ROM Assessment Flashcards
The most common tools to measure joint motion include: Visual Exam/Screen, goniometers, inclinometers, and phone apps
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All tools are used to document AROM and/or PROM to determine impairment, set goals, get reimbursed for services, and assess effects of treatment
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One of the ways we can make our goals for the patient more objective is if we have (subjective/objective) measurements of their ROM.
objective
ROM measurements can be used to show the insurance company that the patient is getting better.
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If the patients ROM is getting better the treatment is working.
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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.
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What is sometimes the only method used to check a person’s lumbar and cervical ROM?
A visual exam/screen
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.
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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.
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What is the most common tool used to measure motion?
A goniometer
Does the size of the goniometer matter when measuring different joints?
Yes
The axis is the (midpoint/endpoint) of the goniometer.
midpoint
The (stationary/moving) arm is considered the part of the goniometer that is attached to the axis.
stationary
The (stationary/moving) arm is the one that moves on top of the stationary arm.
moving
We line up the goniometer with bony landmarks because they are reproducible (the structure does not move/change).
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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.
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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.
180
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.
two
___ 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.
135; 135
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 __.
180; muscle weakness/strength or pain
Our standard position for measuring shoulder internal/external rotation is at __ degrees of abduction without the humerus rotated.
90
__ degrees is considered normal external rotation for most people.
90
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.
flexion; extension
Full elbow extension would be __ degrees (anatomical position).
0
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.
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_degrees of knee extension is normal starting position (anatomical position).
0
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.
flexed
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.
extend
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?
12-90
You use negative numbers to indicate that you can’t get to a starting point.
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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.
supine
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 __.
abducted; -15
Standard position for measuring hip abduction would be __.
supine
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.
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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?
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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.
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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.
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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).
LLPS
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.
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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.
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