END FEEL

K.SOUNDARARAJAN
K. Soundararajan, SRIHER 1
• General concept

• End feel

• Types

• Goniometry

K. Soundararajan, SRIHER 2
GENERAL concept
• Passive ROM is determined by structure of joint
• Joint capsule limits the movements in particular direction
• Other limitation include muscle, skin , fascia, soft tissue
approximation, contact of joint surface

K. Soundararajan, SRIHER 3
End feel - meaning

• Type of structure that limits ROM has a characteristic feel , that

may be detected by examiner who is performing the passive
ROM
• This feeling , which is barrier to further motion at the end of a
passive ROM , is called End feel
K. Soundararajan, SRIHER 4
 Definition

• One of the most important factors to investigate with passive

range-of-motion testing is the end feel. The end feel is the
quality of movement perceived by the practitioner at the very
end of the available range of motion. The end feel can reveal a
great deal about the nature of various
K. Soundararajan, SRIHERpathologies. 5
Types of End feel

• Soft

• Firm

• Hard
K. Soundararajan, SRIHER 6
NORMAL END FEEL

End Feel Structure Example

Soft Soft tissue approximation Knee flexion

Firm Muscular stretch, Hip flexion (knee straight)

Capsular stretch, Extension of MCP Joint at finger
Ligamentous stretch Forearm supination

Hard Bone contacting Bone Elbow extension

K. Soundararajan, SRIHER 7
SHOULDER FLEXION

Range of motion: 0-180

Patient’s position: supine lying
Goniometer positioning: Movable arm = long axis of humerus
Stable arm = parallel to the sternum
Fulcrum = greater tubercle of humerus
End feel = firm end feel
K. Soundararajan, SRIHER 8
SHOULDER EXTENTION

Range of motion: 0-40

Patient’s position: prone lying
Goniometer position: Movable arm = long axis of humerus
Stable arm = parallel to midline
Fulcrum = greater tubercle of humerus
End feel
K. Soundararajan, = firm end feel
SRIHER 9
SHOULDER ABDUCTION & ADDUCTION

Range of motion: 0-180

Patient’s position: supine
Goniometer position: Moveable arm = long axis of humerus
Stable arm = in line with trunk
Fulcrum = acromion process
End feel
K. Soundararajan, = firm end feel
SRIHER 10
LATERAL ROTATION

Range of motion: 0-90

Patient’s position: supine lying, place a sheet below the hand
and move the pillow to elbow to facilitate the scapula-
humeral rhythm
Goniometer position: Moveable arm = long axis of ulna
Stable arm = in the line of trunk
Fulcrum = olecranon process 11
K. Soundararajan, SRIHER

End feel = firm end feel

MEDIAL ROTATION

Range of motion: 0-60

Patient’s position: supine lying, place a sheet below the hand
and move the pillow to elbow to facilitate the scapula-
humeral rhythm
Goniometer position: Moveable arm = long axis of ulna
Stable arm = in the line of trunk
Fulcrum = olecranon process 12
K. Soundararajan, SRIHER
End feel = firm end feel
ELBOW FLEXION

Range of motion: 0-150

Patient’s position: supine lying, place a sheet below the elbow to
avoid compression of olecranon process.
Goniometer position: Movable arm = long axis of radius
Stable arm = long axis of humerus
Fulcrum = lateral epicondyle of humerus
EndK.feel = firm end feel.
Soundararajan, SRIHER 13
PRONATION

Range of motion: 0-90

Patient’s position: sitting with forearm placed on a couch in
midprone position, holding pen at folded hand. Place sheet
below the hand
Goniometer position:
Movable arm = perpendicular to ground / Parallel to Pen
Stable arm = at 90 degree / Perpendicular to ground
Fulcrum = styloid process of ulna / 3rd metacarpal bone
K. Soundararajan, SRIHER 14
End feel = firm end feel
SUPINATION

Range of motion: 0-90

Patient’s position: sitting with forearm placed on a couch in
midprone position, holding pen at folded hand. Place sheet
below the hand
Goniometer position:
Movable arm = perpendicular to ground / Parallel to Pen
Stable arm = at 90 degree / Perpendicular to ground
Fulcrum = styloid process of ulna
K. Soundararajan, / 3rd metacarpal bone
SRIHER 15
End feel = firm end feel
WRIST FLEXION

Range of motion: 0-80

Patient’s position: sitting with forearm placed on couch. Place a she
below the hand
Goniometer position: Movable arm = parallel to third M.C bone
Stable arm = long arm of ulna
Fulcrum = styloid process of ulna
EndK.feel =SRIHER
Soundararajan, firm end feel 16
WRIST EXTENTION

