Peripheral Joint ROM Measurements

Question 1

What is the purpose of the technique i.e. what are you measuring and why?

Answer 1

Measuring the total RoM of a joint during an active movement

Track progression of a programme

Check for impairment of movement

Question 2

How do you know whether the measurement is normal?

Answer 2

Compare to an unaffected limb or normative data

Question 3

What principles are used in carrying out (application) the technique?

Answer 3

1) Explain procedure & informed consent
2) The goniometer axis is placed over the axis of movement of a joint whilst the fixed (stationary) arm and moveable arm are alignedwith specific body landmarks for that joint.
3) The joint can then be moved to its limit and the ‘range’ measured.
4) Measurements are taken three times, same clinician and an average reading is calculated.
5) Check patient for adverse effects & doccument

Question 4

What structures/processes are being assessed?

Answer 4

Joint RoM
Tissues surrounding joint
Pain
Restriction of movement

Question 5

Precautions
/ contraindications

Answer 5

Fracture (new/unhealed)
Joint dislocation/subluxation
Ectopic Ossification
Myositis Ossificans
Joint infection
Joint Inflammation
Uncontrolled/excessive pain
Hypermobility
Haemophilia
Recent/acute soft tissue injury
Bony ankylosis
Fragile bone conditions
Cancer
In the region of a haematoma

Are you feeling well in yourself?
Do you have any known injuries to this joint / pain?
Any fractures/dislocations?
Bone conditions?
Hypermobile?

Question 6

What should be documented?

Answer 6

Date, Time, Patient name
Explanation of procedure & gaining informed consent
The joint movement that was measured
Landmarks used for measurement
Average values for measurement of affected and non-affected joint
Adverse affects?
Sign

Question 7

How do you measure the RoM for Hip Extension

Answer 7

Start Position: Patient in prone. Hip and knee in neutral. The feet are over the end of the plinth.
Goniometer Axis: Axis placed over the greater trochanter of the femur.
Stationary Arm: Parallel to the mid-axillary line of the trunk
Moveable Arm: Parallel to the longitudinal axis of the femur, pointing towards the lateral epicondyle.
Command to Patient: ‘Lift your leg backwards as far as you can’
End Position: Hip extended to the limit of motion.
Trick Movements: Extension of the lumbar spine.

Question 8

How do you measure the RoM for Hip Internal & External Rotation

Answer 8

Start Position: Patient sitting. Hip is in 90º flexion and neural rotation with the knee flexed to 90º. Opposite hip is abducted and the foot is supported on a stool.
Goniometer Axis: Axis placed over midpoint of the patella.
Stationary Arm: Perpendicular to the floor.
Moveable Arm: Parallel to the anterior midline of the tibia.
Command to Patient: ‘Turn your leg and foot in/out as far as you can’
End Position:
Internal Rotation - the hip is internally rotated to the limit of motion, so that the leg and foot move in a lateral direction.
External Rotation - the hip is externally rotated to the limit of motion, so that the leg and foot move in a medial direction

Question 8

How do you measure the RoM for Hip Flexion

Answer 8

Start Position: Patient supine. Hip and knee are in the neutral position.
Goniometer Axis: Axis is over the greater trochanter of the femur
Stationary Arm: Parallel to the mid-axillary line of the trunk.
Moveable Arm: Parallel to the longitudinal axis of the femur, pointing towards the lateral epicondyle.
Command to Patient:
‘Bend your knee up towards your chest as far as you can,
sliding your heel up the plinth’
End Position: The hip is flexed to the limit of motion
Trick Movements: Flexion of the lumbar spine

Question 9

How do you measure the RoM for Hip Abduction

Answer 9

Start Position: Patient supine. Ensure the pelvis is level.
Goniometer Axis: Over the anterior superior iliac spine (ASIS) on the side of the hip being measured.
Stationary Arm: Along a line between the two ASIS’s.
Moveable Arm: Parallel to the longitudinal axis of the femur
Command to Patient: ‘Take your leg out sideways as far as you can, keep your toes pointing to the ceiling’
End Position: Hip is abducted to the limit of motion.
Trick Movements: External rotation of the hip

Question 10

How do you measure the RoM for Ankle Dorsiflexion/ Plantarflexion

Answer 10

Start Position: Supine, knee flexed to 20° - 30º, foot in neutral - 0°.
Goniometer Axis: Axis is placed 1.5cm below lateral malleolus.
Stationary Arm: Parallel to the longitudinal axis of the fibula.
Moveable Arm: Parallel to the longitudinal axis of the 5th metatarsal
Command to Patient: ‘Bend your foot up/push your foot down as far as you can’
End Position: Ankle is dorsiflexed to the limit of motion.
Ankle is plantarflexed to the limit of motion

Question 11

How do you measure the RoM for Foot Inversion and Eversion

Answer 11

Start Position: Supine, roll placed under knee. Ankle in neutral. A piece of paper is placed under the foot. A book is placed against the sole of the foot.
A line is drawn parallel to the book.
Command to Patient: ‘Turn your foot in/out as far as you can’
End Position: Foot placed in inversion, Book placed against full sole of foot and a line drawn parallel to book.
Process repeated for eversion.

