Joint Range Of Motion Flashcards
Which conditions influence structure or normal functioning of a joint?
- Bone impairment:
+ trauma, e.g. fractures leading to impairment of joint surface and osteoarthritis
+ Infections, e.g. osteomyelitis resulting in impairment of epiphysis
+Osteonecrosis, e.g. of the femur head following avascular necrosis - Impairment of joint surface e.g. rheumatoid arthritis and ankylosing starting with inflammation and pain
- Soft tissue impairment:
+ Nervous system, for instance plexus, spinal cord and peripheral damage
+ Spinal and ligament injury, e.g. sprains
+ Skin and cutaneous damage, e.g. burns
+ foreign objects/ bone block, e.g. a pin for fixation
What factors can restrict motion at a joint?
- pain
- bed rest
- habits
- age
- fashion
- ergonomics
- psychological conditions leading to shortening of soft tissue
What are the types of contractures?
- Temporary contracture:
+ full ROM cannot be achieved, but there is the potential to do so with remediation - Fixed contracture
+ totally impossible to achieve full ROM
What are some causes of contractures?
- muscular balance and imbalance: for normal voluntary movement there needs to be a balance between the primary mover, antagonistic mover and synergist mm. If one is damaged there is an imbalance, and they arise under two different circumstances:
+ partial paralysis: e.g. as a result of polio or partial spinal lesion
+ spasticity: e.g. cerebral paralysis - total paralysis: in this instance imbalance is not a factor, but rather wrong alignment due to absence of muscle power
- external factors: e.g. in chronically ill patients, immobilization in plaster of Paris or splints and scar tissue formation (synulosis)
-formation of fibrous tissue: e.g. burns
What deformities can lead to a lack in ROM
bony causes, ROM cannot be restored by means of conservative remedial measures and surgery is often the only workable alternative. e.g. severe rheumatoid arthritis and faulty union of fracture
What are the signs indicating problems in respect of joint range of motion which should be looked at during observation
- alignment and positioning of joint
- spinal column
+ is there deviation in respect of the curves or stiffness of the back - pelvis and hip
+ is there tilting of the pelvis when standing (barefoot)? Is the patient able to bring the pelvis in the middle position? - knees and ankles
+ flexion, contracture, flat-feet, bow-legs or X-legs, for amputation patient. One should look for knee and hip flexion contracture. - bedridden patients should be observed for shoulder addiction contracture (burns), elbow and wrist contracture (in case of spinal patients)
- oedema
+ swelling over or near any joint, especially if accompanied by redness, is a sign of damage of the structures of the joint itself, or surrounding structures. - spasm/spasticity
+ are there indications in the file or in the quality of movement, or abnormal positioning of limbs - contracture
+ is there any shortening or shrinkage of the skin, large scars over joints, shortened muscles? - deformity
+ is there any deformity or pseudo-arthrosis - bone block or jerky movements
+ is there resistance or total blockage during movement of the joint which is not obviously caused by a skin contracture or fixation - fashion
+ the type of carrying a case/bag, high-heeled shoes, ergonomics
how does one prepare for assessment session?
- provide pt. with concise information regarding:
- purpose of assessment
- when assessment will take place. Make arrangements concerning the time with the pt. and the ward
- how long the assessment will take. inform pt. before commencing the assessment
what are some precautions and contra-indications of ROM assessment
assessment is contra-indicated where there is:
- joint dislocation
- immediately post surgery around joint
- presence of myositis ossification/ heterotopic ossification
only assess AROM in case of:
- arthritis
- joint replacements (no PROM within first 3 months)
only assess PROM in the case of paralysis
- skin transplants done 0-2 weeks prior
in which ways is joint range assessed?
- goniometer in case of the following joints:
- shoulder
- elbow
- radio-ulnar
- wrist
- hip
- knee
- ankle
- hand chart in case of MP, PIP, DIP joints
- tape-measure in case of spinal column
considerations when measuring with goniometer
- important precondition:
- joint which is assessed should be exposed as far as possible to enable optimal movement
- first axis is positioned against axis of rotation of the joint to be assessed
- fixed arm is lined with fixated part of the limb, or suitable unmoving surface
- movable arm is lined up with moving part of limb being assessed
- reading is taken of the position at the start of the movement
- reading is taken at the end of a movement
- result is recorded on assessment form
considerations when measuring by hand chart
flexion and extension
- L-shaped pattern on stiff card or cardboard
- palm of hand must be held firmly against the edge
- outline of finger is then traced in flexion and extension of all joints
- for thumb, card is placed firmly against thenar eminence
- re-assessments are done on the same chart and indicated in different colors
adduction and abduction
- trace outline of hand with fingers in adduction
- trace outline of hand with fingers in abduction
- trace outline of middle finger in abduction
- record results
considerations when measuring with tape measure
thoraco-lumbar flexion
- starting position: standing with feet shoulder-width apart
- end position: anterior flexion of trunk
- measurement: distance between spinous process c7-s2
- normal: difference between two measurements 10cm
- lumbar flexion: 10cm above spinous process s2
thoraco-lumbar extension
- starting position: lying prone with cushion beneath pelvis
- end position: extension of trunk- support on UL
- measurement: vertical distance between supra-sternum slit and bed surface
thoraco-lumbar flexion lateral
- starting position: standing with feet shoulder width apart
- end position: lateral flexion of rump
- measurement: vertical distance between tip of middle finger and floor
guard against anterior flexion or extension of rump, hip and knee flexion or lifting of foot
PROM assessment prodecure
- client should be in a comfortable and relaxed position
- uncover the joint to be measured
- explain and demonstrate what will be done to the client
- if there is unilateral involvement, assess PROM of the unaffected side to establish the norm for that client
- establish and palpate bony landmarks for that measurement
- stabilize joints proximal to the joint being measured
- move the part passively through ROM to assess joint mobility and end-feel
- return the part to starting point
when measuring starting point: - place goniometer over and lateral to joint
- place axis over axis of joint using bony landmarks
- place stationery bar on or parallel to longitudinal axis of proximal or stationery bone and movable bar on or parallel to longitudinal axis of distal/ moving bone
- record number of starting degrees and remove goniometer
when measure PROM - hold part securely above and below the joint being measured and gently move the joint through ROM
- do not force the joint and watch for signs of pain and discomfort
- reposition goniometer and record number of degrees of final position
- remove goniometer and gently place limb in resting position
- record findings
