ROM Assessment

Question 1

The most common tools to measure joint motion include: Visual Exam/Screen, goniometers, inclinometers, and phone apps

Answer 1

Got it

Question 2

All tools are used to document AROM and/or PROM to determine impairment, set goals, get reimbursed for services, and assess effects of treatment

Answer 2

Got it

Question 3

One of the ways we can make our goals for the patient more objective is if we have (subjective/objective) measurements of their ROM.

Answer 3

objective

Question 4

ROM measurements can be used to show the insurance company that the patient is getting better.

Answer 4

Roger that

Question 5

If the patients ROM is getting better the treatment is working.

Answer 5

Got it

Question 6

If you can’t put a patient in a standard position, you must document how you measured their ROM so whoever is working with the patient knows the position they were measured in in order to remeasure their ROM to get accurate measurements. Having the patient cooperate with you can help provide more accurate measurements.

Answer 6

Got it

Question 7

What is sometimes the only method used to check a person’s lumbar and cervical ROM?

Answer 7

A visual exam/screen

Question 8

When visually estimating how much motion someone has, you do not need to use any devices. We visually estimate how much motion is in the cervical, thoracic, and lumbar spine visually more often than we do using devices.

Answer 8

Roger that

Question 9

To visually check the ROM in the vertebral column, ask the patient to flex the spine, extend, side bend, and roate and I will estimate how much motion they have based on the working knowledge on what I think is normal. So I am gonna say whether or not it is 100% normal, 75% of normal, 50% of normal, 25% of normal, or no motion at all (0%).
Sometimes this will be recorded as percent limitation or percent of normal depending on the documentation system you used. So sometimes you will see 25% of cervical flexion or 25% limited in cervical flexion, meaning they have 75% of what is normal.

Answer 9

Roger that

Question 10

What is the most common tool used to measure motion?

Answer 10

A goniometer

Question 11

Does the size of the goniometer matter when measuring different joints?

Answer 11

Yes

Question 12

The axis is the (midpoint/endpoint) of the goniometer.

Answer 12

midpoint

Question 13

The (stationary/moving) arm is considered the part of the goniometer that is attached to the axis.

Answer 13

stationary

Question 14

The (stationary/moving) arm is the one that moves on top of the stationary arm.

Answer 14

moving

Question 15

We line up the goniometer with bony landmarks because they are reproducible (the structure does not move/change).

Answer 15

Got it

Question 16

If we are trying to measure motion in a particular joint we have to make sure that we get motion of that joint as opposed to a little motion of that joint we are trying to measure and associated motion in other joints. Need to be good at stabilizing or at least watching when we are getting motion in other structures.

Answer 16

Got it

Question 17

In the 0-180 system when recording goniometric measurements, MOST motions start at the anatomical position and moves to __ degrees no matter which direction the joint is moving.

Answer 17

180

Question 18

When doing measurements you need to record a starting point for your motion which often times is 0 and you have to record your end point as well. You should always have (one/two) numbers that are associated with that measurement.

Answer 18

two

Question 19

___ degrees is considered about normal elbow flexion. ___ degrees is about the normal amount of elbow flexion range to be able to touch their shoulder or do ADLs.

Answer 19

135; 135

Question 20

Normal amount of shoulder abduction should be about ___ degrees.
In the example of someone with only 85 degrees of shoulder abduction, if this was recorded passively then we would know that it is potentially tightness of tissues around that joint unless they have an empty end feel (pain that could have caused them to stop from trying to abduct further). If it was recorded actively, maybe they could only lift 85 degrees and if we assess the passive range and they have more motion than the active range then the most probable cause is __ or __.

Answer 20

180; muscle weakness/strength or pain

Question 21

Our standard position for measuring shoulder internal/external rotation is at __ degrees of abduction without the humerus rotated.

Answer 21

90

Question 22

__ degrees is considered normal external rotation for most people.

Answer 22

90

Question 23

Elbow flexion: 10-135 degrees means that you were not able to start at anatomical position, they for some reason were in 10 degrees of (flexion/extension) when we first went to go measure them and then they progressed to 135 degrees. So they are lacking full elbow (flexion/extension) at this point.

Answer 23

flexion; extension

Question 24

Full elbow extension would be __ degrees (anatomical position).

