Goniometry

Question 1

What do you do first?

Answer 1

Introduce yourself to the client, who you are, what you are, what you’re going to do, and why.
Explain what the goniometer is, especially to kids.
Have the client remove appropriate clothes and jewelry.
Demonstrate the motion.
Perform the test.

Question 2

Goniometry basics

Answer 2

1. You must know the expected ROM of the joint you are measuring.
2. Recognize end feel.
3. Know your landmarks.
   - Think about the axis of motion. This is where you line up the fulcrum of the goniometer.
4. Decide what is appropriate to measure, AROM, PROM, or both.
5. Reliability of goniometry
   - 4-5º difference by you
   - 5-6º difference between different OTs

Question 3

Recording the measurements

Answer 3

Always put
- patient’s name
- right or left
- joint being measured
- start position if not standard
- pain, crepitus
- any deviation from normal testing

Best to do start to finish
- shoulder flexion: 0-160º
- shoulder motion: 50-0-160

Question 4

Hypermobility

Answer 4

Motion more than normal
EX: in the elbow
If the patient has hyperextension of 20º and full elbow flexion of 150º
- Full elbow motion: 20-0-150
- Elbow extension/flexion: +20/150
- Elbow flexion: 0/150
- Elbow extension: 150 + 20 = 170* (rarely used)

Question 5

Factors that might affect AROM

Answer 5

Age
- increased AROM from birth to 2 years
- decreases after 70 year by 10º; tends to decrease based on function, could happen as early as 50 years
Gender
- females tend to have slightly more AROM than males
- pregnant women have even greater AROM
Activity

Compare to other side
Does is affect function?
- WNL (within normal limits): can’t do what they want
- WFL (within functional limits): can do what they want even if not in expected ROM

Question 6

Hypermobility

Answer 6

Hypermobility is not a problem if hyperstability accompanies it.
hyperstability comes from core strength.
Hypermobility is a problem when it is not stable and if it causes pain.

Question 7

Hypermobility Test

Answer 7

Beighton Hypermobility Scale
1. Can you put both hands flat on the floor with your knees straight?
yes =1 no=0
2. Can you bend your elbow backwards
Right =1 left =1
3. Can you bend your knee backwards
Right =1 left =1
4. Can you bend your thumb back on to the side of your forearm
Right -1 left =1
5. Can you bend your little finger back to 90 degrees of the back of your hand
Right =1 left =1
Max score of 9

Question 8

Manual muscle testing

Answer 8

Typically, MMT measures the strength of a muscle group, not an individual muscle
- For example, we test elbow flexion, it is difficult to complete isolate, biceps brachi, brachioradialis and brachialis so we test elbow flexors

MMT should only be done on individuals who have normal tone
- Those with CNS disorders or spasticity are not appropriate

Reliability
You and another tester should not be off by more than ½ a muscle grade

Question 9

Why do we use MMT?

Answer 9

1. To set a baseline
2. As an aid with muscle transfer surgery, a muscle should be at 4 before a transfer is performed.
   - It will lose at least one muscle grade following transfer
3. To determine the functional skills of a client
   - A client with 3 shoulder flexion, could not possibly lift a 20# box
4. Help determine a diagnosis
   - Nerve root problem or peripheral
5. determine the need for a splint or device
   - A client with 1 wrist extension would need a splint to prevent over stretching the extensors
6. Determine and grade a client’s progress or plateau

Question 10

General principle of MMT

Answer 10

You must understand the anatomy and function of the muscle group you are testing.
Eliminate any substitution pattern.
Be consistent with resistance.
Know where to palpate.
Give careful directions.
Typically have patient move through motion one time first.
Follow standard protocol, do not invent your own.
Practice with various types of people.
Resistance is always applied at right angles to the long axis of the segment.
The resistance is opposite to that of the contracting muscle.
If possible, never cross a joint. If testing shoulder flexion, apply resistance to distal humerus.

Question 11

Procedure for MMT

Answer 11

Place the client in the correct position (based on the standard protocol).
- If they are can’t make note
Expose the body part to be examined so you can see and feel (palpate the muscle).
Explain the test.
Stabilize proximal structures as appropriate.
Perform the test.
- You should always palpate
- Avoids substitution patterns, you should be able to feel the contraction
- Apply resistance in correct position
* The position is at the distal end of the segment, do not cross an intervening joint
* Be careful not to fatigue the client
* Smooth and firm
Record the score
Develop plan