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goniometer and endfeels-1

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Measurement of joint motion
Jane M Chela Singoyi
Introduction
Measurement of joint motion is an important
part of the physical examination. For a
measurement to have value, it must be reliable
and valid. Many decisions regarding patient
status, treatment and prognosis are based partly
or wholly on measurements of joint motion.
Range of motion is the measurement of how
much range is available at a joint.
Introduction
• The measurement of possible movement at any
joint is known as Goniometry. It is method used
to measure joint motion.
• The term goniometry is derived from two Greek
words, gōnia, meaning angle, and metron,
meaning measure.
• Since movement at any joint is angular, the unit
‘degrees’ when measuring ROM rather inches or
millimeters is used.
• Range of motion can be measured as active or
passive. Passive range is always greater than
active.
Tools for measuring joint range
• Joint range of motion can be measured using
goniometers, inclinometers and hygrometers.
The commonest and easiest to use in practice
is the goniometer.
• A traditional goniometer comprises of a
protractor and two extending arms, a movable
one and an immovable arm. The movable arm
is attached to the protractor on the fulcrum.
Principles of joint measurement
• All movements of a joint are measured from
defined Zero starting position. Thus, the
degrees of motion are added in the direction
the joint moves from the zero starting
position.
• The extended anatomical position of an
extremity is accepted as zero degrees, rather
than 180 degrees.
• The motion of the extremity being examined
should be compared to that of the opposite
extremity.
Principles continued
• If the opposite motion is not present, the motion
should be compared to the average motion of an
individual of similar age and physical build.
• A distinction is made between the terms
extension and hypertension. Extension is used
when the motion is opposite to flexion, at the
zero starting position, is a natural motion. E.g. at
the wrist joint. If however, the motion opposite to
flexion at the zero starting position is unnatural
one, such as that of the elbow or knees, it is
referred to as hyperextension.
Picture of a goniometer
• The body of the goniometer is designed like a
protractor and may form a full or half circle. A
measuring scale is located around the body.
The scale can extend either from 0 to 180
degrees and 180 to 0 degrees for the half
circle models, or from 0 to 360 degrees and
from 360 to 0 degrees on the full circle
models. The intervals on the scales can vary
from 1 to 10 degrees. Usually 0 degrees
corresponds with the joint placed in anatomic
position
• The stationary arm is structurally a part of the
body
and
therefore
cannot
move
independently of the body
• The moving arm is attached to the fulcrum in
the center of the body by a rivet or screw-like
device that allows the moving arm to move
freely on the body of the device.
How to use the goniometer
1. The patient is positioned in the recommended
testing position. While stabilizing the proximal
joint component, the clinician gently moves the
distal joint component through the available
range of motion until the end feel is determined.
An estimate is made of the available range of
motion and the distal joint component is
returned to the starting position. Ensure that
the other joints are stabilized.
2. The clinician palpates the relevant bony landmarks and
aligns the goniometer parts with the bony landmarks.
Mark the points for the fulcrum and axes for the
goniometer arms on the patient.
3. A record is made of the starting measurement.
4. The goniometer is then removed and the patient
moves the joint through the available range of motion.
Once the joint has been moved through the available
range of motion, the goniometer is replaced and
realigned, and a measurement is read and recorded.
***Talk about documenting normal and limited range***
There are generally certain items which need to be
documented when measuring the range of motion
of a patient’s joints.
a. Whether the motion was tested actively or
passively.
b. Whether the right or left side was being tested
c. The joint that was being tested.
d. The movement that was being tested
e. The position the patient was in during
measurement
f. The starting position in degrees
g. The ending position in degrees
h. Whether or not there was pain
Normal ranges of motion for the
larger joints
JOINT
Shoulder
Elbow
Forearm
Wrist
Hip
Knee
Ankle
Foot
ACTION
Flexion
Extension
Abduction
Internal rotation
External rotation
Flexion
Pronation
Supination
Flexion
Extension
Radial deviation
Ulnar deviation
Flexion
Extension
Abduction
Adduction
Internal rotation
External rotation
Flexion
Plantarflexion
Dorsiflexion
Inversion
Eversion
DEGREES OF MOTION
0-180
0-40
0-180
0-80
0-90
0-150
0-80
0-80
0-60
0-60
0-20
0-30
0-100
0-30
0-40
0-20
0-40
0-50
0-150
0-40
0-20
0-30
0-20
End feels
• When assessing the passive movement, the
examiners should apply overpressure at the
end to determine the end feel. End feel is the
sensation the examiner feels in the joint as it
reaches the end of the passive range of
motion.
• Types of end feels
a. Normal end feel / Physiological – the joint has
full range of motion and the movement is
stopped by the anatomy of the joint.
3 classical normal end feels
i. Bony/hard end feel – this is a hard, unyielding,
abrupt sensation that is painless. This is when
motion is stopped by two bones contacting one
another. An example is the end feel for
extension of the elbow.
ii. Soft tissue approximation soft end feel) - This is
the end feel in which motion is stopped by two
masses of soft tissue pressing on one another.
Tissue meets tissue and it is painless. An
example is in flexion of the elbow, in which the
elbow flexors and knee flexors press on each
other to limit further motion.
iii. Firm/tissue stretch – there is a firm springy or
rubbery type of movement with a slight give
towards the end of the ROM – normal elastic
resistance that is felt when stretching soft tissue
e.g. lateral flexion of the cervical spine.
iv. Capsular stretch - A hard arrest to the
movement that has some give when the joint
capsule stretching a piece of leather. For
example, it occurs in passive shoulder external
rotation. or ligaments are stretched. The feel is
similar to
b. Abnormal/pathological end feels
• Hard - An abrupt hard stop to movement occurs when
bone contacts bone or a bony grating sensation when
rough articular surfaces move past one another as in a
joint that contains loose bodies, degenerative joint
disease, dislocation or a fracture.
• Soft - A boggy sensation indicates the presence of
synovitis or soft tissue edema.
• Firm - A springy sensation or a hard arrest to
movement with some give indicates muscular, capsular
or ligamentous shortening. A rebound is seen or felt
and indicates the presence of an inteinternal
derangement, such as the knee with a torn meniscus.
Pathological end feels
• Empty - If considerable pain is present, there is
no sensation felt before the extreme of passive
ROM as the patient requests the movement be
stopped. This indicates pathology such as an
extra articular abscess, a neoplasm, acute
bursitis, joint inflammation or a fracture
• Spasm - A hard sudden-stop to passive
movement that is often accompanied by pain is
indicative of an acute or sub-acute arthritis,
presence of severe active lesion or fracture. If
pain is absent, a spasm end feel indicates lesion
of the central nervous system, with increased
muscular tone.
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