Answer 24

0

Question 25

If we want to measure elbow extension for this same person that has elbow flexion of 10-135, (remember we start from neutral which is 0 degrees) this person would be 10 degrees short of the actual starting position which would be a -10 start position and this would be the only time we would use only one number to signify our ROM measurement. So this basically says that I am measuring elbow extension and this person is 10 degrees short of the starting position.

Answer 25

Got it

Question 26

_degrees of knee extension is normal starting position (anatomical position).

Answer 26

0

Question 27

Knee extension of -12 means that they were 12 degrees short of being able to achieve that 0 degree position, or that they started off (flexed/extended) 12 degrees.

Answer 27

flexed

Question 28

Knee extension at 0-10 degrees means that the patient started off at normal anatomical position (0 degrees) and was able to (flex/extend) their knee 10 degrees into hyper extension. So it would be 10 degrees of hyper extension.

Answer 28

extend

Question 29

If I was measuring knee flexion for an individual that had knee extension of -12 and their end result of knee flexion was 90 degrees, the knee flexion recording would be what?

Answer 29

12-90

Question 30

You use negative numbers to indicate that you can’t get to a starting point.

Answer 30

Got it

Question 31

The standard position for measuring elbow extension is ___ , you normally take a towel roll and you put it underneath their distal humerus and that allows gravity to put them in full extension and measure them from there.

Answer 31

supine

Question 32

Hip abduction of 15-30 means that they can’t start at anatomical position and their leg is already (adducted/abducted) when taking measurements. If we were measuring hip adduction for this same individual it would be __.

Answer 32

abducted; -15

Question 33

Standard position for measuring hip abduction would be __.

Answer 33

supine

Question 34

When doing these measurements we can compare the measurements of the patient to their opposite side to try and get a normal for them because we know that there are a lot of different reasons as to why someone might not have “normal” ROM in their joints (the way God formed you, prior injuries, age, etc). So if you compare their ROM to the other side it gives you a reference for what is normal for them.

Answer 34

Got it

Question 35

When doing these measurements we can compare the measurements of the patient and see how these limits could potentially limit their functional ability. For example, reaching over your head, shoulder flexion being at 180 degrees is normal but you do not need shoulder flexion to be at 180 degrees to do most things. The question is,is the limitation you identified in the patient really limiting them functionally? If it isn’t we aren’t all that concerned about it. Insurance companies a lot of the time are not concerned with the measurements, but more so what can’t this patient do?

Answer 35

Got it

Question 36

Most times when we do these ROM measurements, we measure both passive ROM and we assess active ROM because we get different information from both of these assessments.

Answer 36

Got it

Question 37

So when we assess someone’s passive ROM we find out how far the joint itself can move and with that we are going to get an idea of end feel and as we push them to their end range we can get an idea of if it is firm, soft, bony, empty, etc. Based on what their end feel feels like we can get an indication on whether or not we can change it.

Answer 37

Got it

Question 38

A capsular pattern of restriction indicates that the capsule is the thing that is restricting motion so direct your treatment at the capsule itself.
A non capsular pattern indicates that the capsule is not causing the restriction and something else is causing it and in that case we would not advocate for (HLBS/LLPS).

Answer 38

LLPS

Question 39

In passive ROM, when we compare all of our measurements we can determine whether or not we have that capsular pattern or not.

Capsular pattern example:
If you measure the passive ROM of the hip joint and we find that when we take those measurements that they are most limited in internal rotation, then their next greatest limitation is flexion, and then abduction, that would be classic capsular pattern and it has to be the capsule around the hip that is causing their restrictions. Now you know to do interventions that target treatment at the capsule itself. For example, you might to do specific stretches at the hip that really target the capsule itself, certain mobilizations that we can do that can really loosen up the capsule itself, etc.

Answer 39

GOT IT

Question 40

If it is not a capsular pattern then it can be other things like muscle that might be restricting motion, maybe a labrum in your hip that is blocking movement, etc. From a treatment perspective now I might direct my treatment to the stretching of the muscles around the hip, maybe based upon the fact of with the end feel and that sort of thing that it might be the labrum restricting motion so we can’t do too much about that and they might have to go see a surgeon.
If you measure their ROM and it falls within normal you do not have to worry about a capsular pattern.

Answer 40

Got it