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228 Cards in this Set
- Front
- Back
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What is goniometry? ***
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the procedure of measuring the amount of motion in a joint
from the Greek words: gonia - angle metron - measure |
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What instruments are commonly used in goniometry? ***
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- universal goniometer (as well as others of differing sizes and shapes)
- inclinometer |
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What is an inclinometer? ***
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a gravity-dependent goniometer
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Composition of a universial goniometer ***
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- stationary or proximal arm
- proximal arm usually stationary - fulcrum/body - moving or distal arm - distal arm usually moving |
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Which ROM is typically greater, AROM or PROM? ***
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PROM
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Which ROM is typically measured/recorded via goniometry? Why? ***
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- PROM
- because the ROM is a bit larger |
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True goniometry includes.... ***
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the last few degrees of ROM
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What is the purpose of goniometry? ***
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- aid in diagnosis
- view progress - modify treatment - provide motivation - establish database; compare to normal - research - medico-legal information (medical charts are legal documents; our SOAP notes, etc.) - orthoses |
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Name some factors affecting ROM norms. ***
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- individual differences - heredity
- age - gender - joint structure - physical activity |
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Goniometric measurements are taken in the _____ _____.***
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cardinal planes
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Name the cardinal planes and their corresponding axes of rotation. ***
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- sagittal plane (medial-lateral or frontal axis)
- frontal plane (anterior-posterior or sagittal axis) - transverse plane (vertical axis) |
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What are osteokinematics? ***
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- gross movement of the bone shaft
- usually the angular motion produced around fixed axis (joint) - e.g., flexion, extension, abduction, rotation |
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What are arthrokinematics? ***
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- movement that occurs at the joint surface
- small movement that cannot be measured with goni - also called accessory motion or joint play motion - e. g., roll, spin, slide/glide, compression, distraction |
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What are some of the notation systems used in goniometry? ***
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-- 0 - 180 degree system
-- 180 - 0 degree system -- 360 degree system |
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Which notation system do we use in goniometry? ***
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0 - 180 degree system
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What is "end feel"? ***
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- a feeling experienced by the examiner as resistance to further motion at the end of ROM
- every motion has a normal end feel |
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What are the physiologic (normal) end feels? ***
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- soft
- firm - hard |
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What is a soft end feel? ***
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- characterized by soft tissue approximation (e.g., elbow, hip, and knee flexion)
- not many in the body |
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What is a firm end feel? ***
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- characterized by muscular, capsular, or ligamentous stretch
- most common end feel |
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What is a hard end feel? ***
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- characterized by bone meeting bone
- e.g., elbow extension, forearm pronation, radial deviation, ankle (tarsal) eversion |
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Describe a pathological soft end feel. ***
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- occurs sooner or later in ROM than usual, or in a
- joint that normally has firm or hard end feel - e.g., due to edema (in documentation, include comment as to reason suspected for the pathological end feel/ROM) |
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Describe a pathological firm end feel. ***
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- occurs sooner or later in ROM than usual, or in a
- joint that normally has soft or hard end feel - e.g., due to shortening of ST (in documentation, include comment as to reason suspected for the pathological end feel/ROM) |
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Describe a pathological hard end feel. ***
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- occurs sooner or later in ROM than usual, or in a
- joint that usually has a soft or firm end feel - bony block - e.g., due to chondromalacia, OA, loose body in joint, myositis ossificans, fx (in documentation, include comment as to reason suspected for the pathological end feel/ROM) |
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Describe a pathological empty end feel. ***
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- no real end feel; pain prevents reaching end of ROM; pt. protects
- e.g., acute inflammation, psychogenic (in documentation, include comment as to reason suspected for the pathological end feel/ROM) |
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What is a capsular pattern in ROM limitation? ***
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- characteristic proportional ROM limitation (pattern of ROM restriction) within joint d/t involvement of synovial membrane or capsule
- other motions in joint may also be restricted - caused by ---- joint effusion – too much fluid in capsule ---- capsular fibrosis – hardening of capsule - per the book, a capsular pattern affects most/all motions at the joint, while a noncapsular pattern affects only about 1-2 motions |
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Describe the capsular pattern effects on the glenohumeral joint. ***
