RANGE OF MOTION (UE)
(NORKIN)
JOINT
Glenohumeral
Joint
MOTION
Flexion
Extension
N VALUES
180
60
Abduction
180
Adduction
Medial
Rotation
Lateral
Rotation
Flexion
Return to zero position from full abduction (not usually measured)
AMA: 90
Supine; c 90 abd
Distal end of
Move FA anteriorly
AAOS: 70 FA perpendicular to
humerus then
supporting surface
scapula
90
Move FA posterioly
Extension
Pronation
Return to zero position from full abduction (not usually measured)
80
Sitting; c Arm close to body
Distal end of
Rotate FA in volar direction
and 90 Elbow flex c FA
humerus
where palm is facing the
midway b/w pron sup
floor
Hard
Firm
Supination
B: 90
AMA: 80
AAOS: 80
Rotate FA in dorsal direction
where palm faces the ceiling
Firm
Flexion
B: 90
AMA: 60
B: 70
AMA: 60
Sitting; c 90 sh abd and 90
elbow flex c FA supported
while hand is free
Radius and ulna
Move hand towards floor
Firm
Radius and Ulna
Move hand towards ceiling
Firm
20
Sitting; c 90 sh abd and 90
elbow flex c palm facing floor
resting of surface
radius and ulna
Move hand towards thumb
Hard
Humeroulnar
Joint
Radioulnar
Joint
Radiocarpal
Joint
Extension
Radial
Deviation
Ulnar Deviation
POSITION
Supine; c knees flex
Prone; c face away from
testing side
Supine; c sh at ext rot
B: 145
Supine; c FA supinated
AMA: 140
AAOS: 150
30
STABILIZATION
Scapula
Scapula
TESTING MOTION
Lift humerus over pt’s head
Lift humerus
END FEEL
Firm
Firm
Scapula
Move humerus away from
trunk
Firm
Humerus
Move hand towards
shoulder
Move hand towards little
finger
Firm
Firm
Soft
GONIOMETER
Fulcrum: lat aspect of greater tubercle
Proximal Arm: midaxillary line of thorax
Distal Arm: Lat midline of humerus
Fulcrum: ant acromial process
Proximal Arm: parallel to sternum
Distal Arm: ant midline of humerus
Fulcrum: olecranon process
Proximal Arm: perpendicular/parallel to floor
Distal Arm: align c ulna
Reference: ulnar styloid
Fulcrum: Lateral epicondyle of humerus
Proximal Arm: lat midline of humerus
Reference: acromion process
Distal Arm: lateral midline of radius
Reference: radial head and radial styloid
Fulcrum: Lat to ulnar styloid
Proximal Arm: Parallel to ant midline of humerus
Distal Arm: post of FA
Reference: Parallel to styloid process of radius and ulna
Fulcrum: Proximal to ulnar styloid
Proximal Arm: parallel to ant midline of humerus
Distal Arm: ant of FA
Reference: Parallel to styloid process of radius and ulna
Fulcrum: over triquetrum
Proximal Arm: Lateral midline of ulna
Reference: olecranon and ulnar styloid process
Distal Arm: lat midline of 5th MCP
Fulcrum: over capitate
Proximal Arm: dorsal midline of FA
Reference: Lateral epicondyle of humerus
Distal Arm: dorsal midline of 3rd MCP
ACCA
Metacarpo
-phalangeal
Joint
Flexion
90
Extension
B: 20
AMA: 45
20
Abduction
PIP Joint
Adduction
Flexion
DIP Joint
Extension
Flexion
Extension
Flexion
Extension
1ST CMC Joint
Abduction
Adduction
Opposition
Sitting; FA in surface and
neutral wrist and hand
Sitting; FA in surface and
neutral wrist and hand
Metacarpal
Metacarpal
Return from full abduction (not usually measured)
120
Sitting; FA in surface and
Proximal phalanx
neutral wrist, hand and MCP
AMA: 0
90
Sitting; FA in surface and
Middle and
neutral wrist, hand and MCP. proximal phalanx
70 to 90 PIP flexion
AMA: 0
AAOS: 15 Sitting; full sup of FA and
Carpals radius
neutral hand and wrist
and ulna
AMA: 50
AAOS: 80
AAOS: 70 Sitting; FA b/w pron sup;
Carpals and 2nd
neutral hand and wrist
Metacarpal
MCP Joint
(THUMB)
Flexion
Extension
Return from full abduction (not usually measured)
Sitting; FA in full sup and
5th MCP
neutral wrist and hand
B: 45
Sitting; FA in full sup with
1st MCP
AAOS: 50 wrist in neutral
AAOS: 0
IP Joint
(THUMB)
Flexion
B: 90
(abduction + flexion)
Desmet:80
Extension
AAOS: 20
Sitting; FA in full sup with
wrist in neutral
Proximal phalanx
Push dorsal side of finger
towards palm
Push palmar surface of prox
phalanx away from palm
Push medial surface of
fingers away from midline
Hard
Firm
Fulcrum: Dorsal aspect of MCP joint.
