

joint motion

as

part

of a

pat ient 's permanent rec-

ord: (1) Anaccurate record ofjoint motion provides informationwhich is

necessary

for

determining

th e

extent

of

d isability.

It is

important

for the

establishment ofrealistic goals, includinganestimate of the degreeof

rehabilitation that

is

feasible

for the

patient.

(2) The

joint measurem ent

record will indicate those treatment proce du res requ ired to improv e the

functional ability of the patient. It w ill also provide abasis for establish-

ing the appropriate activity level for the patient the activities whichhe

should be capable of and shouldb e expectedto perform at any given

time.

(3) Periodic measu reme nts, prope rly recorded , provide ameans of ob-

jectively

evaluatingprogress of the patient an dprovide data for evaluat-

ing the

effectiveness

of the

treatment regime. They

may

also

be an

important factor

in the

motivation

o f thepatient. (4)

Onlythrough

re -

search

can the

value

of a

therapeutic procedure

be

scientifically assessed.

If accurate and comparable measurements are available, theyca n become

th e

foundation

of meaningful studies.

The

m ost commo n methods

of

evaluating joint measurement employ

the

goniometer as the measuring

instrument.

Directions for the two most

commonsystems ofrecording th e

results

of the measurement, the 180

system and the 360 system , will be included in this manual. Indescrib-

in gm otion qu antitatively, both systems depend on the fact that along

bone is

like

a

lever rotating around

a

fulcrum.

As it

m o ve s

it

describes

the arc of acircle.

This

arc is

used

to

d e te rmine

th e

amount

of

motion

which

has occurred.

Although normal joint mobility allowsawide variety ofmo tions, standard-

ization

of the

measurement method

requires

specific definitions

of

each

motion to be evaluated. For this reason , mo vem ent as it occu rs around

an axis perpendicular to one of the three body plan es, sagit tal, coro nal,

or

transverse,

is

measured .

See

Figure 1,

In the

following list

of mo-

tions asterisks designate thosew hich, in the 360 system , are not related

to the fullcircle;an

arbitrary

startingposition has been designatedand

these motionsare calculatedas deviations from 0.


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Figure

1.

Planes ofmotion

Place

the

point

of a

toothpick

on

either

dot.

It

represents

th e coronal

axis.

The arm and thigh

flex

an d

extend

in a

sagittal

plane,,

Holding

the

toothpick

o n

one ofthese dots demon-

strates

the

sagittal axis.

Abduction and adduction

occur in the coronal

plane.

In

this

example the

toothpickrepresents

th evertical axis.

Rotation

of the

head ,

arm, leg,

or

trunk

occurs in the

hori-

zontal plane.

Motions

in a

Sagittal Plane

around

a

Coronal Axis

Shoulder: Flexion and

extension,,

Internal and external rotation.

Elbow: Flexion an dextension

W rist: Flexion and extension

Fingers:

Flexion an d extension

Hip: Flexion an dextension

Knee: Flexion

an d

extension

Ankle:

Dorsi

an dplantar flexion

Thum b: * Abduction

Motions in a Coronal Plane around a Sagittal Axis

Shoulder: Abduction an d adduction

Wrist: *Radial andulnar deviation

Thum b: * Extension

Hip:

Abduction

an daddu ction

Foot: *Eversion an d inversion

4


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Motionsin a Horizontal Plane aroundaVerticalAxis

Forearm: *Supination

and

pronation

Hip:

*

Internal an dexternal rotation

Figure

2

demonstrates motion

at the elbow

joint,,

As the

forearm moves,

th e hand

describes

the arc of acircle. Toprovide anumerical system

fo r analysis ofmotiona 0position of thecircle is arbitrarily designated.

In Figure

2 the 0

position

is

designated

at the

position

of

maximum elbow

extension, which

is the

anatomic position,

and the

hand describes

a

150

arc of

motion

as it

moves

to

maximal flexion.

Figure

2.

Motion

at the

elbow joint

The

goniometer is used tomeasure th eangle produced betweentw obony

segments when maximal motion

in a

particularplane

is

achieved.

It is a

simple device with

two

levers,

or

arms,

and

with

aprotractor

attached

at the end of one

arm.

See

Figure 5.

The

other

arm

forms

a

pointer

at the

end.

At the

center

of the

protractor, where

the two

arms join,

an

axis allows movement.