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ER > abd > IR
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Describe the capsular pattern effects on the elbow joint. ***
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flex > ext
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Describe the capsular pattern effects on the radioulnar joint. ***
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pronation and supination are equally affected
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Describe the capsular pattern effects on the wrist joint. ***
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flexion and extension are equally affected
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Describe the capsular pattern effects on the hip joint. ***
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IR and flex > abd > ext
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Describe the capsular pattern effects on the knee joint. ***
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flex > ext
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Describe the capsular pattern effects on the ankle joint. ***
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PF > DF
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Define "validity" in testing. ***
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degree to which an instrument measures what it is purported to measure
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Define "reliability" in testing. ***
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amount of consistency between successive measurements of same subject under same conditions
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What is intratester reliability? ***
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consistent results with successive measurements made by the same therapist/evaluator
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What is intertester reliability? ***
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consistent results with successive measurements made by different therapists/evaluators
(desired variance within 5 degrees) |
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What is the desired variance range for intertester reliability? ***
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within 5 degrees
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What is biological variation? ***
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varying norms based on age, sex, race, genetics, medical history, and condition
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What is temporal variation? ***
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variation with time of day, activity level, emotional state, circadian rhythm (> 10 degrees)
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What is the threshold for temporal variance? ***
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greater than 10 degrees
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How is the joint positioned for goniometric testing? ***
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- joint in zero starting (if possible)
- allow complete ROM - provide for pt. comfort and modesty (drape if necessary) - measure all you can in same position (don't have patient moving prone, to sitting, to prone, to supine, etc.) |
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How is the joint stabilized for goniometric testing? ***
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- isolate joint being tested
- support joint being tested - stabilize proximal segment (the most correct goniometric measure is obtained when proximal segment is stabilized) - prevent substitution or accessory motion |
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How are the joint and goniometer aligned for goniometric testing? ***
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- use accepted positioning & landmarks
- expose joint tested—needs to be done on skin! |
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Where are the results of goniometric evaluation recorded? ***
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in the "Objective" portion of the SOAP note
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How would a listing of PROMs for the right shoulder be recorded? ***
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PROM ® shoulder:
flex = 160° ext = 50° abd = 150° ER = 75° IR = 60° |
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How would a PROM of the right knee be recorded if there is a lack of full range of extension? (show both list and range forms) ***
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PROM ® knee
flex = 120° ext = -20° or ® knee PROM = 20° to 120° |
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How would a PROM of the right knee be recorded if there is hyperextension? (show both list and range forms) ***
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PROM ® knee
flex = 120° hyperext = 20° or ® knee PROM = 20° to 0° to 120° |
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What instruments may be used to measure cervical and/or trunk ROM? ***
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- tape measure
- universal goniometer - inclinometer - CROM/BROM |
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How is cervical flexion/extension ROM measured with a tape measure? ***
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CTS
(chin to sternum) |
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How is cervical lateral flexion ROM measured with a tape measure? ***
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MTA
(mastoid to acromion) |
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How is cervical rotation ROM measured with a tape measure? ***
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CTA
(chin to acromion) |
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How is cervical flexion/extension ROM measured with a universal goniometer? ***
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F = external auditory meatus (NOT ear)
PA = perpendicular/parallel to floor DA = nose |
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How is cervical lateral flexion ROM measured with a universal goniometer? ***
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F = C7
PA = spine DA = posterior cranium |
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How is cervical rotation ROM measured with a universal goniometer? ***
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F = superior center of cranium
PA = imaginary line from acromion to acromion DA = tip of nose |
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How is cervical flexion/extension ROM measured by (double) inclinometer? ***
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- position at calvaria and T1* in sagittal plane (we are currently only doing single inclinometer at calvaria)
