Evaluation of Joint Motion by Dortha Esch
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EV LU TIONOFJOINTMOTION
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Evaluation
ofJoint Motion
Methods
of
Measurement
and
Recording
byDorthaEschandMarvin Lepley
Illustrations
by Jean Magney
Universityof
Minnesota
Press
Minneapolis
N
N
SO
T
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Copyright 1971 by
Dortha
Esch and Marvin Lepley.
Copyright 1974
by the
University
of
Minnesota.
All
rights
reserved.
Published by theUniversityof MinnesotaPress
111 Third
Avenue
South, Suite 290, Minneapolis, MN 55401-2520
Printed in the United
States
o fAm ericaat
the University of MinnesotaPrintingDepartment.
Eighthprinting,
1997
LibraryofCongress Catalog Card Number: 73-93576
ISBN
0-8166-0714-1
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Preface
The
measurement
of the
motion produced
by an
individual
in any
given joint
of
the
body
is
done
to
determine
the
degree
an d
extent
of
loss
of
mobility
resulting from injury,
disease, o r
disuse.
The
record obtained from such
measurement provides
a
basis
for
patient treatment planning
by
therapists,
nurses, physicians,
an d
other members
of the
health care team.
The techniques ofmeasurement and the methodso frecording are not
diffi-
cult
to
learn.
To
ensure proper patient care each member
of the
health care
team, evenif he is notrequired to evaluate and
record,
should havean
appreciation
of the
problems faced
by a
person with joint impairment. Such
an understanding is enhancedby studyingthe techniques ofmeasuring joint
motion.
This manual presents
th e
most commonly accepted methods
ofmeasurement,
th e
full-circle
or
360 system
and the
half-circle
or
180 system.
A
special
unit
on
hand
evaluation
by use of
graphic means
is
included.
This manualhasbeen usedin the classroom fo r several years previousto
publication. W ehave
found
that students learn measurement techniquesand
recording witheasebecause each pagefollowingthe introductory material
provides
a guide to the techniquefor measuring ajointof the body. Direc-
tions
for the
testing position
and
placement
of the
measuring instrument
are
given. Illustrations
show
graphically correct instrument placement
and
give
th e normal
limits
ofmotionf or each joint. Aform is provided torecord th e
measurements obtained. Students
are
able
to
study
th e
manual quite inde-
pendently and learn techniques with minimal instructor assistance.
Sincethere
is
considerable variability
in
normal
limitsof
motion figures
given byvarious authors, w ehave arbitrarily selected one set: those used
by th ePhysical Medicine Departmentof theUniversity ofMinnesotawith
some modifications resulting from our ownobservations in the clinicand
classroom.
It
is our
belief that
the
manual presents
a
practical approach
to
learning
and
maybe successfully usedby students, therapists, andotherswho are re-
quired
to
evaluate joint mobility.
We would liketo express appreciation to all our colleagues w hohave will-
ingly consulted withu s during th e preparation ofthismanual. W e especially
want tothank JohnD . Allison, R.P,T. , andJames F. Pohtilla, R.P.T.,
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whoprovided information and valuable suggestions during th e earlydevelop-
ment of the manual. Special thank s go to Darlene Kriska and Barbara
Bartholomew
w ho
typed
th e
man uscript. The ir pleasant
an d
cooperative
attitude w as appreciated.
The preparation of the manualw as assisted financially, in
part,
by S . R .S.
Grant
N o.
16-P-56810, awarded
to the
Regional Rehabili tat ion R ese arch
an d
Training
Center,
RT-2, at the University of Minnesota Medical School.
Dor tha Esch,
B. S. ,
O . T . R .
Marvin
Lepley,
B. S. , O . T . R .
Universi ty ofMinnesota
October 1973
vi
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Contents
Introduction 3
The
180 System
6
The 360 System 7
Goniometers 8
General Procedures 10
Upper Extremity Measurement and Recording 14
Shoulder Flexion andExtension 15
ShoulderAbduction
an d
A dduction
16
Shoulder Rotation 17
Elbow Flexion andExtension 18
Pronation
and
Supination
19
Wrist Flexion andExtension 20
Radial
an d
Ulnar Deviation
21
Metacarpophalangeal Flexion andExtension 22
Proximal Interphalangeal FlexionandExtension 23
Distal Interphalangeal Flexion andExtension 24
Thumb Carpometacarpal Extension 25
Thumb
Metacarpophalangeal Flexion
and
Extension
26
T h u m b
Interphalangeal Flexion an dExtension 27
Abduction ofThumb 28
Optional Method:
Fingers an dThumb (Graphic Representation) 29
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Lower Extremity Measuremen t and Reco rding 32
H ip
Flexion an d
Extension
33
Alternate Method: H ipFlexion an d Extension 34
H ip
Abduction
and Addu ction 36
H ip
External
an d
Internal Rotation
37
Knee
Flexion and
Extension
38
Dorsiflexion
an d
Plantar
Flexion 39
Inversion and
Eversion
40
References 43
Index 43
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EV LU TION
OF JOINT MOTION
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Introduction
The
m e a sure m e n t
of
joint motion
is one of a
n u m b e r
of
evaluat ive proce-
dures
important
in
programs
for
rehabilitation
of the
physically handi-
capped.