Question 12

How do you measure the RoM for Knee Flexion - Extension

Answer 12

Start Position: Supine. Hip in neutral, knee in extension.
Goniometer Axis: Axis placed over the lateral epicondyle of femur.
Stationary Arm: Parallel to the longitudinal axis of the femur, pointing towards the greater trochanter.
Moveable Arm: Parallel to the longitudinal axis of the fibula, pointing towards the lateral malleolus.
Command to Patient: ‘Bend you knee / Straighten your leg as much as possible’
End Position: Hip and knee flexed to limit of motion. The heel is moved towards the buttock to the limit of knee flexion.

Question 13

How do you measure the RoM for Shoulder Flexion

Answer 13

Start Position: Patient in crook lying (or sitting). Arm at the side, palm facing medially.
Goniometer Axis: Axis placed at the lateral aspect of the centre of the humeral head, approximately 2.5 cm inferior to the lateral aspect of the acromial process.
Stationary Arm: Parallel to the midline of the trunk.
Moveable Arm: Parallel to the longitudinal axis of the humerus, pointing towards the lateral epicondyle of the humerus.
Command to Patient: ‘Keeping your elbow straight, move your arm forwards and upwards as far as you can’
End Position: The humerus is moved in an anterior direction to the limit of motion.
Trick Movements: Extension of the trunk

Question 14

How do you measure the RoM for Shoulder Extension

Answer 14

Start Position: Patient is in prone (or sitting). Arm at the side, palm facing medially.
Goniometer Axis: Axis placed at the lateral aspect of the centre of the humeral head, approximately 2.5 cm inferior to the lateral aspect of the acromial process.
Stationary Arm: Parallel to the lateral midline of the trunk.
Moveable Arm: Parallel to the longitudinal axis of the humerus, pointing towards the lateral epicondyle of the humerus.
Command to Patient: ‘Keeping your elbow straight, move your arm backwards as far as you can’
End Position: The humerus moves posteriorly to the limit of motion.
Trick Movements: Scapular anterior tilting, elevation and should abduction. The patient may flex the trunk.

Question 15

How do you measure the RoM for Shoulder Abduction

Answer 15

Start Position: Patient in supine (or sitting). Arm is at the side in abduction and external rotation.
Goniometer Axis: Axis is placed at the midpoint of the anterior aspect of theglenohumeral joint, approximately 1.3 cm inferior and lateral to the coracoid process.
Stationary Arm: Parallel to the sternum.
Moveable Arm: Parallel to the longitudinal axis of the humerus.
Command to Patient: ‘Move your arm outwards and upwards towards your head as far as you can, keeping your palm facing the same way’
End Position: The humerus moves laterally to the limit of motion.
Trick Movements: Contralateral trunk side flexion, scapular elevation, and should flexion.

Question 16

How do you measure the RoM for Shoulder Medial Rotation

Answer 16

Start Position: Supine lying. Shoulder in 90° of abduction, elbow flexed to 90° and the forearm pronated.
Goniometer Axis: Axis placed on the olecranon process of the ulna
Stationary Arm: Perpendicular to the floor
Moveable Arm: Parallel to the longitudinal axis of the ulna, pointing towards the ulna styloid process
Command to Patient: ‘Move your palm downwards towards the floor’
End Position: Palm of the hand is moved towards the floor to the limit of medial rotation
Trick Movements: Elbow extension, scapular elevation and abduction

Question 17

How do you measure the RoM for Shoulder Lateral Rotation

Answer 17

Start Position: Patient in supine. The shoulder is in 90º of abduction, the elbow is flexed to 90°, forearm in pronation. A towel is placed under the humerus to achieve abduction.
Goniometer Axis: Axis placed on the olecranon process of the ulna
Stationary Arm: Perpendicular to the floor
Moveable Arm: Parallel to the longitudinal axis of the ulna, pointing towards the ulna styloid process
Command to Patient: ‘Move your hand backwards towards the plinth’
End Position: Dorsum of hand is moved towards the floor to the limit of lateral rotation
Trick Movements: Elbow extension, scapular depression, and adduction.

Question 18

How do you measure the RoM for Elbow Flexion - Extension

Answer 18

Start Position: Patient in supine. The arm is in the anatomical position with the elbow in extension (0º).
Goniometer Axis: Axis is placed over the lateral epicondyle of the humerus.
Stationary Arm: Parallel to the longitudinal axis of the humerus, pointing towards the tip of the acromion process.
Moveable Arm: Parallel to the longitudinal axis of the radius, pointing towards the styloid process of the radius.
Command to Patient: ‘Bend/straighten your elbow as far as you can’
End Position: The forearm is moved in an anterior direction so that the hand approximates the shoulder.