- take the difference between the two - record as: ext – 0 – flex (45° – 0° – 45°) AAOS * actually, for extension the book says to position the inclinometer over the spine of the scapula, since if it is placed directly over T1, the head may contact it in full extension |
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How is cervical lateral flexion ROM measured by (double) inclinometer? ***
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- position at calvaria and T1 in frontal plane (we are currently only doing single inclinometer at calvaria)
- take the difference between the two - record as: L.Lat.Flex. – 0 – R.Lat.Flex (45° - 0° - 45°) AAOS |
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How is cervical rotation ROM measured by inclinometer? ***
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- pt. supine, position on forehead
- record as: L.Rot. – 0 – R.Rot. (60° – 0° – 60°) AAOS |
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How is thoracolumbar flexion/extension measured with a tape measure? ***
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- FTF (fingers to floor)
- record distance between C7 and S1 (book says S2) at neutral and after the motion; subtract to get the difference |
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How is thoracolumbar lateral flexion measured with a tape measure? ***
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- FTF (fingers to fibula)
- record distance between fingertips at neutral and after the motion; subtract to get the difference |
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How is thoracolumbar flexion/extension measured with a universal goniometer? ***
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nothing given in notes and book only has use of tape measure or double inclinometers
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How is thoracolumbar lateral flexion measured with a universal goniometer? ***
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F = S1 (book says S2)
PA = perpendicular to ground DA = C7 ROM = 35 degrees |
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How is thoracolumbar rotation measured with a universal goniometer? ***
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F = center of cranium
PA = parallel to iliac crests DA = acromial processes |
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How is thoracolumbar spinal motion measured by double inclinometer? ***
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- position at T1 and S2
(top "foot" at C7 for superior inclinometer; bottom "foot" at top of gluteal cleft for inferior inclinometer) - zero out both inclinometers - flex forward, read both, subtract the two (inclinometers in sagittal plane) - repeat for extension (inclinometers in sagittal plane) - repeat for lateral bend (inclinometers in frontal plane) - repeat for rotation (inclinometers in transverse plane) |
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How is lumbar spinal flexion/extension measured by double inclinometer? ***
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- position at T12--flex-- measure (inclinometer in sagittal plane)
- position at T12--extend-- measure (inclinometer in sagittal plane) - position at S2--flex--measure (inclinometer in sagittal plane) - position at S2--extend-- measure (inclinometer in sagittal plane) - subtract for true lumbar flexion (60°) and extension (25°) |
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How is lumbar spinal lateral flexion measured by double inclinometer? ***
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- position at T12-- L.Lat.Flex-- measure (inclinometer in frontal plane)
- position at T12-- R.Lat.Flex-- measure (inclinometer in frontal plane) - position at S2--L. Lat.Flex-- measure (inclinometer in frontal plane) - position at S2--R.Lat.Flex-- measure (inclinometer in frontal plane) - subtract for true lumbar lateral flexion - record as: 30° - 0° - 30° |
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What is joint excursion?
How does this compare to muscle excursion? |
- joint excursion is the range of motion a joint goes through during each isolated movement (e.g., flexion, extension, etc.)
- muscle excursion is the change in length of a muscle (lengthening OR shortening) |
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What is the joint excursion:
PROM ® knee flex = 120° ext = -20° PROM ® knee flex = 120° hyperext = 20° |
- 100°
- 140° |
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What is the Thomas test used to assess? ***
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tightness of the hip flexors
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How is the Thomas test conducted? ***
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- pt seated near end of plinth, with lower thighs, knees, and legs off the end
- examiner assists pt to supine position to avoid stressing lower back - pt then brings both knees to chest, flattening lower back and pelvis against plinth - pt should have about 10 degrees of posterior pelvic tilt (if knees are brought too close to chest, exaggerated posterior pelvic tilt will give false appearance of tight hip flexors) - hip not being tested held in flexion, while - pt lowers other leg toward table with knee in approximately 80 degrees of flexion - examiner looking to see that thigh lies flat on table, knee remains in 80 degrees flexion, and LE remains in sagittal plane ("-") - at end of test, hip is in 10 degrees of extension since pelvis is in 10 degrees posterior tilt - if the thigh does not lie flat on the table, hip extension is limited ("+") and further testing is needed to determine the cause |
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How will shortness of the iliopsoas affect the Thomas test?
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- hip extension is limited, but the motion remains in the sagittal plane
- knee position is not affected |
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How will shortness of the rectus femoris affect the Thomas test?
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- the knee passively extends
or - the knee remains flexed but hip extension is limited |
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How will shortness of the sartorius affect the Thomas test?
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- the hip passively abducts* and
- the knee passively flexes * probably passively flexes and externally rotates as well |
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How will shortness of the TFL affect the Thomas test?
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hip passively moves into abduction and internal rotation
(probably some hip flexion and knee extension as well) |
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How will shortness of the pectineus and/or adductor longus/brevis affect the Thomas test?
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hip passively moves into adduction
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If a retest on the Thomas test is needed, how is it conducted?