The

goniometer

is

placed

on the

extremity with

its

axis

centered

on the

joint

and its

arms aligned with designated

skele-

ta l

landmarks.

For

elbow

flexion an d

extension,

as shown in

Figure

2,

one

arm of the

goniometer would

be

aligned with

the humerus and the

other with

the

radius.

The

axis

wouldbe

located

at the

elbow joint.

The

reading on the

protractor

scale for extension

would

be 0 and the reading

for flexion wouldbe150. Theforearm has movedin asagittalplane

from

extension to flexion resulting in a total range ofmotionof 150.


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Assessment ofdisability in apatient requires that th e results ofjoint

measurement

on him be

compared with

a

n o r m .

If the

patient

has a

uni -

lateral

disability th eme asurements of his unaffected extremity shouldb e

used for comparison. Me asureme nts may also be compared to anestab-

l ished normal range ofmot ion . Inthis m anualyouwil l find th e n or ma l

limits given for each mo tion. These are onlyaverageswhichwere cal-

culated

following th e measu r emen t of a n u mber ofnormal sub jec t s .

Slight variations are found in the no rmal lim its given by various autho r-

ities.

Consequently,

it

mu s t

be

remembered that they

are not

absolute

f igures

and can

only

be

used

as a

guide

for

what

may be

normal

for any

individual. A lso to be considere d are a num ber of nonpathological factors

which may affect n ormal joint mo bility, some ofwhich are thefollowing:

(1)

hereditary an d constitutional factors; (2)sex; (3)age; (4) physical

training

and

activity;

(5 )

occupation;

(6 )

pos ture ;

(7 )

anxietyor stress.

TH E 180 SYSTEM

For the 180 system the 0position is designated as the

starting

position

of each motion . In most instances the

starting

position is co mparab le to

the anatom ic position and the halfcircle should be visualized as superim-

posed

on the

body

in the

plane

in

which motion will occ ur.

The

180 posi-

tion is

directly

overhead and the 0 position tow ard the feet. All motions

are

from

0

toward 180.

The

motions at thewristandshoulder in thesagittalplane are different

from

all others

motion

is

possible

in

both directions from

the 0

ana-

tomic position. T he

term

hyperextension is used to describe motion in a

posteriordirection from

the

starting

position.

Figure 3 shows th e normal range ofmotion of the shoulder in flexion and

extension . Shoulder flexion wo uldb e recorded as 170 an d hyperextension

as

60.

The

total range

of

motion

is

230

170 plu s 60.

6


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Figure 3. Motion of the shoulder in

flexion

an dextension (180 system)

TH E

360

SYSTEM

The360 system relatesmovements occurring in the coronal and sagittal

planes

to a

full

circle. Withthe body in

anatomic position,

the circle

may be

visualized

as

superimposed

on it in the

same plane

in

which

mo-

tionwill occur.

The 0 (360)

position will

be

overhead

and the

180

position toward

th e

feet. Thus

flexion and

abduction

are

motions toward

0 andadductionandextension are toward 360.

Certain motions (see page 5) cannot be

related

to the

full

circle for mea-

surement. Forthese motionsastartingposition isarbitrarilydesignated

an d

they

are

measured

as

deviations from

0.


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Figure

4

shows

th e

normal range

of

motion

of the

shoulder

in

flexion

an d

extension. Shoulderflexion would

be

recorded

as 10 and

extension

as

240. Thetotalrange ofmotionisthen 230

240 minus 10.

Figure4. Range of motion of the shoulder in flexion and extension (360 system)

GONIOMETERS

Goniometers are generally madeofplasticormetaland are available

from a number of hospital equipment supply companies. Theyvaryin

size

from

small pocket models

to

rather largeones.

The

advantage

of

th e small goniometer

is

that

it may be

carried

in the

pocket, which

is

convenientif you are seeing wardpatients. Thesmall goniometer is also

more satisfactory for

measuring

the

smaller

joints such

as the

fingers.

Theadvantage

of the

goniometer with longer

armsis its greater

accuracy

inmeasuring the

larger

joints suchas thehip:thelongerarmscan be

lined upwith th e body segments withmore accuracy.

