Upper Extremity Goniometry Flashcards
Muscles responsible for shoulder flexion
anterior deltoid- palpate over anterior aspect of humerus, coracobrachialis
Muscles responsible for shoulder extension
latissimus dorsi - palpate along lateral side of rib cage
teres major- lateral border of scapula
posterior deltoid- apply resistance into flexion and palpate on the posterior aspect of the shoulder
muscles responsible for shoulder abduction
middle deltoid- patient adducts AROM–> palpate on the lateral aspect of the shoulder
supraspinatus- initiation of abduction - palpate in supraspinatus fossa
–> can also be palpated as the patient places their hand on the small of their back with an internally rotated arm (palpate on superior surface of greater tubercle (just distal to the AC joint)
muscles responsible for shoulder internal rotation
subscapularis
PATIENT POSITION- sitting 1. lean forward and let arm hang 2. instruct patient to abduct their arm to approximately 60 degrees, patient will push down like they were about to go into internal rotation (therapist will resist this motion) 3. MUSCLE BELLY- palpate in the posterior/lateral aspect of the axilla for muscle belly 4. TENDON- palpate tendons just medial to the lesser tubercle during resisted internal rotation
muscles responsible for shoulder external rotation
infraspinatus
-palpate below the spine of the scapula
teres minor
-palpate at the axillary border
PATIENT POSITION: sitting 1. slightly abducted and externally rotated at shoulder (apply resistance in opposite direction) 2. palpate infraspinatus below spine of scapula 2. lateral border of scapula–> teres minor MUSCLE BELLY (while you press into adduction and internal rotation) 3. TENDON OF INFRASPINATUS- exaggerated extension of the shoulder and slight adduction –> tendon is just posterior to the greater tubercle (ALSO can palpate tendon with patient prone and leaning forward on elbows)
Landmarks for shoulder flexion goniometry
axis: greater tubercle of the humerus, moving arm:- lateral epicondyle of the humerus, stationary arm: midaxillary line
landmarks for shoulder extension goniometry
axis: greater tubercle of the humerus, moving arm:- lateral epicondyle of the humerus, stationary arm: midaxillary line
landmarks for shoulder abduction goniometry
axis: anterior acromion moving arm: bisecting the condyles of the humerus stationary arm: parallel to sternum
landmarks for shoulder internal rotation goniometry
axis: olecranon process moving arm: ulnar styloid process stationary arm: perpendicular to the floor
landmarks for shoulder external rotation goniometry
axis: olecranon process moving arm: ulnar styloid process stationary arm: perpendicular to the floor
expected ROM shoulder flexion
0-180
expected ROM shoulder extension
0-50
expected ROM: shoulder abduction
0-180
expected ROM: internal rotation
0-70
expected ROM: external rotation
0-90
END FEEL: shoulder flexion and extension
flexion- firm due to posterior capsule, muscle tension, ligaments
extension- firm due to anterior capsule, muscle tension, or ligaments
END FEEL- shoulder abduction
GH abduction- firm due to SC capsule, muscle tension, or ligaments
END FEEL- shoulder internal and external rotation
internal rotation- firm; when you feel an anterior pressure at the humeral head; due to posterior joint capsule muscle tension or ligs
external rotation- firm due to anterior joint capsule muscle tension or ligaments
END FEEL- shoulder internal and external rotation
internal rotation- firm; when you feel an anterior pressure at the humeral head; due to posterior joint capsule muscle tension or ligs
external rotation- firm due to anterior joint capsule muscle tension or ligaments
patient position/stabilization shoulder flexion goniometry
patient- supine
stabilize- ribcage/thorax
patient position/stabilization shoulder extension goniometry
patient- prone
stabilize- upper to mid thorax
patient position/stabilization shoulder abduction goniometry
patient- supine
stabilization- avoid shoulder elevation, maintain neutral shoulder position, stabilize through ribcage/thorax to limit lateral flexion of the spine
patient position/stabilization shoulder internal rotation goniometry
patient- supine with shoulder abducted 90 and elbow flexed 90 (forearm pointing up to the ceiling to start)
stabilization- anterior, proximal humerus
patient position/stabilization shoulder external rotation goniometry
patient: supine with shoulder abducted and elbow flexed to 90 degrees, towel under humerus so that humerus is parallel to table