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- put patient in same starting position
- this time, lower the leg with the knee supported in extension to put rectus femoris on slack - if the thigh is then able to lie on table, rectus femoris is determined to be short (could confirm with Ely) - if the thigh still cannot lie on the table, iliopsoas, anterior joint capsule, iliofemoral ligament and/or ischiofemoral ligament may be short - if thigh doesn't remain in sagittal plane ---- external rotation and abduction = probable short sartorius ---- internal rotation and abduction = probable short TFL (do Ober) ---- adduction = probable short pectineus, adductor longus/brevis (check abduction ROM) |
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Which LE special test results are recorded as "+" or "-"? ***
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- Thomas test
- Ely test - Hamstring SLR (proximal) - Hamstring distal - (Modified) Ober - Thompson - Trendelenberg |
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Which LE special test results are recorded in cm? ***
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- girth
- figure 8 - leg length |
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Which LE special test results are recorded in degrees? ***
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Q- angle
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How could the examiner measure progression in Thomas test results? ***
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- by measuring the distance the hanging thigh rests from the table
- (probably could measure the angle of hip flexion as well--approach to 0° or even hip extension = improvement) - increasingly smaller measurements show progress |
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Name the two hip flexor length tests. ***
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- Thomas test
- Ely test (rectus femoris) |
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In addition to providing the stretch in hamstring special testing, what should the examiner also be doing? ***
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palpating the muscle to check for tightness
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On which muscle does the Ely test specifically focus? ***
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rectus femoris
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How is the Ely test conducted? ***
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- patient is prone
- knee is passively bent to at least 90 degrees - if pelvis/ASIS rises off the table (i.e., hip passively flexes), "+" |
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Of what other use are the LE special tests? ***
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the tests can also double as the stretches to be done to elongate the exact same muscles they help identify as tight
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How is the hamstring straight leg raise (HS-SLR) test conducted? ***
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- pt supine with knees extended
- examiner flexes hip by lifting lower extremity - keep knee in full extension - firm pressure to anterior thigh - as hip flexes, pelvis and lower back should flatten against plinth - end of ROM is when further resistance produces knee flexion, posterior pelvic tilt, or lumbar flexion - if hip can flex to 70-80 degrees with knee extended, "-" (her notes said 90 degrees) |
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What is the desired angle for the HS-SLR test with knee extended? ***
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70-80 degrees
(her notes said 90 degrees) |
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How may short hip flexors or lumbar extensors affect the HS-SLR test?
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- short hip flexors or lumbar extensors will hold the pelvis in an anterior tilt
- this tilt will decrease the distance the leg being lifted can rise off the table, giving a false impression (false "+") of less hamstring length than is actually present - to remedy, put the short hip flexors on slack by bolstering the thigh or putting foot flat on plinth on non-tested side (but avoid excessive posterior pelvic tilt and/or lumbar flexion) - for the short lumbar extensors, be sure to align goniometer with midline of pelvis |
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Why should the HS-SLR not be documented as simply "SLR"? ***
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because there is also an SLR test for back pain
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If the rectus femoris is short, knee flexion is limited when hip is....
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- maintained in a neutral position (Ely test)
- further knee flexion will then cause hip flexion |
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If knee flexion is limited when the hip is flexed....
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- the limitation is not due to a short rectus femoris
- a joint abnormality or short one-joint knee extensor muscle should be suspected |
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Another name for the distal hamstring length (HS-distal) test
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popliteal angle test (because the angle between the femur and lower leg is what is being measured)
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How is the HS-distal test conducted? ***
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- pt supine with hip on the tested side flexed to 90 degrees
- contralateral LE rests on table with knee fully extended - initially, knee being tested is allowed to relax in flexion - examiner stabilizes femur to prevent rotation, abduction or adduction of hip and to keep it at 90 degrees of flexion - knee is passively extended until resistance felt and further knee extension causes hip to move toward extension (cannot find a "normal" measurement--we were fully extending/straightening the knee; have found mention of comparing to contralateral side) |
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How were we instructed to notate HS-distal test measurements (give example)? ***
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w/thigh @ 90° flex
® HS lacks 7° knee ext w/palpable tension |
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How is the Ober test conducted? ***
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- pt sidelying with posterior near edge of plinth and hip being tested on top
- flex bottom hip and knee for support and to stabilize trunk, flatten lumbar curve and maintain posterior pelvic tilt - examiner stands behind pt, stabilizing iliac crest with one hand to prevent pelvis from tilting - support leg being tested by holding medial aspect of knee and lower leg - move hip into abduction and extension to position TFL over greater trochanter - lower leg into hip adduction while preventing lateral pelvic tilt or flexion of testing hip - keep knee flexed as well (listed norms were between 10 and 20 degrees) |
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How could one measure progression in the Ely test? ***
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measure the knee flexion angle for an increase
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How could one measure progression in the Ober test? ***
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either by measuring the angle of adduction or by tape measure (distance between knee and plinth)
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If a patient presents with a tight TFL/IT band and an order for treatment via ultrasound, what is one way you could position them? ***
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you could do the US while the patient is in the position of the Ober test to provide additional stretch to the TFL/IT band
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How much hip extension is required to perform the Ober test? Why?
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- at least 0 degrees of hip extension
- in order to properly position the TFL over the greater trochanter |
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If the rectus femoris is short on the tested leg, how would one modify positioning for the Ober test?
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- the knee may be extended, but extreme care must be taken to avoid internal rotation of the hip as the leg is lowered
- this is the modified Ober test |
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How is the modified Ober test conducted? ***
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- essentially the same as the Ober, but with the knee extended instead of flexed on the testing leg
- extreme care must be taken to avoid internal rotation of testing leg; this may require two people to conduct the test |
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Why was the modified Ober test proposed?