Goniometers are either 180 (half

circle)

or360 (full circle). Thefull-

circlegoniometer is somewhat more convenientto usewiththe360 sys-

8


18/53

tern

because

it has the

completecirclescale

and

readings

in

excess

of

180

may betaken directly from th e scale. Half-circle goniometers pose

no

real

probleminmeasuring;on e canadaptto their use with relative

ease. Their inconveniencelies

in the

fact that

you

must

ad ddegreesif

an extremity movesbeyond 180an dalso that it mustbereversed in

some cases resulting in the scale facing th e body of

your

subject. The

goniometer must thenbe removedfromyour subject s body and reversed

so that

th e

scale

may be

read.

One very important feature to look for on a goniometer is a lockingnut

fo r th e

fulcrum.

The lockingnut is tightened just

before

removingthe

goniometer from th e body segment, assuring an accurate reading. See

Figure 5.

There are other types ofgoniometers on themarket.

Some

incorporate

fluids withafree floating bubble. Thebubble provides th e reading upon

completion

of

motion.

Figure

5.

Agoniometer in twopositions


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GeneralProcedures

The

following are the general procedures recommended

for measurement of joint motion

1.

Evaluat ion

of the

patient should

be

done

in a

roomwhich

is

warm

an d

wel l lighted. Themeasuremen t process and its purpose should be ex-

plained. During

th e

evaluation

you

should

be

alert

tosigns of

discomfort

or fat igue . Requ iringyou r subjecttomaintaina given position for a pro-

longed period wil l cause muscle fatigue which

may

result

in

decreased

motion.

2. Expose

the

extremity

to be

m easured us ing draping

when

appropria te .

3. Place the extrem ity in the proper testing pos ition. For teaching pur -

poses

this

manua l

has

specified testing positions. Actually positions vary

but

should allow freedom

of

m o ve m e nt

and

attempt

to

decrease

th e

proba-

bility ofcompen satory motion. A sprev ious ly indicated, thecalcula t ion

of

range ofmotion

(ROM)

is based onm o ve m e ntwhich

starts

with the ex-

trem ity in anatomic position or an arbitrary starting position. The pre-

ferred

testingpositions

do not

always exactly duplicate anatomic position.

For purposes ofcalculation it willbe necessary for you to visualize th e

circle superimposed

on the

extremitywith

the 0

po sition placed

as it

would

be if the extremity were in anatomic position . Figures 6 and 7

demonstrate

this

process.

4. Instruct your subje cttomovethe extremity through the desired range

o f

motion.

Besure

that

th e

extremity

is

maintained

in theproper

plane

of motion since deviations will result

in

inaccura te measurem ent .

5. When

maximum motion

is

achieved

th e

measurement should

be

taken,

using th e goniometer as follows:

The fulcrum must becentered over th e joint and thearms lined upprop-

erly on the

body

segmen ts. Reading s should be takenas quickly as

possible

to

minim ize fa t iguing

of the

patient.

The pre fe r r e d method

of

taking

a

reading

is to

have

your patient complete

th e range, watchfor subst i tut ions, an d then lineup the goniometer for

measurement .

10


20/53

Figure

6. The

360 system. Regardless

of the

testing position,

the 0

position of the

circlemust

be

located

as it would be if the

extremity

were in anatomic position.


21/53

Figure7. The180 system. Regardless of thetestingposition the

0 position must belocated as it would be if the extremity were in

anatomicposition.


22/53

Metalgoniometers should

be

pre-warmed withyourhands before placing

them in

contact

with th e

patient'sskin.

In

addition,

you

must

be careful

not

topinchthepatient's skin orcatch hair

between

the arm and the scale

as y ou use thegoniometer. It is frequently unnecessaryto hold th egoni-

ometer

in

direct contact with

the

skin.

It can be

held

a

short distance

away

without

loss ofaccuracy. Youreyes should be in a direct line with

the scale. Reading a goniometer at an angleresultsin inaccurate reading,

Thegoniometer should

be

carefully placed: fulcrum over

th e

axis

of the

joint

and the

arms centered along

th e

body

segments.

See

Figure

8. The

eye of the

person reading

th e

goniometershould

be on a

level

with the

scale

to

assure accuracy.

6.

Themeasurement may be ofpassive oractive motionan dthis should

bespecified on therecord. For various reasons these mayvary and in

manyinstances both active an dpassive motion

should

bemeasured.

Figure

8.

Placement

of the

goniometer


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Upper

Extremity Measurement

andRecording

The

following study m ethod

is

recommended:

1. In the

classroom sett ing

it is

recommen ded that subjects being mea-

sured complete

less

than normal limitsofmotion. Doingthiswill pro-

duce a more

realistic

experience, mo re

similar

to measu ring an extremity

with actual joint limitation.