Effective
rehabilitation planning requires con sideratio n
of all
aspects of
behavior ,
includingth e degree towhich an individualcanmove ,
for this influences
the
degree
to
which
he can
functionindependent ly .
The
following
are
some
of the
ways
in
wh ich physicians
an dtherapists
utilize
th e
evaluation
of
joint motion
as
part
of a
pat ient 's permanent rec-
ord: (1) Anaccurate record ofjoint motion provides informationwhich is
necessary
for
determining
th e
extent
of
d isability.
It is
important
for the
establishment ofrealistic goals, includinganestimate of the degreeof
rehabilitation that
is
feasible
for the
patient.
(2) The
joint measurem ent
record will indicate those treatment proce du res requ ired to improv e the
functional ability of the patient. It w ill also provide abasis for establish-
ing the appropriate activity level for the patient the activities whichhe
should be capable of and shouldb e expectedto perform at any given
time.
(3) Periodic measu reme nts, prope rly recorded , provide ameans of ob-
jectively
evaluatingprogress of the patient an dprovide data for evaluat-
ing the
effectiveness
of the
treatment regime. They
may
also
be an
important factor
in the
motivation
o f thepatient. (4)
Onlythrough
re -
search
can the
value
of a
therapeutic procedure
be
scientifically assessed.
If accurate and comparable measurements are available, theyca n become
th e
foundation
of meaningful studies.
The
m ost commo n methods
of
evaluating joint measurement employ
the
goniometer as the measuring
instrument.
Directions for the two most
commonsystems ofrecording th e
results
of the measurement, the 180
system and the 360 system , will be included in this manual. Indescrib-
in gm otion qu antitatively, both systems depend on the fact that along
bone is
like
a
lever rotating around
a
fulcrum.
As it
m o ve s
it
describes
the arc of acircle.
This
arc is
used
to
d e te rmine
th e
amount
of
motion
which
has occurred.
Although normal joint mobility allowsawide variety ofmo tions, standard-
ization
of the
measurement method
requires
specific definitions
of
each
motion to be evaluated. For this reason , mo vem ent as it occu rs around
an axis perpendicular to one of the three body plan es, sagit tal, coro nal,
or
transverse,
is
measured .
See
Figure 1,
In the
following list
of mo-
tions asterisks designate thosew hich, in the 360 system , are not related
to the fullcircle;an
arbitrary
startingposition has been designatedand
these motionsare calculatedas deviations from 0.
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Figure
1.
Planes ofmotion
Place
the
point
of a
toothpick
on
either
dot.
It
represents
th e coronal
axis.
The arm and thigh
flex
an d
extend
in a
sagittal
plane,,
Holding
the
toothpick
o n
one ofthese dots demon-
strates
the
sagittal axis.
Abduction and adduction
occur in the coronal
plane.
In
this
example the
toothpickrepresents
th evertical axis.
Rotation
of the
head ,
arm, leg,
or
trunk
occurs in the
hori-
zontal plane.
Motions
in a
Sagittal Plane
around
a
Coronal Axis
Shoulder: Flexion and
extension,,
Internal and external rotation.
Elbow: Flexion an dextension
W rist: Flexion and extension
Fingers:
Flexion an d extension
Hip: Flexion an dextension
Knee: Flexion
an d
extension
Ankle:
Dorsi
an dplantar flexion
Thum b: * Abduction
Motions in a Coronal Plane around a Sagittal Axis
Shoulder: Abduction an d adduction
Wrist: *Radial andulnar deviation
Thum b: * Extension
Hip:
Abduction
an daddu ction
Foot: *Eversion an d inversion
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Motionsin a Horizontal Plane aroundaVerticalAxis
Forearm: *Supination
and
pronation
Hip:
*
Internal an dexternal rotation
Figure
2
demonstrates motion
at the elbow
joint,,
As the
forearm moves,
th e hand
describes
the arc of acircle. Toprovide anumerical system
fo r analysis ofmotiona 0position of thecircle is arbitrarily designated.