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- to reduce strain in the medial aspect of the knee joint
- to reduce tension on the patella - to reduce the influence of a tight two-joint rectus femoris muscle |
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May the Ober test and modified Ober test be used interchangeably?
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no, as some research has suggested the two tests yield different results
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If the TFL is short, what motion restrictions are noted?
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- hip adduction is limited
- also some effect on hip extension, external rotation, and knee flexion |
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What two articulations are contained within the single joint capsule of the knee?
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- tibiofemoral joint
- patellofemoral joint |
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Describe the Thompson test. ***
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- used to assess integrity of Achilles/gastrocnemius
- pt prone - squeeze gastrocnemius to cause plantar flexion - if no plantar flexion, "+" |
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Shortened hamstrings may contribute to..... ***
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low back pain (by causing posterior pelvic tilt and disruption of normal lumbar lordosis)
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What is the valgus test at the knee used to assess? ***
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the integrity of the MCL of the knee
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What is the varus test at the knee used to assess? ***
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the integrity of the LCL of the knee
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What is the anterior drawer test at the knee used to assess? ***
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the integrity of the ACL of the knee
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What is the posterior drawer test at the knee used to assess? ***
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the integrity of the PCL of the knee
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What is the Lachman's test? ***
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- tests for ACL integrity
- pt supine with slight ER - examiner grasps femur and displaces tibia - increased displacement or soft end point = ACL injury (sort of looks like an anterior drawer, but leg is ER and only slightly flexed) |
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Describe the MacMurray's test. ***
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- test of medial and lateral menisci
- flex knee, place fingers on medial joint line ---- ER, valgus, extend knee - flex knee, place fingers on lateral joint line ---- IR, varus, extend knee - pop, click, pain etc. considered positive test |
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Describe the Trendelenburg test. ***
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- test for gluteus medius strength (ability to produce hip abduction)
- side step up with one leg onto stool, should be able to maintain level pelvis - hip drop = positive ("+") test |
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How would you Trendelenburg test an elderly patient? ***
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instead of having them step up onto a stool with one leg, simply have them lift one leg off the ground
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What is the Scour test? ***
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- weighted (by body weight of clinician) circumduction of femur in supine position
- positive if elicits pain in joint, possible indicator of OA or other hip pathology |
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What is a normal Q-angle? ***
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10 to 20 degrees
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Increased Q angles are associated with... ***
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increased knee pain
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How is Q-angle measured? ***
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- with patient supine and knee(s) extended, find center of patella and mark it
(it helps if you mark superior, inferior, medial, and lateral patellar poles, then find where the superior-inferior and medial-lateral lines intersect) - mark tibial tuberosity - using yardstick, draw line from ASIS to/through/past patella center - using yardstick, draw line from tibial tuberosity to/through/past patella center (do not push yardstick into skin, as it will skew measurements, let it lie) - the smaller vertical congruent angles are the Q angles (you may measure either, as they are equal) |
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How is leg length measured? ***
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- it helps to start out with loosening the legs (shake them out lightly, like with strength-training ropes! :)
- then tug them straight, bring them together and visually check medial malleoli for discrepancies - locate ASISs and have patient place fingers on them - measure ASIS to medial malleoli (I do most anterior/prominent point of ASIS to just inferior to medial malleoli) |
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What is another way to visually estimate leg length discrepancy? ***
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- pt in hook-lying position
- higher knee = longer tibia - more forward tibial tuberosity = longer femur |
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Differentiate between an apparent and a real leg length discrepancy. ***
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- a real leg length discrepancy is due to a difference in bone length
- an apparent leg length discrepancy is caused by other factors such as muscle spasm, Trendelenburg hip drop, etc. |
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Describe the anterior drawer ankle test. ***
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- test for integrity of ankle
- especially anterior talofibular and calcaneofibular ligaments |
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Describe the talar tilt test. ***
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- test for ligamenous laxity of calcaneofibular ligaments and/or deltoid ligament
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What is the ABI? ***
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- ankle brachial index
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For what is the ABI used? ***
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- used to assess arterial flow
- abnormal reading may indicate peripheral vascular disease and compression therapy precautioned or contraindicated - determined by dividing brachial systolic pressure by ankle (dorsalis pedis) systolic pressure. Normal = 1.0 |
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Describe figure-8 measurement at the ankle. ***
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- begin in front of ankle between lateral malleolus and tibialis anterior
- pull tape medially to distal navicular - go under foot to base of 5th metatarsal - cross in front and wrap around back of the ankle - continue distal to medial malleolus over Achilles tendon, distal to lateral malleolus and back to starting point - read where tape crosses |
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Describe the SLR test for low back pain. ***
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- assessment of neural mobility
- pt supine, raises straight leg at least 45 degrees - at apex, dorsiflex the foot - positive if low back or buttocks pain |
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What points should be remembered during girth testing? ***
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- think about where you measure based on pt and sx
- give the examiner good bony landmarks to enhance interexaminer reliability (e.g., "3 cm superior to superior patellar pole") - ensure the tape measure is level - take at least 3 measurements |
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Name the only measurements we perform that entail a soft end feel. ***