Proximal Arm: dorsal midline of metacarpal
Distal Arm: dorsal midline of proximal phalanx
Push dorsal side of middle
phalanx towards palm
Push palmar side away
Push dorsal side of distal
phalanx towards palm
Push palmar side away
Push dorsal surface of
thumb towards ulnar aspect
Push palmar surface of
thumb towards radial aspect
Move metacarpal away
from palm of hand
Hard
Fulcrum: dorsal aspect of PIP joint
Proximal Arm: dorsal midline of proximal phalanx
Distal Arm: dorsal midline of middle phalanx
Fulcrum: dorsal aspect of DIP joint
Proximal Arm: dorsal midline of middle phalanx
Distal Arm: dorsal midline of distal phalanx
Fulcrum: palmar aspect of 1st CMC
Proximal Arm: Ventral midline of radius
Reference: Ventral radial head and styloid process
Distal Arm: Ventral midline of 1st metacarpal
Fulcrum: over lateral aspect of radial styloid
Proximal Arm: lateral midline of 2nd MCP
Reference: center of 2nd MCP
Distal Arm: lateral midline of 1st MCP
Reference: center if 1st MCP
Move 1st MCP away from
palm and in ulnar deviation
Move thumb towards ulnar
aspect
Move thumb towards radial
aspect
Push distal phalanx towards
ulnar aspect
Soft/Firm
Push palmar surface of
distal phalanx towards
radial
Firm
Firm
Hard
Firm
Firm
Soft
Firm
Firm
Fulcrum: over MCP joint
Proximal Arm: dorsal midline of metacarpal
Distal Arm: dorsal midline of proximal phalanx
Ruler: measure distance b/w tip of thumb and tip of little
finger / base of little finger
Hard/Firm Fulcrum: over dorsal aspect of MCP
Proximal Arm: dorsal midline of MCP
Distal Arm: dorsal midline of prox phalanx
Firm
Firm
Fulcrum: Over dorsal surface of IP joint
Proximal Arm: dorsal midline of proximal phalanx
Distal Arm: dorsal midline of distal phalanx
Fulcrum: over dorsal surface of IP joint
Proximal Arm: dorsal midline of proximal phalanx
Distal Arm: dorsal midline of distal phalanx
ACCA
RANGE OF MOTION (LE)
JOINT
Acetabulofemoral
Joint
(HIP)
Tibiofemoral
Joint
(KNEE)
Talocrural Joint
(ANKLE)
Tarsal Joint
MOTION
Flexion
N VALUES
120
POSITION
Supine; knees ext
STABILIZATION
Pelvis
TESTING MOTION
Lift thigh off the table and
allow passive knee flex
Raise LE off the table c
knees ext
END FEEL
Soft/ Firm
Extension
B: 10
AMA: 30
Prone; knees ext
Pelvis
Abduction
Adduction
B: 45
B: 40
AAOS: 30
Supine; knees ext
Supine; abd C/L LE
Pelvis
Pelvis
Slide LE laterally
Slide LE medially
Firm
Firm
Medial
Rotation
Lateral Rotaion
B: 35
Sitting; Hip and Knees 90 flex
AMA: 40
Towel under distal femur
B: 45
Same as above but flex C/L
AMA: 50
knee >90
B: 120
Supine; knees extended
AMA 150
Return to zero position from full flexion
Distal end of
femur
Distal end of
femur
Femur
Move lower leg laterally
Firm
Move lower leg medially
Firm
Hold ankle and move knee
to flexion
Soft/ Firm
Dorsiflexion
B: 15
AAOS: 20
Tibia and fibula
Push bottom of the foot
upward
Firm
Plantarflexion
B: 45
AAOS: 50
Tibia and fibula
Push dorsum of the foot
downward
Push forefoot into add and
downward
Push forefoot into abd and
upward
Pull calcaneus medially into