In Figure
2 the 0
position
is
designated
at the
position
of
maximum elbow
extension, which
is the
anatomic position,
and the
hand describes
a
150
arc of
motion
as it
moves
to
maximal flexion.
Figure
2.
Motion
at the
elbow joint
The
goniometer is used tomeasure th eangle produced betweentw obony
segments when maximal motion
in a
particularplane
is
achieved.
It is a
simple device with
two
levers,
or
arms,
and
with
aprotractor
attached
at the end of one
arm.
See
Figure 5.
The
other
arm
forms
a
pointer
at the
end.
At the
center
of the
protractor, where
the two
arms join,
an
axis allows movement.
The
goniometer
is
placed
on the
extremity with
its
axis
centered
on the
joint
and its
arms aligned with designated
skele-
ta l
landmarks.
For
elbow
flexion an d
extension,
as shown in
Figure
2,
one
arm of the
goniometer would
be
aligned with
the humerus and the
other with
the
radius.
The
axis
wouldbe
located
at the
elbow joint.
The
reading on the
protractor
scale for extension
would
be 0 and the reading
for flexion wouldbe150. Theforearm has movedin asagittalplane
from
extension to flexion resulting in a total range ofmotionof 150.
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Assessment ofdisability in apatient requires that th e results ofjoint
measurement
on him be
compared with
a
n o r m .
If the
patient
has a
uni -
lateral
disability th eme asurements of his unaffected extremity shouldb e
used for comparison. Me asureme nts may also be compared to anestab-
l ished normal range ofmot ion . Inthis m anualyouwil l find th e n or ma l
limits given for each mo tion. These are onlyaverageswhichwere cal-
culated
following th e measu r emen t of a n u mber ofnormal sub jec t s .
Slight variations are found in the no rmal lim its given by various autho r-
ities.
Consequently,
it
mu s t
be
remembered that they
are not
absolute
f igures
and can
only
be
used
as a
guide
for
what
may be
normal
for any
individual. A lso to be considere d are a num ber of nonpathological factors
which may affect n ormal joint mo bility, some ofwhich are thefollowing:
(1)
hereditary an d constitutional factors; (2)sex; (3)age; (4) physical
training
and
activity;
(5 )
occupation;
(6 )
pos ture ;
(7 )
anxietyor stress.
TH E 180 SYSTEM
For the 180 system the 0position is designated as the
starting
position
of each motion . In most instances the
starting
position is co mparab le to
the anatom ic position and the halfcircle should be visualized as superim-
posed
on the
body
in the
plane
in
which motion will occ ur.
The
180 posi-
tion is
directly
overhead and the 0 position tow ard the feet. All motions
are
from
0
toward 180.
The
motions at thewristandshoulder in thesagittalplane are different
from
all others
motion
is
possible
in
both directions from
the 0
ana-
tomic position. T he
term
hyperextension is used to describe motion in a
posteriordirection from
the
starting
position.
Figure 3 shows th e normal range ofmotion of the shoulder in flexion and
extension . Shoulder flexion wo uldb e recorded as 170 an d hyperextension
as
60.
The
total range
of
motion
is
230
170 plu s 60.
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Figure 3. Motion of the shoulder in
flexion
an dextension (180 system)
TH E
360
SYSTEM
The360 system relatesmovements occurring in the coronal and sagittal
planes
to a
full
circle. Withthe body in
anatomic position,
the circle
may be
visualized
as
superimposed
on it in the
same plane
in
which
mo-
tionwill occur.
The 0 (360)
position will
be
overhead
and the
180
position toward
th e
feet. Thus
flexion and
abduction
are
motions toward
0 andadductionandextension are toward 360.
Certain motions (see page 5) cannot be
related
to the
full
circle for mea-
surement. Forthese motionsastartingposition isarbitrarilydesignated
an d
they
are
measured
as
deviations from
0.
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Figure
4
shows
th e
normal range
of
motion
of the
shoulder
in
flexion
an d
extension. Shoulderflexion would
be
recorded
as 10 and
extension
as
240. Thetotalrange ofmotionisthen 230
240 minus 10.
Figure4. Range of motion of the shoulder in flexion and extension (360 system)
GONIOMETERS
Goniometers are generally madeofplasticormetaland are available
from a number of hospital equipment supply companies. Theyvaryin
size
from
small pocket models
to
rather largeones.