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- elbow flexion
- hip flexion - knee flexion |
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Name the only measurements we perform that entail a hard end feel. ***
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- tarsal eversion
- elbow extension - forearm pronation - radial deviation |
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Average ROM for shoulder extension per AAOS. ***
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60 degrees
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Average ROM for shoulder flexion per AAOS. ***
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180 degrees
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Average ROM for shoulder abduction per AAOS. ***
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180 degrees
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Average ROM for shoulder external rotation per AAOS. ***
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90 degrees
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Average ROM for shoulder internal rotation per AAOS. ***
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70 degrees
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Average ROM for elbow flexion per AAOS. ***
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150 degrees
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Average ROM for elbow extension per AAOS. ***
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0 degrees
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Average ROM for forearm supination per AAOS. ***
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80 degrees
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Average ROM for forearm pronation per AAOS. ***
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80 degrees
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Average ROM for wrist flexion per AAOS. ***
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80 degrees
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Average ROM for wrist extension per AAOS. ***
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70 degrees
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Average ROM for radial deviation per AAOS. ***
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20 degrees
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Average ROM for ulnar deviation per AAOS. ***
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30 degrees
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Average ROM for cervical flexion per AAOS. ***
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45 degrees
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Average ROM for cervical lateral flexion per AAOS. ***
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45 degrees
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All our required measurements have firm end feels except: ***
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- elbow flexion (soft)
- hip flexion (soft) - knee flexion (soft) - elbow extension (hard) - forearm pronation (hard) - radial deviation (hard) - tarsal eversion (hard) |
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Average ROM for hip extension per AAOS. ***
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20 degrees
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Average ROM for hip flexion per AAOS. ***
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120 degrees
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Average ROM for knee extension per AAOS. ***
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0 degrees
(up to 10 degrees hyperextension currently considered normal) |
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Average ROM for knee flexion per AAOS. ***
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135 degrees
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Average ROM for hip abduction per AMA. ***
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40 degrees
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Average ROM for hip adduction per AMA. ***
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20 degrees
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Average ROM for ankle dorsiflexion per AAOS. ***
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20 degrees
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Average ROM for ankle plantar flexion per AAOS. ***
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50 degrees
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Average ROM for ankle (tarsal) inversion per AAOS. ***
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35 degrees
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Average ROM for ankle (tarsal) eversion per AAOS. ***
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15 degrees
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Average ROM for hip external rotation per AAOS. ***
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45 degrees
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Average ROM for hip internal rotation per AAOS. ***
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45 degrees
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Average ROM for thoracolumbar flexion per AAOS/AMA. ***
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- 80 degrees (M - AAOS)
- 60 degrees (F - AMA) |
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Average ROM for thoracolumbar extension per AAOS. ***
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25 degrees
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Methods of measuring cervical ROM. ***
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- tape measure
- universal goniometer - inclinometer - CROM |
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How is a tape measure used to measure cervical ROM? ***
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- CTS for flexion/extension
- MTA for lateral flexion - CTA for rotation |
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What does "CTS" mean, with respect to measuring cervical ROM? ***
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- chin to sternum
- use tape measure to measure between tip of chin and sternal notch for cervical flexion and extension |
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What does "CTA" mean, with respect to measuring cervical ROM? ***
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- chin to acromion
- use tape measure to measure between chin and acromion process for cervical rotation |
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What does "MTA" mean, with respect to measuring cervical ROM? ***
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- mastoid to acromion
- use tape measure to measure between mastoid process and acromion for cervical lateral flexion |
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Where is the universal goniometer placed to measure cervical flexion and extension? ***
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F: external auditory meatus (NOT "ear")
PA: perpendicular/parallel to floor DA: nose, parallel to nares |
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Where is the universal goniometer placed to measure cervical lateral flexion? ***
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F: C7
PA: along spine DA: posterior cranium |
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Where is the universal goniometer placed to measure cervical rotation? ***
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F: superior cranium
PA: line from acromion to acromion DA: nose |
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Where is the (single) inclinometer placed to measure cervical flexion and extension? ***
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top of calvaria/cranium
(in sagittal plane) |
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Where is the (single) inclinometer placed to measure cervical lateral flexion? ***
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top of calvaria/cranium
(in frontal plane) |
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Where is the inclinometer placed to measure cervical rotation? ***
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on forehead, with patient supine
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Goniometry may be used to determine both...