Question 19

How do you measure the RoM for Forearm– Supination/Pronation

Answer 19

Start Position: Patient in sitting. Shoulder is adducted, elbow flexed to 90° with forearm in mid-position. A pencil is held in the tightly closed fist, with the pencil protruding from the radial aspect of the hand.
Goniometer Axis: The axis is placed over the head of the third metacarpal.
Stationary Arm: Perpendicular to the floor
Moveable Arm: Parallel to the pencil
Command to Patient: ‘Twist your arm as far as you can in each direction, turning the pencil towards the floor’
End Position: The forearm is rotated externally from mid-position so the palm faces upwards (supination).
The forearm is rotated internally so the palm faces
downwards (pronation)
Trick Movements: Altered grip / wrist movements, shoulder movements

Question 20

How do you measure the RoM for Wrist Flexion and Extension

Answer 20

Start Position: Patient is sitting – forearm resting on a table, in pronation – wrist in neutral position. The hand is over the end of the table
Goniometer Axis: At the level of the ulnar styloid process
Stationary Arm: Parallel to the long axis of the ulna.
Moveable Arm: Parallel to the long axis of the 5th metacarpal
Command to Patient: ‘Move your hand downwards/upwards as far as you can’
End Position: Wrist is flexed or extended to limit of motion
Trick Movements: Ensure that no wrist deviation occurs as the hand is flexed and extended.

Question 21

How do you measure the RoM for Wrist Ulnar and Radial Deviation

Answer 21

Start Position: Patient is sitting, forearm pronated, and hand resting on a table.
Goniometer Axis: Axis is placed on the dorsal aspect of the wrist over the capitate.
Stationary Arm: Along the midline of the forearm
Moveable Arm: Parallel to the long axis of the shaft of the 3rd metacarpal
Command to Patient: ‘Move your hand in/out as far as you can’
End Position: Hand is moved to the limit of radial/ulna deviation
Trick Movements: Ensure that the wrist is not moved into flexion or extension as the patient adducts/ abducts to each side

Question 22

How do you measure the RoM for Finger Metacarpophalangeal Flexion

Answer 22

Start Position: Patient is sitting, forearm resting on a table, elbow is flexed, wrist slightly extended. MCP joint being measured is in 0º extension
Goniometer Axis: Dorsal aspect of joint being measured, lateral aspect of the metacarpal (index or 5th finger).
Stationary Arm: Parallel to the longitudinal axis of the shaft of the metacarpal
Moveable Arm: Parallel to the longitudinal axis of the proximal phalanx
Command to Patient: ‘Bend your finger as far as you can’
End Position: MCP joint is flexed to the limit of motion
Notes: During the movement the proximal interphalangeal joint is allowed to flex and the distal interphalangeal joint remains in extension

Question 23

How do you measure the RoM for Finger Metacarpophalangeal Abduction

Answer 23

Start Position: The patient is sitting, elbow flexed to 90º, forearm pronate and resting on a table, wrist in neutral and fingers in the anatomical position.
Goniometer Axis: Dorsal surface of the MCP joint being measured
Stationary Arm: Parallel to the long axis of the shaft of the metacarpal
Moveable Arm: Parallel to the long axis of the proximal phalanx
Command to Patient: ‘Spread your fingers apart’
End Position: The finger is moved away from the mid-line

Alternate method:
The patient spreads his/her hand out on a page.
The therapist draws round the hand.
The patient removes their hand.
The therapist records the linear measurement between the mid-point of each finger

Question 24

How do you measure the RoM for Finger Interphalangeal Flexion/Extension

Answer 24

Start Position: Patient in sitting, forearm resting on a table in mid-position or pronated, wrist and fingers in anatomical position (0º extension at MCP and IP joints).
Goniometer Axis: Dorsal surface of joint being measured (lateral surface of first phalanx).
Stationary Arm:
- PIP: parallel to the longitudinal axis of the proximal phalanx.
- DIP: parallel to the longitudinal axis of the middle phalanx.
Moveable Arm:
- PIP: parallel to the longitudinal axis of the middle phalanx.
- DIP: parallel to the longitudinal axis of the distal phalanx.
Command to Patient: ‘Bend your finger as far as you can’
End Position: Limits of motion

Question 25

How do you measure the RoM for Thumb Carpometacarpal Joint (CMC) – Abduction

Answer 25

Start Position: Patient sitting. Elbow flexed, forearm in mid-position – resting on a table. Wrist in anatomical position and the thumb maintains contact with the metacarpal of the index finger
Goniometer Axis: The axis is placed at the junction of the bases of the first and second metacarpal
Stationary Arm: Parallel to the longitudinal axis of the second metacarpal
Moveable Arm: Parallel to the longitudinal axis of the first metacarpal. In the start position this will indicate 15 - 20º. Record as 0º
Command to Patient: ‘Take your thumb out to the side as far as you can’
End Position: The thumb is abducted (70º).

Question 26

How do you measure the RoM for Thumb Carpometacarpal Joint (CMC) – Flexion/ Extension

Answer 26

Start Position: Patient sitting. Elbow flexed, forearm in mid-position, resting on a table.
Goniometer Axis: The axis is placed over the CMC joint
Stationary Arm: Parallel to the longitudinal axis of the radius
Moveable Arm: Parallel to the longitudinal axis of the thumb metacarpal
Command to Patient: ‘Take thumb downwards / Lift thumb upwards as far as you can’
End Position:
Flexion – thumb if flexed across palm (15º).
Extension – thumb is extended away from the palm (20º)