stabilization: anterior, proximal humerus
muscles responsible for elbow flexion
biceps brachii, brachialis, brachioradialis
normative value for elbow flexion ROM
0-150
landmarks for elbow flexion goniometry
axis- lateral epicondyle of the humerus
moving arm - radial styloid process
stationary arm- acromion process
patient position/stabilization elbow flexion goniometry:
patient- supine with towel under humerus
stabilization- proximal humerus
end feel for elbow flexion
END FEEL: soft due to approx of bicep and forearm musculature
STEPS OF GONIOMETRY PROCEDURE:
- AROM then PROM assessment
- palpate muscles of interest
- have patient hold the position (so that you can measure)
- measure difference from beginning to end
Muscles responsible for elbow extension:
triceps brachii
normative range for elbow extension
0
patient position/stabilization elbow extension goniometry
patient- supine, towel under humerus but an elbow is hanging off the towel
stabilization: proximal humerus
landmarks elbow extension goniometry
axis: lateral epicondyle of the humerus
stationary arm: acromion process
moving arm: radial styloid process
end feel for elbow extension
HARD- hard due to posterior, bony approximation of the olecranon process into the olecranon fossa
muscles responsible for pronation of forearm
pronator teres, pronator quadratus
normative value for forearm pronation
80 degrees
patient position/stabilization for pronation of the forearm
patient- seated with elbow in 90 degrees flexion and neutral rotation of forearm, humerus at thorax
stabilization- at posterior elbow
landmarks- forearm pronation
axis: dorsal and proximal to the ulnar styloid process
stationary arm: mid line of humerus (perpendicular to the floor)
moving arm: dorsal surface of wrist, proximal and parallel to the ulnar and radial styloid processes
forearm pronation end feel
END FEEL: firm due to joint capsule, muscle tension, ligaments
supination muscles
supinator, biceps brachii
normative value supination
80 degrees
patient position/stabilization supination goniometry
patient- seated with elbow in 90 degrees flexion and neutral rotation of forearm, humerus at thorax
stabilization- at posterior elbow
landmarks for forearm supination goniometry
axis: ventral and proximal to ulnar styloid process
stationary arm: midline of humerus
moving arm: ventral surface of the wrist; proximal and parallel to the styloid processes
end feel forearm supination
END FEEL: firm due to joint capsule, muscle tension, ligaments
wrist flexion muscles
FCR
FCU
wrist flexion normative value
0-80 degrees
patient position/stabilization wrist flexion goniometry
patient- seated, forearm pronated and supported on table, wrist hanging off edge of table
stabilization: distal forearm (radius and ulna on posterior aspect of distal forearm)
landmarks for wrist flexion goniometry:
axis: lateral to triquetrum
stationary arm: from triquetrum to the olecranon process
moving arm: parallel with the 5th metacarpal
end feel for wrist flexion
firm due to joint capsule, muscle tension, ligaments
muscles for wrist extension
ECRL, ECRB
ECU
normative value wrist extension
70
patient position/stabilization wrist extension
patient- seated, forearm pronated and supported on table, wrist hanging off edge of table
stabilization: distal forearm (radius and ulna on posterior aspect of distal forearm)
landmarks wrist extension
axis: lateral to triquetrum
stationary arm: from triquetrum to the olecranon process
moving arm: parallel with the 5th metacarpal
Ulnar deviation patient position/stabilization
patient- seated with shoulder abducted and elbow flexed to 90, forearm pronated, palm flat on table with forearm supported
stabilization- posterior radius and ulna
ulnar deviation normative value
0-30
ulnar deviation landmarks
axis:capitate
stationary arm:bisect the dorsal midline of the forearm
moving arm: dorsal midline of third metacarpal
ulnar deviation end feel
firm
radial deviation patient position/stabilization
shoulder abducted, elbow flexed 90, forearm pronated and supported on table, palm flat on table
stabilization: radius and ulna (posterior aspect of forearm)
radial deviation normative value
0-20
radial deviation landmarks
axis:capitate
stationary arm:bisect the dorsal midline of the forearm
moving arm: dorsal midline of third metacarpal
radial deviation end feel
END FEEL: hard due to bony approximation, firm due to joint capsule, muscle tension, ligaments