2.

Study

each illustration noting goniom eter placementand the normal

limits ofmo t ion.

3. Read the instructions for testing position andgoniometer placement .

4.

Place

your subject

in the

proper

testing

position

asdescribed.

Have

him complete

th e

range

of

motion

he is

capable

of

produc ing.

5.

Place

the

goniometer

asdirectedand

carefully take

areading.

6.

En ter the readings in the spaces provid ed. Calculate the total range

of motion (ROM) an denter the figure in the space provided.

14


24/53

Shoulder Flexion

and

Extension

TESTING POSITION: Arm atside. Forearm extended. Palm

facing

body.

GONIOMETER P L A C E M E N T :

Fulcrum: Center

at the

shoulder joint just below

th e

acromion.

Arms: (1)Parallelto the

mid-axillaryline

of the trunk. (2)

Parallel

to

th e

longitudinal axis of the humerus alongth elateral

side.

Joint Measurement Record:

(180 System) Flexion.

(360 System) Flexion

Hyperextension

Extension

Total

R OM

.Total

ROM.


25/53

Shoulder Abduction and Adduction

TESTING POSITION: Arm at side. Forearm extended.

Palm

facing body.

GONIOMETER

PLACEMENT:

Fulcrum: Center

at the

shoulder joint,

posteriorly.

Arms: (1)Parallel with themidline of the body. (Longitudinal

axis

of the

vertebral

column.) (2)

Parallel

to the longitudinal axisof the humerus,

Note: It is

necessary

torotate externally at the end of the

range

to

achieve maximum abduction.

Joint

Measurement

Record:

(180 System) Abduction

(360 System) Abduction

.Adduction.

Adduction

.TotalRO M

Total

RO M

16


26/53

Shoulder Rotation

TESTING POSITION:Arm

abducted

to

90.

Elbow

flexed

to

90.

Palm

down.

GONIOMETER

P L A C E M E N T :

Fulcrum: Center

on the

elbow joint.

Arms-.

(1)Parallel to the

mid-axillary line

of the

thorax.

(2)Parallel to

the longitudinal

axis

of theulna.

JointMeasurement Record:

(180 System) Int. Rotation

(360

System) Int. Rotation

.Ext. Rotation

Ext. Rotation

Total ROM.

TotalROM


27/53

Elbow Flexion

andExtension

TESTING POSITION: Arm at side. Forearm extended andsupinated.

GONIOMETER P L A C E M E N T :

Fulcrum: Centered over lateralaspect of the

elbow

joint.

Arms:

(1)Parallel to the

longitudinal axis

of the

humerus.

(2)

Parallel

to the longitudinal axisof the

radius.


(180 System)Flexion.

(360System) Flexion.

.Extension.

Extension

.Total RO M.

Total ROM.

18


28/53

Pronationand Supination

TESTING

POSITION: A rm adducted, elbowflexed to 90, to rule out

should er rotation. Forearm midway between pronation andsupina-

tion.

GON IOM ET ER PL A C EM EN T :

Fulcrum: Centered at the

ulnar

styloid.

A r m s : (1 )

Parallel

with th e longitudinalaxis of the hu mer u s anteriorly.

2 Pronation on the dorsal surface of thewrist. Supination on

th evolar su rface of the

wrist.


(Both Systems) Pronation.

.Supination.

Total ROM .


29/53

Wrist

Flexion

and

Extension

TESTING POSITION: Arm at side

0

Elbow flexed to a comfortable position.

Palm

down.

GONIOMETER

PLACEMENT:

Fulcrum: Centeredat th eulnar styloid.

Arms: (1)Parallel to the longitudinal axis of theulna. (2)Parallel to

th e

longitudinalaxis

of the

fifth metacarpal.

Joint Measurement Record

(180 System)

Flexion

(360System) Flexion.

Extension

Extension.

.Total ROM

Total

ROM.

20


30/53

Radialand UlnarDeviation

TESTING POSITION: Arm at side. Elbow

flexed

to a

comfortable

position. Forearm pronated.

GON I OM E TE R P L A C E M E N T :

Fulcrum: Centered just proximal to the thirdmetacarpalover the

capitate.

Arms:

(1)Alongthe

midline

of the

dorsal surface

of the

forearm.

2 Parallel to the longitudinal axisof the third metacarpal.


(Both

Systems) Radial Dev

UlnarDev.