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- joint position
- total amount of motion available at a joint (active and/or passive) |
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If abnormal active ranges of motion are observed, the examiner...
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should perform passive joint motions to determine reasons for joint limitations
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"Arthrokinematics" refers to...
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the translatory and/or rotary movement of joint surfaces (rolls, slides, glides, spins, etc.)
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A slide is a translatory motion in which all points on the moving surface travel....
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the same distance
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A spin is a rotary motion in which points on the moving surface that are closer to the axis of motion....
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travel a smaller distance than points further from the axis
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How are arthrokinematic motions assessed?
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- they are too small to be measured via goniometry
- they are typically subjectively compared to the contralateral side - or they are compared to an examiner's past experience testing people of similar age and gender |
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Arthrokinematic motion is also called...
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- accessory motion
or - joint play motion |
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"Osteokinematics" refers to...
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- the gross movements of the shafts of bones
- usually described in terms of the rotary or angular motion produced (e.g., flexion, extension) |
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What does goniometry measure?
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- angles created by rotary motion of shafts of bones
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How are motions in more than one plane (e.g., circumduction) measured by goniometry?
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they aren't
goniometry can only measure single-plane motion |
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What is the starting position for measuring all ROM (except rotations in the transverse plane)?
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anatomical position
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What notation system do we use to measure ROM?
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0 to 180 degree notation system
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What is another name for the 0 to 180 degree notation system?
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the neutral zero method
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Documentation of extension ROM usually incorporates only ...
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the extension that occurs beyond the zero starting position
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If a patient presents with full PROM, but no/limited AROM, the cause is likely....
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lack of muscle strength
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What should be tested prior to MMT?
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PROM, since MMT grading is based on the patient having full ROM in the joint
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What tissue motions produce a firm end feel?
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- muscular stretch
- capsular stretch - ligamentous stretch |
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What conditions are associated with joint effusion and/or synovial inflammation?
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- traumatic arthritis
- infectious arthritis - RA - gout (with these conditions, the joint capsule is distended by excessive fluid, causing the joint to maintain a position that allows the greatest intra-articular joint volume, thus producing the capsular pattern) |
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What scale is used to assess hypermobility?
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Beighton Hypermobility Scale
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Which side of the body tends to have a slightly decreased ROM in the UE?
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the dominant side
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If a two-joint or multi-joint muscle crosses a joint the examiner is assessing, the subject must be positioned so that...
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- the passive tension in the muscle does not limit the joint's ROM
- the muscle must be put on slack at all joints except the one being assessed (e.g., when assessing elbow flexion, the shoulder must be in neutral; if flexed, the triceps would reduce the elbow flexion ROM) |
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What three functions must a goniometric testing position serve?
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- place joint in starting position of 0 degrees
- permit complete ROM - provide stabilization of proximal joint segment |
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May universal goniometers and inclinometers be used interchangeably?
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they should not be
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Why is alignment of the proximal and distal arms of the goniometer more important than alignment of the fulcrum?
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- with motion at the joint, the fulcrum will likely move
- if the arms are properly aligned on the right landmarks, they should force the fulcrum to the axis of motion |
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From what level should the goniometer be read?
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eye level (to avoid parallax)
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How can one prevent errors in reading the goniometer?
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- first, estimate the measurement (e.g., if the motion hasn't gone 90 degrees and you're reading 120 degrees, you're reading in the wrong direction)
- also, ensure you're reading the intervals correctly; some goniometers are marked in 5-degree increments, some in 1-degree increments, etc. - finally, read at eye level to avoid parallax |
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What 10 things belong in the documentation of goniometric measurements?
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1) subject's name, age, and gender
2) examiner's name 3) date and time of measurements 4) make and type of goniometer 5) side of body, joint, and motion being measured (e.g., right knee flexion) 6) ROM 7) type of motion (PROM or AROM, etc.) 8) subjective info - pain, etc. reported by pt 9) objective info - spasm, crepitus, capsular pattern, etc. noted by examiner 10) complete description of any deviation from recommended testing position, so it can be replicated by others if need be |
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What factors can affect reliability of goniometric measurements?