add and rotate to
supination
Pull calcaneus laterally into
abd and rotate to pronation
Grasp metatarsal and push
forefoot into pf and add
Pull forefoot laterally into
abd and upward into df
Firm
Flexion
Extension
Inversion
Sitting; knees 90 flex
Sitting; knee 90 flex
Firm
Tibia and fibula
(sup+add+pf)
Eversion
Tibia and fibula
(Pron+abd+df)
Subtalar Joint
(Rearfoot)
Transverse Tarsal
Joint
Inversion
(Sup+add+pf)
5
Eversion
(pron+abd+df)
Inversion
5
Eversion
15 to 21
30 to 37
Prone; hip and knees ext
Tibia and fibula
Tibia and fibula
Sitting; knees and hip 90 flex
Firm
Calcaneus
Calcaneus
GONIOMETER
Fulcrum: Over lateral ascpect of hip joint
Reference: greater trochanter
Proximal Arm: lateral midline of pelvis
Distal Arm: lateral midline of femur
Reference: lateral epicondyle
Fulcrum: over ASIS
Proximal Arm: imaginary horizontal line ASIS to ASIS
Distal Arm: ant midline of femur
Reference: patella
Fulcrum: over anterior aspect of patella
Proximal Arm: Perpendicular to the floor
Distal Arm: ant midline of lower leg
Reference: midway b/w 2 malleoli
Fulcrum: over lateral epicondyle of femur
Proximal Arm: lateral midline of femur
Reference: greater trochanter
Distal Arm: lateral midline of fibula
Reference: lat malleolus and fibular head
Fulcrum: over lat aspect of lat malleolus
Proximal Arm: lateral midline of fibula
Refrence: head of fibula
Distal Arm: parallel lateral aspect of 5th MTT
Firm
Fulcrum: over anterior aspect of ankle
Proximal Arm: ant midline of lower leg
Hard/Firm Reference: Tibial tuberosity
Distal Arm: ant midline of 2nd MTT
Firm
Fulcrum: over posterior aspect of ankle midway bet
malleoli
Proximal Arm: midline of lower leg
Hard/Firm Distal Arm: posterior midline of calcaneus
Firm
Firm
Fulcrum: over ant aspect of ankle midway b/w malleoli
Proximal Arm: ant midline of lower leg
Reference: Tibial tuberosity
Distal Arm: ant midline of 2nd MTT
ACCA
Metatarso
-phalangeal Joint
Flexion
B: 40
Supine; Neutral ankle
N:30 to 45
Metatarsals
Pull great toe downward
Firm
Extension
B: 80
N:50 to 70
Metatarsals
Push proximal phalanx
towards dorsum of foot
Pull proximal phalanx
laterally away from midline
Firm
Abduction
IP Joint of big toe
&
PIP Joint of 4 toes
DIP Joint of 4 toes
Supine/Sitting; Neutral ankle
Metatarsals
Adduction
Return to zero position from full abduction; not usually measured
Flexion
B: 60
Supine/Sitting; Neutral ankle
N:35 to 65
Extension
Return to zero position from full flexion; not usually measured
Flexion
N: 30
Extension
Supine/ Sitting; neutral ankle
Metatarsals and
proximal phalanx
Push phalanx downward
towards plantar surface
Metatarsals
Push distal phalanx towards
Proximal phalanx plantar surface
Middle phalanx
Return to zero position from full flexion; not usually measured
Fulcrum: over dorsal aspect if MTP joint
Proximal Arm: dorsal midline of metatarsal
Distal Arm: dorsal midline of proximal phalanx
Firm
Fulcrum: dorsal aspect of MTP joint
Proximal Arm: dorsal midline of metatarsals
Distal Arm: dorsal midline of proximal phalanx
