Upper Extremity Goniometry

Question 1

Muscles responsible for shoulder flexion

Answer 1

anterior deltoid- palpate over anterior aspect of humerus, coracobrachialis

Question 2

Muscles responsible for shoulder extension

Answer 2

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

Question 3

muscles responsible for shoulder abduction

Answer 3

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)

Question 4

muscles responsible for shoulder internal rotation

Answer 4

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

Question 5

muscles responsible for shoulder external rotation

Answer 5

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)

Question 6

Landmarks for shoulder flexion goniometry

Answer 6

axis: greater tubercle of the humerus, moving arm:- lateral epicondyle of the humerus, stationary arm: midaxillary line

Question 7

landmarks for shoulder extension goniometry

Answer 7

axis: greater tubercle of the humerus, moving arm:- lateral epicondyle of the humerus, stationary arm: midaxillary line

Question 8

landmarks for shoulder abduction goniometry

Answer 8

axis: anterior acromion moving arm: bisecting the condyles of the humerus stationary arm: parallel to sternum

Question 9

landmarks for shoulder internal rotation goniometry

Answer 9

axis: olecranon process moving arm: ulnar styloid process stationary arm: perpendicular to the floor

Question 10

landmarks for shoulder external rotation goniometry

Answer 10

axis: olecranon process moving arm: ulnar styloid process stationary arm: perpendicular to the floor

Question 11

expected ROM shoulder flexion

Answer 11

0-180

Question 12

expected ROM shoulder extension

Answer 12

0-50

Question 13

expected ROM: shoulder abduction

Answer 13

0-180

Question 14

expected ROM: internal rotation

Answer 14

0-70

Question 15

expected ROM: external rotation

Answer 15

0-90

Question 16

END FEEL: shoulder flexion and extension

Answer 16

flexion- firm due to posterior capsule, muscle tension, ligaments

extension- firm due to anterior capsule, muscle tension, or ligaments

Question 17

END FEEL- shoulder abduction

Answer 17

GH abduction- firm due to SC capsule, muscle tension, or ligaments

Question 18

END FEEL- shoulder internal and external rotation

Answer 18

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

Question 18

END FEEL- shoulder internal and external rotation

Answer 18

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

Question 19

patient position/stabilization shoulder flexion goniometry

Answer 19

patient- supine

stabilize- ribcage/thorax

Question 20

patient position/stabilization shoulder extension goniometry

Answer 20

patient- prone

stabilize- upper to mid thorax

Question 21

patient position/stabilization shoulder abduction goniometry

Answer 21

patient- supine

stabilization- avoid shoulder elevation, maintain neutral shoulder position, stabilize through ribcage/thorax to limit lateral flexion of the spine

Question 22

patient position/stabilization shoulder internal rotation goniometry

Answer 22

patient- supine with shoulder abducted 90 and elbow flexed 90 (forearm pointing up to the ceiling to start)

stabilization- anterior, proximal humerus

Question 23

patient position/stabilization shoulder external rotation goniometry

Answer 23

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

Question 24

muscles responsible for elbow flexion

Answer 24

biceps brachii, brachialis, brachioradialis

Question 25

normative value for elbow flexion ROM

Answer 25

0-150

Question 26

landmarks for elbow flexion goniometry

Answer 26

axis- lateral epicondyle of the humerus moving arm - radial styloid process stationary arm- acromion process

Question 27

patient position/stabilization elbow flexion goniometry:

Answer 27

patient- supine with towel under humerus stabilization- proximal humerus

Question 28

end feel for elbow flexion

Answer 28

END FEEL: soft due to approx of bicep and forearm musculature

Question 29

STEPS OF GONIOMETRY PROCEDURE:

Answer 29

1. AROM then PROM assessment 3. palpate muscles of interest 4. have patient hold the position (so that you can measure) 5. measure difference from beginning to end

Question 30

Muscles responsible for elbow extension:

Answer 30

triceps brachii

Question 31

normative range for elbow extension

Answer 31

0

Question 32

patient position/stabilization elbow extension goniometry

Answer 32

patient- supine, towel under humerus but an elbow is hanging off the towel stabilization: proximal humerus

Question 33

landmarks elbow extension goniometry

Answer 33

axis: lateral epicondyle of the humerus stationary arm: acromion process moving arm: radial styloid process

Question 34

end feel for elbow extension

Answer 34

HARD- hard due to posterior, bony approximation of the olecranon process into the olecranon fossa

Question 35

muscles responsible for pronation of forearm

Answer 35

pronator teres, pronator quadratus

Question 36

normative value for forearm pronation

Answer 36

80 degrees

Question 37

patient position/stabilization for pronation of the forearm

Answer 37

patient- seated with elbow in 90 degrees flexion and neutral rotation of forearm, humerus at thorax stabilization- at posterior elbow

Question 38

landmarks- forearm pronation

Answer 38

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

Question 39

forearm pronation end feel

Answer 39

END FEEL: firm due to joint capsule, muscle tension, ligaments

Question 40

supination muscles

Answer 40

supinator, biceps brachii

Question 41

normative value supination

Answer 41

80 degrees

Question 42

patient position/stabilization supination goniometry

Answer 42

patient- seated with elbow in 90 degrees flexion and neutral rotation of forearm, humerus at thorax stabilization- at posterior elbow

Question 43

landmarks for forearm supination goniometry

Answer 43

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

Question 44

end feel forearm supination

Answer 44

END FEEL: firm due to joint capsule, muscle tension, ligaments

Question 45

wrist flexion muscles

Answer 45

FCR | FCU

Question 46

wrist flexion normative value

Answer 46

0-80 degrees

Question 47

patient position/stabilization wrist flexion goniometry

Answer 47

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)

Question 48

landmarks for wrist flexion goniometry:

Answer 48

axis: lateral to triquetrum stationary arm: from triquetrum to the olecranon process moving arm: parallel with the 5th metacarpal

Question 49

end feel for wrist flexion

Answer 49

firm due to joint capsule, muscle tension, ligaments

Question 50

muscles for wrist extension

Answer 50

ECRL, ECRB ECU

Question 51

normative value wrist extension

Answer 51

70

Question 52

patient position/stabilization wrist extension

Answer 52

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)

Question 53

landmarks wrist extension

Answer 53

axis: lateral to triquetrum stationary arm: from triquetrum to the olecranon process moving arm: parallel with the 5th metacarpal

Question 54

Ulnar deviation patient position/stabilization

Answer 54

patient- seated with shoulder abducted and elbow flexed to 90, forearm pronated, palm flat on table with forearm supported stabilization- posterior radius and ulna

Question 55

ulnar deviation normative value

Answer 55

0-30

Question 56

ulnar deviation landmarks

Answer 56

axis:capitate stationary arm:bisect the dorsal midline of the forearm moving arm: dorsal midline of third metacarpal

Question 57

ulnar deviation end feel

Answer 57

firm

Question 58

radial deviation patient position/stabilization

Answer 58

shoulder abducted, elbow flexed 90, forearm pronated and supported on table, palm flat on table stabilization: radius and ulna (posterior aspect of forearm)

Question 59

radial deviation normative value

Answer 59

0-20

Question 60

radial deviation landmarks

Answer 60

axis:capitate stationary arm:bisect the dorsal midline of the forearm moving arm: dorsal midline of third metacarpal

Question 61

radial deviation end feel

Answer 61

END FEEL: hard due to bony approximation, firm due to joint capsule, muscle tension, ligaments