Total

RO M


31/53

MetacarpophalangealFlexion

and Extension

TESTING

POSITION: Hand in aco mfo rtable posi tion for measurement .

Wrist in a neutral position as illustrated to allow for proper place-

ment of the goniometer .

G O N I O M E T E R :

Fulcrum: Cen tered at the

metacarpophalangeal

joint.

A r m s : (1) On the dorsum of the metacarpal. (2) On the dorsum of

th eproximal phalanx.

Jo in t Me asurement Reco rd:


(360

System) Flexion.

.Extension.

.Extension.

.TotalR O M .

Total ROM.

22


32/53

Proximal

Interphalangeal Flexion

and

Extension

TESTING

POSITION:

Hand

in a

com fortable

position

fo r

measure-

me nt. W rist in a neu tral or slightly do rsiflexed position.

GON I OM E TE RP L A C E M E N T :

Fulcrum: Centered at the proximal interphalangeal joint,,

Arm s:

(1) On the

dorsal surface

of the

proximal phalanx.

(2) On the

dorsal surface

o f the

middle phalanx.

Joint Measureme nt Record :



Extension.

Extension.

.Total ROM.

TotalRO M


33/53

Distal Interphalangeal Flexion

and Extension

TESTING POSITION: Hand in a comfo rtable position fo r measure -

ment . Wris t

in a

neu tral

or

slightly dorsiflexed position.

G O N I O M E T E R P L A C E M E N T :

Fulcru m: Cen tered at the distal interphalangeal joint.

Arms: (1) On the dorsal surface of the middle phalanx,

th edorsal

surface

of thedistal

phalanx.

(2)

On



(360

System) Flexion

.Extension,

Extension

.TotalROM

Total

ROM

24


34/53

Thumb

Carpometacarpal Extension

TES TING POSITION: Hand supinated.

GONIOMETER

P L A C E M E N T :

Arms:

(1)

Along

the

volar surface

of the

third metacarpal.

(2)

Paral-

lel to the midline of the first metacarpal.


(BothSystems) Extension from

to TotalR OM


35/53

Thumb

Metacarpophalangeal

Flexion

and Extension

TESTING

POSITION:

Hand

supinated.

G O N I O M E T E R

P L A C E M E N T :

Fulcrum: Centered at the metacarpophalangeal

joint,,

A r m s : (1) On the dorsal surface of the first metacarpal. (2) On the

do rsal surface of the proximal phalanx.

Note: Mobility of the metacarpophalangeal jointof the thumbvaries,

Itsho uld fall withinth elimits specified.


.Extension.

Extension

.TotalR O M .

Total

R OM

26




36/53

Thumb

Interphalangeal Flexion

andExtension

TESTING

POSITION:

Hand

supinated.

GONIOMETER PLACEMENT:

Fulcrum: Centered

at the

interphalangeal joint.

Arms:

(1) On the

dorsalsurface

of the

proximalphalanx.

(2) On the

dorsal surface of thedistal phalanx.

Note: Thumb interphalangeal flexion an dextension vary. Flexion should

approximate90 as illustrated.



(360System) Flexion

.Extension.

.Extension.

.Total

ROM.

.Total

ROM.


37/53

Abduction

of

Thumb

TESTING POSITION: Forearm midw ay between pronation

an d

supination.

GONIOMETEPx P L A C E M E N T :

A r ms : (1 )Alongthe

lateral

surface of the second metacarpal. (2 )

Paral-

lel to the midline of thefirstmetacarpal.

Joint

Me asurement Reco rd:

(Both

Systems)

Adduction.

.Abduction.

Total ROM .

28


38/53

Optional Method: Fingers

and

Thumb

Graphic Representation)

Graphic

representation

is an

evaluative procedure which

may be

substituted for or supplemental togoniometric measurement of the

f ingers

andthumb. Becauseitresultsin apicture, it may bemore

meaningful to thepatient and mayhelp toincrease motivation.

Graphic

representation

may

also

beuseful to

healthcare team mem-

bers unfamiliar with goniometry.

It may be

used

for

flexion, exten-

sion, abduction, an d adductionof the fingers an dthumb. Theprocedure

is as

follows.


39/53

Abduction and

Add uction

1. Drawastraight line throughthe centerof an 81/2 x 11 sheetof

paper.

2. Place the hand, palm down, on thepaper,

with

th e third finger

centered

over theline.

