SECTION 4 – RANGE OF MOTION (continued)

Scoring: Example 1

The recommendation is to score using both methods The raw data scores for a patient in a study were:
(normal contralateral side and normative tables) and
then record the worse score. 138 degrees – Left knee
151 degrees – Right knee
1) Normal Contralateral side
Scoring using the Normal - Contralateral side for the One assessor gave a score of 0 for flexion loss in both the
Flexion and Extension Loss categories is as follows: left and right knee for this patient using normative
tables. However, although the 138 degrees is within
 0 = < 5 degrees normal range for the child’s age, obviously his right knee
has significantly better range. Therefore, if both methods
 1 = Loss of 5 to 10°
had been used (i.e. looking at the pediatric norms and
 2 = Loss of 11° - 20° the contralateral side) and the worse score given, the
 3 = Loss of > 20° assessor should have recorded a score of 2 for the left
knee.
2) Normative tables
Scoring using the Normative table for the Flexion and Example 2
Extension Loss categories is as follows:
In both the knee and elbow joints, hyperextension is
When using the normative tables, 2.0 standard often present. Hyperextension is defined as having more
deviations are included. Therefore, any measurement extension (beyond 0). This hyperextension is recorded as
outside of the provided range should have a minimum a positive number. In a person who demonstrates
score of 1. hyperextension, an extension measure of 0 may
indicate a loss of extension from his baseline. This loss of
 0 = Within normative table range hyperextension needs to be accounted for.
 1 = Loss of 1 to 4°
 2 = Loss of 5° - 10° Scenario 1:
 3 = Loss of > 10°
Elbow extension scores:
10° hyperextension – Left elbow
2° hyperextension - Right elbow

Using normative range tables, both of these values would

score 0. However, since the right elbow measures 8° less
than the left, this loss of hyperextension should be given
a score of 1.

Scenario 2:

10° hyperextension - Left elbow

-6° extension - Right elbow
Hyperextension
Total loss of extension is the 10° hyperextension + the
additional 6° (from 0). Therefore the total loss is 16°, so
the score would be 2.

8 Hemophilia Joint Health Score 2.1 Instruction Manual

 TABLE - RANGE OF MOTION

Normal Ranges of joint motion (degrees) in males ranging from 2 to 69 yrs. of age

Age (years) 2-8 9 - 19 20 - 44 45 - 69

N 55 48 114 96
Mean Range Mean Range Mean Range Mean Range
(Includes + 2 SD) (Includes + 2 SD) (Includes + 2 SD) (Includes + 2 SD)
ELBOW
Flexion 146.6 – 156.2 137.9 – 158.7 133.6 – 155.6 131.5 – 155.5
Extension - 8.0 – + 12.0 - 6.7 – + 17.3 - 6.8 – + 8.4 - 8.5 – + 7.1
KNEE
Flexion 138.4 – 157.2 129.6 – 154.8 124.7 – 150.7 120.3 – 145.5
Extension - 3.4 – + 6.6 - 4.6 – + 8.2 - 3.6 – + 5.6 - 3.3 – + 4.3
ANKLE
Plantarflexion 45.4 – 66.2 38.8 – 66.8 39.0 – 70.2 32.6 – 66.2
Dorsiflexion 11.6 – 34.0 6.1 – 26.5 0.9 – 24.5 1.9 – 21.9

SYMBOL DESCRIPTION
+ Hyperextension, or BEYOND zero degrees (0) of extension
- Flexion, or BEFORE / NOT QUITE zero degrees (0) of extension

Notes:
N = Total number of joints
The values provided represent means of the right and left joints.
All values for ankle plantarflexion and dorsiflexion were measured with the knee in a slightly bent position

Soucie JM, Wang C, Forsyth A, Funk S, Denny M, Roach K and Boone D. Range of motion measurements: reference values and a
database for comparison studies. Haemophilia. 2010: 1-8.

9 Hemophilia Joint Health Score 2.1 Instruction Manual