Range of motion: 0-70

Patient’s position: sitting with forearm placed on couch. Place a
sheet below the hand
Goniometer position: Movable arm = parallel to third M.C bone
Stable arm = long arm of ulna
Fulcrum = styloid process of ulna
End feel SRIHER
K. Soundararajan, = firm end feel 17
ULNAR DEVIATION

Range of movement: 0-20

Patient’s position: sitting with forearm placed on the couch and
pronated. place a sheet below the hand.
Goniometer position: Movable arm =along third metacarpal bone
Stable arm = along the middle of forearm
Fulcrum = middle of wrist joint
EndK.feel = firm end feel.
Soundararajan, SRIHER 18
RADIAL DEVIATION

Range of movement: 0-20

Patient’s position: sitting with forearm placed on the couch and
pronated place a sheet below the hand.
Goniometer position: Movable arm =along third metacarpal bone
Stable arm = along the middle of forearm
Fulcrum = middle of wrist joint
End feel
K. Soundararajan, = firm end feel.
SRIHER 19
 HIP FLEXION

Range of motion: 0-120

Patient’s position: side lying with knee flexion
Goniometer position: Moveable arm = long axis of femur
Stable arm = in line with the trunk
Fulcrum = greater trochanter of femur
End feel = firm end feel
K. Soundararajan, SRIHER 20
 HIP EXTENTION

Range of motion: 0-30

Patient’s position: prone lying
Goniometer position: Movable arm =long axis of femur
Stable arm =in the line with trunk
Fulcrum = greater trochanter of femur
End feel = firm end feel
K. Soundararajan, SRIHER 21
HIP ABDUCTION

Range of motion: 0-45

Patient’s position: supine lying
Goniometer position: Movable arm = in the line with femur bone
Stable arm = imaginary line between two
ASIS
Fulcrum = ASIS
End feel
K. Soundararajan, = firm end feel
SRIHER 22
HIP ADDUCTION

Range of motion: 0-45

Patient’s position: supine lying
Goniometer position: Movable arm = in the line with femur bone
Stable arm = imaginary line between two
ASIS
Fulcrum = ASIS
End feel = firm end feel
K. Soundararajan, SRIHER 23
 MEDIAL ROTATION

Range of motion: 0-45

Patient’s position: high sitting with sheet below the knee to
prevent popliteal fossa compression.
Goniometer position: Moveable arm = long axis of tibia
Stable arm = perpendicular to ground
Fulcrum = apex of patella
EndK.feel = firm end feel
Soundararajan, SRIHER 24
 LATERAL ROTATION

Range of motion: 0-45

Patient’s position: high sitting with sheet below the knee to prevent
popliteal fossa compression.
Goniometer position: Moveable arm = long axis of tibia
Stable arm = perpendicular to ground
Fulcrum = apex of patella
End feel = firm end feel
K. Soundararajan, SRIHER 25
 KNEE FLEXION & EXTENTION

Range of motion: 0-150

Patient’s position: prone lying, patients should lie in end of
couch to start from neutral position. Place a sheet below
ankle
Goniometer position: Movable arm = long axis of fibula
Stable arm = in line with femur
Fulcrum = lateral condoyle of femur
K. Soundararajan, SRIHER 26
End feel = soft feel
 DORSIFLEXION

Range of motion: 0-20

Patient’s position: high sitting, foot should be in neutral for
gastronemius relaxation
Goniometer position: Movable arm = fifth metacarpal bone
Stable arm = long axis of fibula
Fulcrum = lateral to lateral malleoli
End feel = firm end feel
K. Soundararajan, SRIHER 27
PLANTAR FLEXION

Range of motion: 0-30

Patient’s position: high sitting, foot should be in neutral for
gastronemius relaxation
Goniometer position: Movable arm = fifth metacarpal bone
Stable arm = long axis of fibula
Fulcrum = lateral to lateral malleoli
End feel = firm end feel
K. Soundararajan, SRIHER 28
INVERSION

Range of motion: 0-20

Patient’s position: supine lying
Procedure: place a paper below the heel and place a
cardboard in line with the foot and draw a straight-line. Ask
the patient to perform inversion and then draw a line.
Measure with goniometer.
End feel: firm end feel. K. Soundararajan, SRIHER 29
 EVERSION

Range of motion: 0-10

Patient’s position: supine lying
Procedure: place a paper below the heel and place a cardboard in
line with the foot and draw a straight line. Ask the patient to
perform inversion and then draw a line. Measure with
goniometer.
End feel: firm end feel. K. Soundararajan, SRIHER 30
 Reference

Measurement of Joint Motion A Guide to Goniometry ; Cynthia

K. Soundararajan, SRIHER 31
C.Norkin, D.Joyce White; Japee ; 3rd edition.
K. Soundararajan, SRIHER 32
K. Soundararajan, SRIHER 33