3. Draw around each finger and the thum b in the adducted

position,,

4. Ask your subject to abduct the fingers and thum b and draw around

them

again.

Inordertorepresent abduction of the

third

finger it should

be

movedfirst in aradial

direction

andthenin an

ulnar

direction.

5.

The

patient's name

and

hospitalnumber ,

the

therapist's

name,

the

type

of

motion (passive

or

active),

and the

date should

be

recorded

on

each drawing. Left or right hand should be specified.

6.

The drawings shouldbe repeated on

separate

sheets, generally once

a week , to

record

progressor

regression.

Thesheetsmay be overlayed

an d heldup to alight sourcetoillustrate change inmotion. It is

possible

to record both abduction and adduction on a single sheet; how ever , the

overlay of

lines

becomes

confusing.

The

third

metacarpal should

bemaintained overthecenter

lineas the fingers are moved .

The middle finger should be

abducted

ulnarward andradial-

ward from

the

center line.

30


40/53

Flexion

an d

Extension

Place theulnar side of the index finger on the edge of a5 x 8

file

card.

The

card will

be at

right angles

to the

dorsal surface

of the

hand.

2.

With

the metacarpophalangeal and

interphalangeal joints

in

maxi-

mal extension, draw aroundthe finger.

3. Askyour subject to

flex

his finger an ddraw around it in

this

position.

4. Progress

will

be shownbest if the

periodic drawings

are

done

on

the

same

sheet

orcards. The use of ad ifferent colored pencilfor each

drawingis recommended.

5.

Record

th e

same information

on

each card

as was

necessary

for

abduction

an dadduction.

Maintain a 90 angle between

the

dor

sum o f the hand and the

card.

Trace

around the finger

in

th e fully extended position

and then in maximal flexion.

Theillustration shows a completed card. Lines may be

projected along the

center

line of each finger and the joint

axis indicated

if

desired.

A

goniometer

can

then

be

super-

imposed

on theline an daxis torecord degrees of

mo tion.


41/53

Lower

Extremity Measurement

and Recording

Follow

th e

recommended study methods outlined

for the

upper

extremities.

32


42/53


43/53

Alternate Method:

Hip

Flexion

and

Extension

This method of me asurem ent is sub ject to inaccuracy because of

posterior

pelvic

tilt.

As the leg

extends

so

does

th e

lumbar

spine

Therefore , one

mu s t

be as

carefu l

as

possible that motion

is confined

to the hip

joint.

This is, however, almost impossible to achieve.

Theresult is a

greater

excu rsion of exten sion, part of it hip join t,

partof it

lumbar spine.

TESTING

POSITION: For flexion -

supine;

for

extension

-

prone.

GONIOMETER PLACEMENT:

Fulcrum:

Centered

at the

greater t rochanter .

A r m s :

(1 )

Parallel

to the longitudinal

axis

of the trunk . (2)

Parallel

to the longitudinalaxis of thef e m u r .

Note.-

Onlymeasu reme nt of extension is illustrated. For flexion you r

subject is supine and the goniometer placement is the same as for ex-

tension. Maximal limits for flexion with knee extended using th e 180

system are 90 and for the 360 system 90. With the knee

flexed,

180 system 130 and360 system 50.

34


44/53

Joint

Measurement Record:

(180 System) Flexion_

(360System) Flexion_

.Extension.

Extension

.Total

ROM.

Total ROM.


45/53

Hip

Abduction

and Adduction

G O NIO ME T E R PLACEMENT:

Arms: (1)

Parallel

to a

line

drawnbetween the two

anterior superior

iliac spines- at thelevelof thegreater trochanter.

(An

alternate

methodplaces

the

goniometer

on the

line

betweenthe two

anterior

superior iliac spines.) (2 )Parallel to the lon gitudinalaxiso f the

femur .

Joint

Measurement

Record:

(180 System) Adduction.

(360 System) Adduction.

.Abduction.

.Abduction.

.TotalROM.

.TotalROM.

36


46/53

HipExternal

and

InternalRotation

TESTING

POSITION: (1)Sittingwith the knee flexed to 90. (2) Supine

with th ekneeflexed to 90.

G O N I O M E T E R PLACEMENT:

Fulcrum: Centered

on the

anterior surface

of the

knee joint.

Arms: Both

arms

are placedparallelto the longitudinal

axis

of the

tibiawith the leg in the testing position. One arm remains in

this position

and the

other follows

the

tibia

as the hip is

rotated.