The
advantage
of
th e small goniometer
is
that
it may be
carried
in the
pocket, which
is
convenientif you are seeing wardpatients. Thesmall goniometer is also
more satisfactory for
measuring
the
smaller
joints such
as the
fingers.
Theadvantage
of the
goniometer with longer
armsis its greater
accuracy
inmeasuring the
larger
joints suchas thehip:thelongerarmscan be
lined upwith th e body segments withmore accuracy.
Goniometers are either 180 (half
circle)
or360 (full circle). Thefull-
circlegoniometer is somewhat more convenientto usewiththe360 sys-
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tern
because
it has the
completecirclescale
and
readings
in
excess
of
180
may betaken directly from th e scale. Half-circle goniometers pose
no
real
probleminmeasuring;on e canadaptto their use with relative
ease. Their inconveniencelies
in the
fact that
you
must
ad ddegreesif
an extremity movesbeyond 180an dalso that it mustbereversed in
some cases resulting in the scale facing th e body of
your
subject. The
goniometer must thenbe removedfromyour subject s body and reversed
so that
th e
scale
may be
read.
One very important feature to look for on a goniometer is a lockingnut
fo r th e
fulcrum.
The lockingnut is tightened just
before
removingthe
goniometer from th e body segment, assuring an accurate reading. See
Figure 5.
There are other types ofgoniometers on themarket.
Some
incorporate
fluids withafree floating bubble. Thebubble provides th e reading upon
completion
of
motion.
Figure
5.
Agoniometer in twopositions
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GeneralProcedures
The
following are the general procedures recommended
for measurement of joint motion
1.
Evaluat ion
of the
patient should
be
done
in a
roomwhich
is
warm
an d
wel l lighted. Themeasuremen t process and its purpose should be ex-
plained. During
th e
evaluation
you
should
be
alert
tosigns of
discomfort
or fat igue . Requ iringyou r subjecttomaintaina given position for a pro-
longed period wil l cause muscle fatigue which
may
result
in
decreased
motion.
2. Expose
the
extremity
to be
m easured us ing draping
when
appropria te .
3. Place the extrem ity in the proper testing pos ition. For teaching pur -
poses
this
manua l
has
specified testing positions. Actually positions vary
but
should allow freedom
of
m o ve m e nt
and
attempt
to
decrease
th e
proba-
bility ofcompen satory motion. A sprev ious ly indicated, thecalcula t ion
of
range ofmotion
(ROM)
is based onm o ve m e ntwhich
starts
with the ex-
trem ity in anatomic position or an arbitrary starting position. The pre-
ferred
testingpositions
do not
always exactly duplicate anatomic position.
For purposes ofcalculation it willbe necessary for you to visualize th e
circle superimposed
on the
extremitywith
the 0
po sition placed
as it
would
be if the extremity were in anatomic position . Figures 6 and 7
demonstrate
this
process.
4. Instruct your subje cttomovethe extremity through the desired range
o f
motion.
Besure
that
th e
extremity
is
maintained
in theproper
plane
of motion since deviations will result
in
inaccura te measurem ent .
5. When
maximum motion
is
achieved
th e
measurement should
be
taken,
using th e goniometer as follows:
The fulcrum must becentered over th e joint and thearms lined upprop-
erly on the
body
segmen ts. Reading s should be takenas quickly as
possible
to
minim ize fa t iguing
of the
patient.
The pre fe r r e d method
of
taking
a
reading
is to
have
your patient complete
th e range, watchfor subst i tut ions, an d then lineup the goniometer for
measurement .
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Figure
6. The
360 system. Regardless
of the
testing position,
the 0
position of the
circlemust
be
located
as it would be if the
extremity
were in anatomic position.
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Figure7. The180 system. Regardless of thetestingposition the
0 position must belocated as it would be if the extremity were in
anatomicposition.
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Metalgoniometers should
be
pre-warmed withyourhands before placing
them in
contact
with th e
patient'sskin.
In
addition,
you
must
be careful
not
topinchthepatient's skin orcatch hair
between
the arm and the scale
as y ou use thegoniometer. It is frequently unnecessaryto hold th egoni-
ometer
in
direct contact with
the
skin.
It can be
held
a
short distance
away
without
loss ofaccuracy. Youreyes should be in a direct line with
the scale. Reading a goniometer at an angleresultsin inaccurate reading,
Thegoniometer should
be
carefully placed: fulcrum over
th e
axis
of the
joint
and the
arms centered along
th e
body
segments.
See
Figure
8. The
eye of the
person reading
th e
goniometershould
be on a
level
with the
scale
to
assure accuracy.
6.
