Range of Motion Flashcards
range of motion
Amount of motion available at a joint
anatomical position
Starting position for measurement
osteokinematics
study of movement of bones around joints – i.e. the gross movement/physiological movement
arthrokinematics
study of movement of joint surfaces/ ‘joint play’, accessory movements
goniometry
measures angles of the osteokinematic motion and not arthrokinematics
sagittal plane movements on that axis
flexion/extension
separate left to right
frontal/coronal plane movements on axis
adduction/ abduction
anterior and posterior
transverse plane movements
rotation around vertical
superior and inferior
arthrokinematics movement
slide/glide
spin
roll
slide/glide
: Translatory motion i.e. the slide of one joint surface over another
spin
Rotary motion where all points on the moving joint surface rotate at a constant distance around a fixed axis of motion (spinning top)
roll
Rotary motion (wheel rotating across surface
principles of movement convex on concave surface movement
For a convex-on-concave surface movement, the convex surface rolls and slides in opposite direction to the movement of the shaft of the bone.
principles of movement concave-convex on CONCAVE surface
For a concave-on-convex surface movement, the concave surface rolls and slides in the same direction
physiological movement
– joint movement that can occur voluntarily
accessory movement
– movement that accompanies physiological joint movement but cannot be performed voluntarily i.e. arthrokinematic motions
AROM
Active ->unassisted voluntary joint range of movement
PROM
Passive ->assisted joint movement (document ROM – whether A or P for repeatability)
close packed position
Position of maximal congruency of joint surfaces.
In this position, most ligaments and parts of capsule are taut providing an efficient & stable joint position.
accessory motions of close packed position
minimal
loose packed position
Position(s) in which ligaments and capsule are most slackened.
Potential volume of joint is at its greatest effused joints adopt this position.
accessory motions of loose packed position
maximal accessory motions Often mid-range
what influences joint ROM
Age – joint specific not in general Gender – a/a Occupation Time of day – Circadian Rhythm Temperature
Components of joint ROM assessment
quality of movement quantity presence of resistance through range pain behaviour joint sounds reactive muscle spasms Endf eel
end feel
sensation transmitted to therapists hands
indicate structure limit the movement
soft end feel structure
Soft Tissue Approximation
soft end feel example
Knee flexion (contact between posterior soft tissue of the calf and thigh
firm end feel structure
muscular stretch
capsular stretch
ligament stretch
firm end feel muscular stretch example
Hip flexion with the knee straight (passive elastic tension of the hamstring muscles)
firm end feel capsular stretch example
Extension of the metacarpophalangeal joints (tension in the anterior capsule)
firm end feel ligament stretch example
Forearm supination (tension in the palmar radioulnar ligament of the inferior radio-ulnar joint and interosseous membrane)
example of hard end feel structure
elbow extension
hard end feel example
Contact between olecranon fossa of humerus and olecranon process of ulna
abnormal soft end feels description
Occurs sooner or later in the ROM than is usual in a joint that normally has a firm or hard end-feel. Feels boggy
abnormal soft end feels examples
Soft-tissue oedema (swelling)
Synovitis
abnormal firm end feel description
Occurs sooner or later in the ROM than is usual in a joint that normally has a soft or hard end-feel
abnormal firm end feel example
Capsular, ligamentous, muscular and fascial shortening
abnormal hard end feel description
Occurs sooner or later in the ROM than is usual in a joint that normally has a soft or firm end-feel. A bony grating or bony-block is felt.
abnormal hard end feel example
Osteoarthritis (esp advanced stage)
Loose bodies in joint
Fracture
Myositis ossificans
abnormal empty end feel description
No real end-feel as pain prevents reaching end of ROM. No resistance is felt except for patient’s splinting or muscle spasm
abnormal empty end feel example
Pain limiting pathologies e.g. Fracture
Abscess
Acute bursitis
Other acute inflammation
capsular pattern
pattern of passive limitation evident when a pathological condition involves the entire joint capsule
conition where capsular pattern can be useful
Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Shoulder Adhesive Capsulitis.
non capsular pattern
variable and usually results from a condition involving structures other than joint capsule e.g. ligament, muscle or small adhesion in part of capsule.
contraindications to joint assessment
Joint dislocation (that has not been reduced) Unhealed / untreated fracture Immediately post-op to tendons, muscle, joint capsule or skin
JT assessment precautions
Infection/ inflammatory process in or close to joint Early stage of healing Analgesia or Muscle relaxants taken Bone fragility e.g. Osteoporosis Hypermobile or subluxed joint haemophilia region of a haematoma
measurement tools to quantify ROM
Inclinometer
Universal goniometer
Goniometer app
benefits of universal goniometer
Inexpensive
Reliable and valid
Easy to use in clinical setting
where is universal goniometer measured
Stationary Arm
Fulcrum
Moveable arm