Soft/Firm
Fulcrum: over dorsal aspect of IP joint
Proximal Arm: dorsal midline of proximal phalanx
Distal Arm: over distal midline of phalanx distal to joint
being tested
Firm
Fulcrum: over dorsal aspect of DIP joint
Proximal Arm: dorsal midline of middle phalanx
Distal Arm: dorsal midline of distal phalanx
Legend:
B: Brunnstrom
N: Norkin
AAOS: American Academy of Orthopedic Surgeons
AMA: American Medical Association
ACCA
SPINE AND TMJ RANGE OF MOTION
MOTION
Flexion
Cervical
N VALUES
40
Extension
50
Lateral Flexion
22
Rotation
Magee:
70-90
Flexion
Thoracic
and
Lumbar
Lumbar
Extension
Lateral Flexion
Gonio: 18-38
Tape M: 5-7cm
Rotation
Flexion
Male: 6.7cm
POSITION
Sitting; c thoracic and
lumbar spine well
supported
STABILIZATION
Shoulder girdle c
strap
Shoulder girdle c
strap
Shoulder girdle
TESTING MOTION
One hand on head and one
hand on chin; move head
ant and downward
Move head upward and
posterior
Pull head towards the
shoulder
END FEEL
Firm
Firm
Firm
Sitting; c thoracic and
lumbar spine well
supported
Shoulder girdle
Grasp chin and rotate head
towards shoulder
Firm
Standing; neutral spine
Pelvis
Firm
Standing;
Standing
Pelvis
Pelvis
Ask pt to bend forward
while keeping hands relaxed
Ask pt to bend backward
Ask pt to bend trunk to one
side c arms relaxed
Sitting
Pelvis
Ask pt to turn body to
opposite side
Firm
Standing;
Pelvis
Ask pt to bend forward
Firm
Firm
Firm
MEASUREMENT
Fulcrum: over external auditory meatus
Proximal Arm: perpendicular/parallel to ground
Distal Arm: base of nares
Fulcrum: over C7 spinous process
Proximal Arm: perpendicular to the groud
Distal Arm: dorsal midline of head
Reference: Occipital protruberance
Fulcrum: over center of cranial aspect of head
Proximal Arm: parallel to imaginary line b/w 2 acromial
process
Distal Arm: tip of the nose
Tape measure: C7 spinous process to S1 spinous process
Record distance before and after bending
Fulcrum: over spinous process of S1
Proximal Arm: perpendicular to ground
Distal Arm: align c spinoud process of C7
Fulcrum: over center of cranial aspect
Proximal Arm: parallel to imaginary line b/w 2 prominent
tubercles on the iliac crest
Distal Arm: imaginary line b/w 2 acromial process
Modified-modified schober’s test: (Tape measure
ACCA
Female: 5.8 cm
TMJ
Extension
Depression
35mm to 50mm
Protrusion
6mm to 9mm
Lateral Deviation
6mm to 15mm
Standing
Sitting; neutral cervical
spine
Sitting; neutral cervical
spine
Sitting; neutral cervical
spine
Pelvis
Post aspect of
head
Post aspect of
the head
Posterior aspect
of the head
Ask pt to bend backward
Grasp mandible b/w index
and thumb and pull inf
Grasp mandible and pull
chin anteriorly
Grasp mandible and move it
to one side
Firm
Firm
Firm
Firm
1st mark -Midway b/w 2 PSIS
2nd mark- 15cm above 1st mark
Measure distance b/w upper and lower central incisor
teeth c a ruler
Measure distance b/w upper and lower central incisor
teeth c a ruler
Measure distance b/w most lateral points of the lower and
upper cuspid or the first bicuspid teeth c a ruler
ACCA