04-08: Goniometry of Shoulder, Elbow, and Forearm

Question 1

End Feels - Elbow

Answer 1

Elbow Flexion - Soft
Elbow Extension - Hard
Forearm Supination - Firm
Forearm Pronation - Soft

Question 2

Elbow Flexion

Answer 2

ROM: 0˚-145˚
Pt: Supine
Axis: Lateral Epicondyle
SA: Lateral midline of humerus toward acromion
MA: Lateral radius midline toward radial styloid
ST: Distal humerus; maybe shoulder

• Towel fold under distal humerus to keep it level with glenoid fossa

Question 3

Elbow Extension

Answer 3

ROM: 0˚ ( > 0˚ is hyperextension and should be noted)
Pt: Supine
Axis: Lateral Epicondyle
SA: Lateral midline of humerus toward acromion
MA: Lateral radius midline toward radial styloid
ST: Distal humerus; maybe shoulder

• Towel fold under distal humerus to keep it level with glenoid fossa
• Document as “lacking ____ extension”

Question 4

Forearm Supination

Answer 4

ROM: 0˚-90˚
Pt: Sitting
Axis: Medial to ulnar styloid process
SA: Ventral wrist, parallel to humeral shaft, protractor part of goni away from wrist
MA: Palmar surface of forearm, proximal and parallel to radial and ulnar styloid processes
ST: humerus

• Avoid shoulder ADD/ER
• Avoid ipsilateral flexion ot trunk

Question 5

Forearm Pronation

Answer 5

ROM: 0˚-90˚
Pt: Sitting
Axis: Lateral to ulnar styloid process
SA: Dorsal wrist, parallel to humeral shaft, protractor part of goni away from wrist
MA: Dorsal surface of forearm, proximal and parallel to radial and ulnar styloid processes
ST: humerus

• Avoid shoulder ABD/IR
• Avoid contralateral lateral flexion of trunk

Question 6

End Feels - Shoulder

Answer 6

All positions - Firm

Question 7

Shoulder Flexion

Answer 7

ROM: 0˚-180˚
Pt: Supine, hips and knees flexed
Axis: Acromion process through head of humerus
SA: Midline of trunk toward greater trochanter
MA: Lateral midline of humerus toward lateral epicondyle at beginning of ROM/medial epicondyle at end of ROM
ST: scapula

• Avoid GH jt ABD, elevation of scapula
• Allow medial rotation of GH at 90˚
• Allow clavicular/scapular motion after 30˚ flexion

Question 8

Shoulder Extension

Answer 8

ROM: 0˚-50˚
Pt: Prone, elbow slightly flexed, forearm pronated
Axis: Slightly inferior to acromion in line with head of humerus
SA: Midline of trunk toward greater trochanter
MA: Lateral midline of humerus toward lateral epicondyle
ST: scapula

• Avoid GH jt ABD, scapular ADD

Question 9

Shoulder Abduction

Answer 9

ROM: 0˚-180˚
Pt: Supine, hips and knees flexed
Axis: Ant portion of acromion process through center of head of humerus
SA: Lateral ant surface of trunk, parallel with midline of sternum
MA: Anterior Arm, parallel to midline of humerus toward medial epicondyle
ST: thorax and scapula

• Avoid spine flexion toward contralateral side
• Avoid elevation of scapula
• Allow lateral rotation of humerus at 90˚

Question 10

Shoulder Adduction

Answer 10

ROM: 0˚-180˚
Pt: Supine, hips and knees flexed
Axis: Ant portion of acromion process through center of head of humerus
SA: Lateral ant surface of trunk, parallel with midline of sternum
MA: Anterior Arm, parallel to midline of humerus toward medial epicondyle
ST: thorax and scapula

• Avoid spine flexion toward contralateral side
• Avoid elevation of scapula
• Allow lateral rotation of humerus at 90˚

Question 11

Shoulder Internal Rotation

Answer 11

ROM: 0˚-70˚
Pt: Supine, hips and knees flexed, shoulder ABD and elbow flexed 90˚, forearm neutral
Axis: Olecranon process toward humeral head
SA: Parallel with table or perpendicular to floor
MA: Along ulnar shaft to ulnar styloid process
ST: Distal humerus through ROM, scapula/thorax at end of ROM

• Keep shoulder ABD 90˚ to keep axis aligned
• Avoid flexion/extension at GH
• Avoid verterba flexion
• Avoid elbow extension

Question 12

Shoulder External Rotation

Answer 12

ROM: 0˚-90˚
Pt: Supine, hips and knees flexed, shoulder ABD and elbow flexed 90˚, forearm neutral
Axis: Olecranon process toward humeral head
SA: Parallel with table or perpendicular to floor
MA: Along ulnar shaft to ulnar styloid process
ST: Distal humerus through ROM, scapula/thorax at end of ROM

• Keep shoulder ABD 90˚ to keep axis aligned
• Avoid flexion/extension, ABD, ADD at GH
• Avoid verterba extension
• Avoid elbow extension

Question 13

Shoulder Horizontal ABD

Answer 13

ROM: 0˚-120˚ from neutral
Pt: Short sitting, shoulder/elbow flexed 90˚, shoulder rotation neutral (add 90˚ to measure)
Axis: Superiorly on acromion, through head of humerus
SA: midline of shoulder toward neck
MA: midline of humerus toward lateral epicondyle
ST: scapula and thorax

Question 14

Shoulder Horizontal ADD

Answer 14

ROM: 0˚-30˚
Pt: Short sitting, shoulder/elbow flexed 90˚, shoulder rotation neutral (add 90˚ to measure)
Axis: Superiorly on acromion, through head of humerus
SA: midline of shoulder toward neck
MA: midline of humerus toward lateral epicondyle
ST: scapula and thorax