Themeasurement may be ofpassive oractive motionan dthis should
bespecified on therecord. For various reasons these mayvary and in
manyinstances both active an dpassive motion
should
bemeasured.
Figure
8.
Placement
of the
goniometer
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Upper
Extremity Measurement
andRecording
The
following study m ethod
is
recommended:
1. In the
classroom sett ing
it is
recommen ded that subjects being mea-
sured complete
less
than normal limitsofmotion. Doingthiswill pro-
duce a more
realistic
experience, mo re
similar
to measu ring an extremity
with actual joint limitation.
2.
Study
each illustration noting goniom eter placementand the normal
limits ofmo t ion.
3. Read the instructions for testing position andgoniometer placement .
4.
Place
your subject
in the
proper
testing
position
asdescribed.
Have
him complete
th e
range
of
motion
he is
capable
of
produc ing.
5.
Place
the
goniometer
asdirectedand
carefully take
areading.
6.
En ter the readings in the spaces provid ed. Calculate the total range
of motion (ROM) an denter the figure in the space provided.
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Shoulder Flexion
and
Extension
TESTING POSITION: Arm atside. Forearm extended. Palm
facing
body.
GONIOMETER P L A C E M E N T :
Fulcrum: Center
at the
shoulder joint just below
th e
acromion.
Arms: (1)Parallelto the
mid-axillaryline
of the trunk. (2)
Parallel
to
th e
longitudinal axis of the humerus alongth elateral
side.
Joint Measurement Record:
(180 System) Flexion.
(360 System) Flexion
Hyperextension
Extension
Total
R OM
.Total
ROM.
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Shoulder Abduction and Adduction
TESTING POSITION: Arm at side. Forearm extended.
Palm
facing body.
GONIOMETER
PLACEMENT:
Fulcrum: Center
at the
shoulder joint,
posteriorly.
Arms: (1)Parallel with themidline of the body. (Longitudinal
axis
of the
vertebral
column.) (2)
Parallel
to the longitudinal axisof the humerus,
Note: It is
necessary
torotate externally at the end of the
range
to
achieve maximum abduction.
Joint
Measurement
Record:
(180 System) Abduction
(360 System) Abduction
.Adduction.
Adduction
.TotalRO M
Total
RO M
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Shoulder Rotation
TESTING POSITION:Arm
abducted
to
90.
Elbow
flexed
to
90.
Palm
down.
GONIOMETER
P L A C E M E N T :
Fulcrum: Center
on the
elbow joint.
Arms-.
(1)Parallel to the
mid-axillary line
of the
thorax.
(2)Parallel to
the longitudinal
axis
of theulna.
JointMeasurement Record:
(180 System) Int. Rotation
(360
System) Int. Rotation
.Ext. Rotation
Ext. Rotation
Total ROM.
TotalROM
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Elbow Flexion
andExtension
TESTING POSITION: Arm at side. Forearm extended andsupinated.
GONIOMETER P L A C E M E N T :
Fulcrum: Centered over lateralaspect of the
elbow
joint.
Arms:
(1)Parallel to the
longitudinal axis
of the
humerus.
(2)
Parallel
to the longitudinal axisof the
radius.
Joint Measurement Record:
(180 System)Flexion.
(360System) Flexion.
.Extension.
Extension
.Total RO M.
Total ROM.
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Pronationand Supination
TESTING
POSITION: A rm adducted, elbowflexed to 90, to rule out
should er rotation. Forearm midway between pronation andsupina-
tion.
GON IOM ET ER PL A C EM EN T :
Fulcrum: Centered at the
ulnar
styloid.
A r m s : (1 )
Parallel
with th e longitudinalaxis of the hu mer u s anteriorly.
2 Pronation on the dorsal surface of thewrist. Supination on
th evolar su rface of the
wrist.
Joint Measurement Record:
(Both Systems) Pronation.
.Supination.
Total ROM .
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Wrist
Flexion
and
Extension
TESTING POSITION: Arm at side
0
Elbow flexed to a comfortable position.
Palm
down.
GONIOMETER
PLACEMENT:
Fulcrum: Centeredat th eulnar styloid.
Arms: (1)Parallel to the longitudinal axis of theulna. (2)Parallel to
th e
longitudinalaxis
of the
fifth metacarpal.
Joint Measurement Record
(180 System)
Flexion
(360System) Flexion.
Extension
Extension.
.Total ROM
Total
ROM.
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Radialand UlnarDeviation
TESTING POSITION: Arm at side. Elbow
flexed
to a
comfortable
position. Forearm pronated.
