Quiz 2 Flashcards
ROM Theory and Practice
ROM amount of motion that is available at any given joint
AROM is amt of jt motion attained by voluntary jt motion
PROM is amount of jt motion attained by examiner w/o assistance from client
Why Examine ROM
Provides info regarding: muscle strength, coordination, willingness to move, ability to follow directions, level of consciousness, attention span, joint ROM,
May be limited to: muscle weakness, pain, edema, restricted jt mobility
Why Assess PROM
Provides info about - integrity of articular surfaces, extensibility of joint capsule, ligaments, muscles
Additional pts - PROM is usually slightly greater than AROM, comparison of PROM/AROM is useful esp w/ hands to determine soft tissue vs. bony vs. jt pathology
When Used w/ Other Info, ROM Data can Provide a Basis For…
Determining presence/absence of dysfunction
Establishing diagnosis
Developing treatment goals
Evaluating progress
Modifying treatment
Research effectiveness of therapy
Determining orthoses and/or adaptive equipment
General Instructions
Intro, explanation, and demonstration
Place subject in recommended test position
Have client perform AROM and observe for substitutions/quality of motion
Expose jt
Stabilize proximal jt segment if necessary and move limb through its PROM - note crepitus, examine and feel
Palpate and identify landmarks
Align goniometer w/ its axis on jt axis
Stationary arm is aligned parallel to longitudinal axis of proximal limb segment
Moving arm is aligned parallel to the longitudinal axis of distal limb segment
Read and record starting position. Remove goniometer
Stabilize proximal component
Move distal component through full AROM/PROM
Replace/realign goniometer. Palpate anatomical landmarks if necessary
Record AROM/PROM
Compared ROM to opposite side
Recording ROM
Include start and end position to define jt range
Motion that begins at 0 and ends at 150 - 0-150
Motion that begins at 20 and ends at 120 is recorded as 20-120 (some may record -20 ext)
If hyperext occurs, - 20-0-150
If jt doesn’t need to be measured w/ device, ROM may be recorded as full, WFLs, WNLs
Every space on ROM form should have notation
Use NT if not tested
Usually, PROM is recorded before AROM (even though active range is examined first) - knee flex = 0-120/10-95
Reliability
Depends on jt - Intertester always lower than intratester reliability, hinge jts (knee/elbow) more reliable than multiaxis jts, such as shoulder/ankle
Depends on motion - shoulder flex/abd > ext, ankle DF/PF > inversion/eversion
Depends on test position - SLR changes w/ opp. leg position, shoulder range in sitting vs. supine
To Improve Reliability
Standardize positions
Stabilize proximal body parts
Use bony landmarks to align goniometer
Use same examiner (intratester)
Factors Affecting ROM
Pathological conditions such as pain and inflammation
Fear
Age - infants/young children vs. adults vs. older adults
Gender
Precautions for ROM
Infection or inflammatory process in jt
Meds for muscle rxn and pain
Osteoporosis (esp. PROM)
Jt hypermobility
Pain
Hemophilia
Jt in region of hematoma
Immediately after an injury where disruption of soft tissue, tendon, muscle, ligament is suspected
Cervical pain
Probable Contraindications for ROM
Region of dislocation or unhealed fracture
Immediately following surgical procedures to tendon, ligament, muscle, jt capsule
Myositis ossificans
Normal/Physiological End Feels
Soft - soft tissue approx. (knee flex, elbow flex)
Firm - muscular stretch, capsular stretch, ligamentous stretch (SLR, MCP ext, forearm supination)
Hard - bone contacting bone (elbow ext)
Abnormal/Pathological End Feels
Soft: occurs sooner/later in range than usual or in jt that normally has firm/hard end feel - feels boggy (swelling - jt effusion)
Firm: occurs sooner/later in range than usual or in jt that normally has soft/hard end feel (capsule tightness, ligamentous shortening)
Hard: occurs sooner or later in range than usual or in joint that normally has soft or firm end feel. Bony grating or bony block is felt (fracture, OA, osteophytes)
Empty: no real end feel b/c pain prevents reaching end of range. No resistance is felt except for muscle guard or spasm (acute bursitis, neoplasm, fracture, hysteria)
Capsular vs. Non-Capsular Patterns
Analyze pattern of jt range limitation
Particular capsular patterns exist for each jt to indicate jt capsule involvement (pattern specific to anatomy of specific capsule - causes include arthritis, prolonged immobilization, acute trauma w/ effusion)
When limitations don’t follow capsular patterns, then limitation can be considered non-capsular pattern. May be due to ligamentous adhesions, internal derangement (fragments in jts), extra-articular limitation (contractures)
Capsular Pattern Differences - Hip
Need to go in specific ordered
Marked restriction in IR
Limitations in flex and abd
May be slight in ext
No limitations in ER or ADD
Capsular Pattern Differences - Shoulder
Marked restriction in ER
Limitation in ABD
May be slight limitation in IR
Muscle Length Testing
To determine if range of muscle length is normal, excessive, limited
Muscles w/ limited length are usually strong, promoting lengthening of opposing muscles
Muscles w/ excessive length are usually weak, allowing for adaptive shortening of opposing muscle
Muscle Imbalance
Can lead to: injury, faulty posture, abnormal mvt patterns
Pain on shortened/lengthened side
Dominant vs. non-dominant
Left side greater than right
Quality vs. Quantity
Assess quality of mvt - substitutions may be occurring
Total range may be WNLs but disproportionate amt of mobility may be arising from one structure, thus leading to abnormal stress (gastroc, hamstrings)
Range of Jt Measurement
of degrees in motion present in jt
Range of Muscle Length
of degrees of motion in muscle
May be measured w/ tape measure
One Joint Muscles
Muscle length = jt range