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- complexity of the joint
- difficulty palpating landmarks - difficulty moving heavy body parts into full PROM - varying force used to move body segments - type of device (universal, inclinometer, etc.) - proportion of goniometer arms to size of body segments |
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Alignment for hip extension ***
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F: greater trochanter
PA: lateral midline of pelvis, between ASIS and PSIS DA: lateral epicondyle of femur |
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Alignment for hip flexion ***
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F: greater trochanter
PA: lateral midline of pelvis, between ASIS and PSIS DA: lateral epicondyle of femur |
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Alignment for knee extension ***
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F: lateral epicondyle of femur
PA: greater trochanter DA: fibular head and lateral malleolus |
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Alignment for knee flexion ***
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F: lateral epicondyle of femur
PA: greater trochanter DA: fibular head and lateral malleolus |
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Alignment for hip abduction ***
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F: ASIS of extremity being measured
PA: imaginary horizontal line between ASISs DA: mid patella |
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Alignment for hip adduction ***
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F: ASIS of extremity being measured
PA: imaginary horizontal line between ASISs DA: mid patella |
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Alignment for ankle dorsiflexion ***
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F: lateral malleolus
PA: fibular head DA: along lateral aspect of 5th metatarsal |
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Alignment for ankle plantar flexion ***
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F: lateral malleolus
PA: fibular head DA: along lateral aspect of 5th metatarsal |
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Alignment for ankle (tarsal) inversion ***
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F: midway between malleoli
PA: tibial tuberosity DA: midline of 2nd metatarsal |
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Alignment for ankle (tarsal) eversion ***
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F: midway between malleoli
PA: tibial tuberosity DA: midline of 2nd metatarsal |
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Alignment for hip external rotation ***
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F: mid patella
PA: parallel to plinth DA: tibial crest; midway between malleoli |
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Alignment for hip internal rotation ***
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F: mid patella
PA: parallel to plinth DA: tibial crest; midway between malleoli |
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Alignment for thoracolumbar flexion ***
|
- top inclinometer centered over T1 (put top "foot" on C7)
- bottom inclinometer centered over S2 (put bottom "foot" at top of gluteal cleft) |
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Alignment for thoracolumbar extension ***
|
- top inclinometer centered over T1 (put top "foot" on C7)
- bottom inclinometer centered over S2 (put bottom "foot" at top of gluteal cleft) |
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Alignment for shoulder extension ***
|
F: lateral aspect of greater tubercle
PA: parallel to plinth DA: lateral epicondyle of humerus |
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Alignment for shoulder flexion ***
|
F: lateral aspect of greater tubercle
PA: along mid(axillary) line of thorax DA: lateral epicondyle of humerus |
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Alignment for shoulder abduction ***
|
F: over acromion process
PA: parallel to sternum DA: medial epicondyle of humerus |
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Alignment for shoulder external rotation ***
|
F: olecranon process
PA: perpendicular or parallel to floor DA: ulnar styloid |
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Alignment for shoulder internal rotation ***
|
F: olecranon process
PA: perpendicular or parallel to floor DA: ulnar styloid |
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Alignment for elbow extension ***
|
F: lateral epicondyle of humerus
PA: center of acromion process DA: radial head and styloid |
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Alignment for elbow flexion ***
|
F: lateral epicondyle of humerus
PA: center of acromion process DA: radial head and styloid |
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Alignment for forearm pronation ***
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F: lateral and proximal to ulnar styloid
PA: parallel to anterior midline of humerus DA: across dorsal forearm, proximal to radial and ulnar styloids |
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Alignment for forearm supination ***
|
F: medial and proximal to ulnar styloid
PA: parallel to anterior midline of humerus DA: across ventral forearm, proximal to radial and ulnar styloids |
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Alignment for wrist extension ***
|
F: lateral wrist at triquetrum
PA: ulnar styloid and olecranon process DA: lateral midline of 5th metacarpal (NOT hypothenar eminence) |
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Alignment for wrist flexion ***
|
F: lateral wrist at triquetrum
PA: ulnar styloid and olecranon process DA: lateral midline of 5th metacarpal (NOT hypothenar eminence) |
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Alignment for radial deviation ***
|
F: dorsal wrist over capitate
PA: midline of forearm and lateral epicondyle DA: dorsal midline of 3rd metacarpal (NOT finger) |
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Alignment for ulnar deviation ***
|
F: dorsal wrist over capitate
PA: midline of forearm and lateral epicondyle DA: dorsal midline of 3rd metacarpal (NOT finger) |
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Inclinometer alignment for cervical flexion ***
|
inclinometer in sagittal plane at top of cranium
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Alignment for cervical lateral flexion ***
|
inclinometer in frontal plane at top of cranium
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