GON I OM E TE R P L A C E M E N T :
Fulcrum: Centered just proximal to the thirdmetacarpalover the
capitate.
Arms:
(1)Alongthe
midline
of the
dorsal surface
of the
forearm.
2 Parallel to the longitudinal axisof the third metacarpal.
Joint Measurement Record:
(Both
Systems) Radial Dev
UlnarDev.
Total
RO M
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MetacarpophalangealFlexion
and Extension
TESTING
POSITION: Hand in aco mfo rtable posi tion for measurement .
Wrist in a neutral position as illustrated to allow for proper place-
ment of the goniometer .
G O N I O M E T E R :
Fulcrum: Cen tered at the
metacarpophalangeal
joint.
A r m s : (1) On the dorsum of the metacarpal. (2) On the dorsum of
th eproximal phalanx.
Jo in t Me asurement Reco rd:
(180 System) Flexion.
(360
System) Flexion.
.Extension.
.Extension.
.TotalR O M .
Total ROM.
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Proximal
Interphalangeal Flexion
and
Extension
TESTING
POSITION:
Hand
in a
com fortable
position
fo r
measure-
me nt. W rist in a neu tral or slightly do rsiflexed position.
GON I OM E TE RP L A C E M E N T :
Fulcrum: Centered at the proximal interphalangeal joint,,
Arm s:
(1) On the
dorsal surface
of the
proximal phalanx.
(2) On the
dorsal surface
o f the
middle phalanx.
Joint Measureme nt Record :
(180 System) Flexion
(360 System) Flexion
Extension.
Extension.
.Total ROM.
TotalRO M
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Distal Interphalangeal Flexion
and Extension
TESTING POSITION: Hand in a comfo rtable position fo r measure -
ment . Wris t
in a
neu tral
or
slightly dorsiflexed position.
G O N I O M E T E R P L A C E M E N T :
Fulcru m: Cen tered at the distal interphalangeal joint.
Arms: (1) On the dorsal surface of the middle phalanx,
th edorsal
surface
of thedistal
phalanx.
(2)
On
Joint Measurement Record:
(180 System) Flexion
(360
System) Flexion
.Extension,
Extension
.TotalROM
Total
ROM
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Thumb
Carpometacarpal Extension
TES TING POSITION: Hand supinated.
GONIOMETER
P L A C E M E N T :
Arms:
(1)
Along
the
volar surface
of the
third metacarpal.
(2)
Paral-
lel to the midline of the first metacarpal.
Joint Measurement Record:
(BothSystems) Extension from
to TotalR OM
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Thumb
Metacarpophalangeal
Flexion
and Extension
TESTING
POSITION:
Hand
supinated.
G O N I O M E T E R
P L A C E M E N T :
Fulcrum: Centered at the metacarpophalangeal
joint,,
A r m s : (1) On the dorsal surface of the first metacarpal. (2) On the
do rsal surface of the proximal phalanx.
Note: Mobility of the metacarpophalangeal jointof the thumbvaries,
Itsho uld fall withinth elimits specified.
Joint Measurement Record:
.Extension.
Extension
.TotalR O M .
Total
R OM
26
(180 System) Flexion
(360 System) Flexion
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Thumb
Interphalangeal Flexion
andExtension
TESTING
POSITION:
Hand
supinated.
GONIOMETER PLACEMENT:
Fulcrum: Centered
at the
interphalangeal joint.
Arms:
(1) On the
dorsalsurface
of the
proximalphalanx.
(2) On the
dorsal surface of thedistal phalanx.
Note: Thumb interphalangeal flexion an dextension vary. Flexion should
approximate90 as illustrated.
Joint Measurement Record:
(180 System) Flexion
(360System) Flexion
.Extension.
.Extension.
.Total
ROM.
.Total
ROM.
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Abduction
of
Thumb
TESTING POSITION: Forearm midw ay between pronation
an d
supination.
GONIOMETEPx P L A C E M E N T :
A r ms : (1 )Alongthe
lateral
surface of the second metacarpal. (2 )
Paral-
lel to the midline of thefirstmetacarpal.
Joint
Me asurement Reco rd:
(Both
Systems)
Adduction.
.Abduction.
Total ROM .
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Optional Method: Fingers
and
Thumb
Graphic Representation)
Graphic
representation
is an
evaluative procedure which
may be
substituted for or supplemental togoniometric measurement of the
f ingers
andthumb. Becauseitresultsin apicture, it may bemore
meaningful to thepatient and mayhelp toincrease motivation.
