Goniometry: Joint Range of Motion

Question 1

Goniometry

Answer 1

• gonia=angle
• metron=measure
• identify total motion available at a joint
• measuring: ROM at joint, and end ROM
• how many degrees away from anatomical position
• bilateral comparison is important
• reliability: repeatable and consistent
• validity: does it measure what you’re seeking?

Question 2

Standardized Techniques

Answer 2

• goniometry better than visual estimation
• standardized techniques increases reliability (consistency) of measurements
• 0 to 180 degree system
• anatomical position is 0 degrees (fully extended)
• measure how many degrees moved away from 0

Question 3

Purpose of Goniometry

Answer 3

• to develop treatment goals
• to evaluate progress or lack of progress
• to modify treatments
• to motivate patients
• to research effectiveness of intervention
• to increase safety
• to justify services

Question 4

AROM vs. PROM

Answer 4

• AROM: no assistance from examiner, provides information regarding muscle strength and coordination as well as functional ability; “performance”
• PROM: without assistance from patient, usually greater than AROM, provides info regarding integrity of joint surfaces, joint capsular, ligaments, and muscles; “capacity”
• want to narrow gap between “performance” and “capacity”

Question 5

End Feel

Answer 5

• characteristic feel to resistance encountered at end of normal ROM
• bony: bony approximation, bone limits motion
• capsular (FIRM): capsule/ligaments limit motion; slight give as capsule is stretched, think of a leather strap
• muscular: muscular tension reached; firm but more yielding than capsular, think muscle length limits from going farther
• soft tissue: tissue approximation, think big belly getting in way of IR
• empty: pain limitations

Question 6

Normal or Physiological vs. Abnormal or Pathological End Feels

Answer 6

• normal: hard: bony (bone on bone); firm: capsular (firm with slight yielding stop or tissue stretch firm with slightly yielding stop); soft: soft tissue approximation
• abnormal: springy (stop and rebound); muscle spasm (sudden/abrupt/painful); empty (no mechanical restriction but painful restriction)

Question 7

End Feel Examples

Answer 7

• hard: elbow extension
• firm (capsular): hip medial rotation
• muscular: knee extension with hip flexion
• soft tissue: knee flexion
• empty: bursitis, tumor

Question 8

Joint and Muscle Requirements for ROM

Answer 8

• full ROM dependent upon: joint ROM (osteokinematics), and muscle length
• osteokinematics: bony structure, connective tissue, joint capsule, ligaments, arthrokinematic motion, etc
• muscle length: ability of muscle to lengthen allowing joints to move throughout associated ROMs, single joint muscle: ROM and muscle length equal, multi joint muscle: mm length less than sum of joint ROM

Question 9

Arthrokinematics

Answer 9

• roll: rotary movement, one object (bone) rolling on another
• glide: translatory movement, sliding of one object (joint surface) over another
• spin: rotary movement, one body (bone on bone) spinning on another
• study pictures in notes

Question 10

Convex-Concave Rule

Answer 10

• when a concave surface moves on convex the direction of joint glide is in same direction as physiologic motion
• convex surface moves on concave surface, direction of joint glide is in opposite direction of physiologic motion

Question 11

Description and Types

Answer 11

• body: resembles protractor
• stationary arm: attached to body
• moving arm: moves independently of body; aligned with moving body part
• types: sizes vary according to body part being measured

Question 12

Techniques and Procedures: Knowledge

Answer 12

• recommeded testing positions and alternate positions
• demonstrate PROM or position
• stabilization requirement
• joint structure and function
• normal end feel with PROM
• palpation of anatomical bone or structure
• alignment of goniometer

Question 13

Techniques and Procedures: Skill

Answer 13

• position and stabilize correctly
• move a part through appropriate PROM
• determine end feel
• palpate appropriate structures
• align measuring instrument with landmarks
• perform motion
• read instrument
• record measurements

Question 14

Techniques and Procedures: Positioning

Answer 14

• place joint in 0 degrees to start
• position so proximal joint component are stabilized (often by gravity)
• palpate necessary bony landmarks
• joint should be positioned to permit unobstructed ROM
• may require manual stabilization by examiner
• reduces influence of substitution of other muscle groups to produce movement or other joints to provide or allow intended motion

Question 15

techniques and Procedures: Alignment

Answer 15

• anatomical landmarks can be marked for consistency
• stationary arm=proximal arm
• moving arm=distal arm
• fulcrum=center of body, place over joint axis
• alignment of axis of motion is less important than alignment of two arms

Question 16

Documenting ROM

Answer 16

• single motion recording (end ROM)
• book: should record begining joint position
• clinically: endpoint of motion in some settings ex: knee (0-10)
• SFTR: 3 number sequence, extreme of one motion, starting position, extreme of opposite position ex: knee 10/0/140

Question 17

Interpreting Results

Answer 17

• end feel
• capsular pattern: restriction of motion results when impaired flexibility of capsule fibers
• pattern: most to least limited
• ex: capsular involvement of shoulder suspected if ROM limitations (percentage) was most limited in LR, followed by abduction, and least MR (may not be limited at all)

Question 18

What factors can affect goniometric measurements? Common mistakes?

Answer 18

• inflammation, pain

- not realigning, reading wrong scale