(Both

Systems) Ext. Rotation

Int.

Rotation Total ROM.


47/53

Knee Flexionand Extension

G O N I O M E T E R P L A C E M E N T :

Fulcrum : Ce ntered on the lateral side of the knee joint.

Arms: (1)Parallel to the longitudinalaxis of the femur . (2 )Parallel

to the

longitudinal axis

of the

tibia.

Joint

Measurement Record:


(360System)

Flexion.

.Extension.

Extension

.TotalR O M .

.TotalROM

38


48/53

Dorsiflexion andPlantar Flexion

TESTING POSITION:

Sitting

with

the

knee flexed.

GONIOMETER

PLACEMENT:

Fulcrum: Center at the sole of the foot in

line

withthe longitudinal

axis

of thefibula.

Arms: (1)Parallel to the longitudinal axis of the fibula. (2 )Parallel

to the longitudinal axis of the

fifth metatarsal.


(180

System)Plantar Flex

Dorsiflex

Total ROM.

(360

System)

Plantar

Flex Dorsiflex Total ROM.


49/53

Inversion andEversion

TESTING POSITION: Sitting

with

the knee

flexed.

G O NIO ME T E R PLACEMENT:

A r m s : Eversion (1)Parallel to the longitudinal axis of thetibia medially.

(2)

Parallel

to theplantar

surface

of the

sole. Inversion

(1)

Parallel

to the longitudinal axis of thetibia laterally. (2 )Parallel to the

plantar

surface of the

heel.


(Both Systems) Inversion Eversion Total ROM.

4


50/53

REFERENCES ND

INDEX


51/53



52/53

References

Clayson SJ, MundaleMO,

Kottke

FJ:

Goniometer Adaptation

for

Measuring

H ip

Extension. ArchPhys

Med 47:

255, 1966.

JointMotion:

A

Method

of

Measuring

an d

Recording. Chicago,

American AcademyofOrthopaedic Surgeons, 1965.

Moore

ML in Licht: Therapeutic

Exercise,

2nd ed. revised. New

Haven ,

Elizabeth Licht,

Publisher,

1965,

pp. 128-162.

Muscle FunctionTests andMeasurements, Laboratory Manual.

Course

in Physical

Therapy, University

of

Minnesota.

Index

Abduction, 16, 21, 28, 30, 36

Adduction,

16 , 21 , 30, 36

Ankle: dorsiflexion,

39;plantar

f lexion, 39

Axes

of

motion,

4

Dorsiflexion, 39

Elbow:

extension,

18;

flexion,

18

Eversion,

40

Extension,

15, 18, 20, 22, 23, 24,

25 , 26, 27, 31,

33-35,

38

External rotation, 17,

37

Fingers:

abduction,

30;

adduction,

30;extension,

22, 23, 24, 31;

f lexion,

22, 23, 24, 31

Flexion,

15, 18, 20, 22, 23, 24, 26,

27,

31,

33-35,

38

Foot:eversion,

4 0 ;

inversion, 40 ;

pronation,

40 ;

supination

40

Forearm:pronation, 19;supina-

tion,

19

Goniometers:

types o f , 8, 9; use of ,

10, 13

Graphic Representation, 29-31

Hip:

abduction, 36; adduction, 36;

extension,

33-35;

external

rota-

tion,

37; flexion,

33-35; internal

rotation, 37;

lateral

rotation, 37;

medial rotation,37

Internal rotation,

17,37

Inversion, 40


53/53

Knee: extension, 38;flexion, 38

Lateral

rota t ion, 17 ,37

Measurement: 180

system,

6, 7;

360

system,

7,8

Medialrotation, 17,37

Planes

of motion, 4

Plantar flexion, 39

Pronation, 19,40

Radial deviation, 21

Shoulder: abduction, 16; adduction,

16;extension, 15;external

rota-

t ion, 17; flexion,

15 ;

internal

rotation, 17;

lateral rotation,

17; medial rotation,

17

Supination,

19,40

Thumb:

abduction, 28, 30; adduc-

t ion, 30;extension, 25, 26, 27 ,

31;

flexion,

26, 27, 31

Ulnar deviation, 21

Wrist : abduction, 21; adduction, 21;

extension, 20; flexion, 20 ; radial

deviation, 21;ulnar deviation, 21

Documents

Evaluation of Joint Motion by Dortha Esch