Graphic
representation
may
also
beuseful to
healthcare team mem-
bers unfamiliar with goniometry.
It may be
used
for
flexion, exten-
sion, abduction, an d adductionof the fingers an dthumb. Theprocedure
is as
follows.
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Abduction and
Add uction
1. Drawastraight line throughthe centerof an 81/2 x 11 sheetof
paper.
2. Place the hand, palm down, on thepaper,
with
th e third finger
centered
over theline.
3. Draw around each finger and the thum b in the adducted
position,,
4. Ask your subject to abduct the fingers and thum b and draw around
them
again.
Inordertorepresent abduction of the
third
finger it should
be
movedfirst in aradial
direction
andthenin an
ulnar
direction.
5.
The
patient's name
and
hospitalnumber ,
the
therapist's
name,
the
type
of
motion (passive
or
active),
and the
date should
be
recorded
on
each drawing. Left or right hand should be specified.
6.
The drawings shouldbe repeated on
separate
sheets, generally once
a week , to
record
progressor
regression.
Thesheetsmay be overlayed
an d heldup to alight sourcetoillustrate change inmotion. It is
possible
to record both abduction and adduction on a single sheet; how ever , the
overlay of
lines
becomes
confusing.
The
third
metacarpal should
bemaintained overthecenter
lineas the fingers are moved .
The middle finger should be
abducted
ulnarward andradial-
ward from
the
center line.
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Flexion
an d
Extension
Place theulnar side of the index finger on the edge of a5 x 8
file
card.
The
card will
be at
right angles
to the
dorsal surface
of the
hand.
2.
With
the metacarpophalangeal and
interphalangeal joints
in
maxi-
mal extension, draw aroundthe finger.
3. Askyour subject to
flex
his finger an ddraw around it in
this
position.
4. Progress
will
be shownbest if the
periodic drawings
are
done
on
the
same
sheet
orcards. The use of ad ifferent colored pencilfor each
drawingis recommended.
5.
Record
th e
same information
on
each card
as was
necessary
for
abduction
an dadduction.
Maintain a 90 angle between
the
dor
sum o f the hand and the
card.
Trace
around the finger
in
th e fully extended position
and then in maximal flexion.
Theillustration shows a completed card. Lines may be
projected along the
center
line of each finger and the joint
axis indicated
if
desired.
A
goniometer
can
then
be
super-
imposed
on theline an daxis torecord degrees of
mo tion.
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Lower
Extremity Measurement
and Recording
Follow
th e
recommended study methods outlined
for the
upper
extremities.
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Alternate Method:
Hip
Flexion
and
Extension
This method of me asurem ent is sub ject to inaccuracy because of
posterior
pelvic
tilt.
As the leg
extends
so
does
th e
lumbar
spine
Therefore , one
mu s t
be as
carefu l
as
possible that motion
is confined
to the hip
joint.
This is, however, almost impossible to achieve.
Theresult is a
greater
excu rsion of exten sion, part of it hip join t,
partof it
lumbar spine.
TESTING
POSITION: For flexion -
supine;
for
extension
-
prone.
GONIOMETER PLACEMENT:
Fulcrum:
Centered
at the
greater t rochanter .
A r m s :
(1 )
Parallel
to the longitudinal
axis
of the trunk . (2)
Parallel
to the longitudinalaxis of thef e m u r .
Note.-
Onlymeasu reme nt of extension is illustrated. For flexion you r
subject is supine and the goniometer placement is the same as for ex-
tension. Maximal limits for flexion with knee extended using th e 180
system are 90 and for the 360 system 90. With the knee
flexed,
180 system 130 and360 system 50.
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Joint
Measurement Record:
(180 System) Flexion_
(360System) Flexion_
.Extension.
Extension
.Total
ROM.
Total ROM.
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Hip
Abduction
and Adduction
G O NIO ME T E R PLACEMENT:
Arms: (1)
Parallel
to a
line
drawnbetween the two
anterior superior
iliac spines- at thelevelof thegreater trochanter.
(An
alternate
methodplaces
the
goniometer
on the
line
betweenthe two
anterior
superior iliac spines.) (2 )Parallel to the lon gitudinalaxiso f the
femur .
Joint
Measurement
Record:
(180 System) Adduction.
(360 System) Adduction.
.Abduction.
.Abduction.
.TotalROM.
.TotalROM.
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HipExternal
and
InternalRotation
TESTING
POSITION: (1)Sittingwith the knee flexed to 90. (2) Supine
with th ekneeflexed to 90.
G O N I O M E T E R PLACEMENT:
Fulcrum: Centered
on the
anterior surface
of the
knee joint.
Arms: Both
arms
are placedparallelto the longitudinal
axis
of the
tibiawith the leg in the testing position. One arm remains in
this position
and the
other follows
the
tibia
as the hip is
rotated.
Joint Measurement Record:
(Both
Systems) Ext. Rotation
Int.
Rotation Total ROM.
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Knee Flexionand Extension
G O N I O M E T E R P L A C E M E N T :
Fulcrum : Ce ntered on the lateral side of the knee joint.
Arms: (1)Parallel to the longitudinalaxis of the femur . (2 )Parallel
to the
longitudinal axis
of the
tibia.
Joint
Measurement Record:
(180 System) Flexion.
(360System)
Flexion.
.Extension.
Extension
.TotalR O M .
.TotalROM
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Dorsiflexion andPlantar Flexion
TESTING POSITION:
Sitting
with
the
knee flexed.
GONIOMETER
PLACEMENT:
Fulcrum: Center at the sole of the foot in
line
withthe longitudinal
axis
of thefibula.
Arms: (1)Parallel to the longitudinal axis of the fibula. (2 )Parallel
to the longitudinal axis of the
fifth metatarsal.
Joint Measurement Record:
(180
System)Plantar Flex
Dorsiflex
Total ROM.
(360
System)
Plantar
Flex Dorsiflex Total ROM.
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Inversion andEversion
TESTING POSITION: Sitting
with
the knee
flexed.
G O NIO ME T E R PLACEMENT:
A r m s : Eversion (1)Parallel to the longitudinal axis of thetibia medially.
(2)
Parallel
to theplantar
surface
of the
sole. Inversion
(1)
Parallel
to the longitudinal axis of thetibia laterally. (2 )Parallel to the
plantar
surface of the
heel.
Joint Measurement Record:
(Both Systems) Inversion Eversion Total ROM.
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REFERENCES ND
INDEX
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References
Clayson SJ, MundaleMO,
Kottke
FJ:
Goniometer Adaptation
for
Measuring
H ip
Extension. ArchPhys
Med 47:
255, 1966.
JointMotion:
A
Method
of
Measuring
an d
Recording. Chicago,
American AcademyofOrthopaedic Surgeons, 1965.
Moore
ML in Licht: Therapeutic
Exercise,
2nd ed. revised. New
Haven ,
Elizabeth Licht,
Publisher,
1965,
pp. 128-162.
Muscle FunctionTests andMeasurements, Laboratory Manual.
Course
in Physical
Therapy, University
of
Minnesota.
Index
Abduction, 16, 21, 28, 30, 36
Adduction,
16 , 21 , 30, 36
Ankle: dorsiflexion,
39;plantar
f lexion, 39
Axes
of
motion,
4
Dorsiflexion, 39
Elbow:
extension,
18;
flexion,
18
Eversion,
40
Extension,
15, 18, 20, 22, 23, 24,
25 , 26, 27, 31,
33-35,
38
External rotation, 17,
37
Fingers:
abduction,
30;
adduction,
30;extension,
22, 23, 24, 31;
f lexion,
22, 23, 24, 31
Flexion,
15, 18, 20, 22, 23, 24, 26,
27,
31,
33-35,
38
Foot:eversion,
4 0 ;
inversion, 40 ;
pronation,
40 ;
supination
40
Forearm:pronation, 19;supina-
tion,
19
Goniometers:
types o f , 8, 9; use of ,
10, 13
Graphic Representation, 29-31
Hip:
abduction, 36; adduction, 36;
extension,
33-35;
external
rota-
tion,
37; flexion,
33-35; internal
rotation, 37;
lateral
rotation, 37;
medial rotation,37
Internal rotation,
17,37
Inversion, 40
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Knee: extension, 38;flexion, 38
Lateral
rota t ion, 17 ,37
Measurement: 180
system,
6, 7;
360
system,
7,8
Medialrotation, 17,37
Planes
of motion, 4
Plantar flexion, 39
Pronation, 19,40
Radial deviation, 21
Shoulder: abduction, 16; adduction,
16;extension, 15;external
rota-
t ion, 17; flexion,
15 ;
internal
rotation, 17;
lateral rotation,
17; medial rotation,
17
Supination,
19,40
Thumb:
abduction, 28, 30; adduc-
t ion, 30;extension, 25, 26, 27 ,
31;
flexion,
26, 27, 31
Ulnar deviation, 21
Wrist : abduction, 21; adduction, 21;
extension, 20; flexion, 20 ; radial
deviation, 21;ulnar deviation, 21