Practical Evaluation

Range of motion
By: Ahmed Taha Amer
 Some basis information :

• The spinous processes of C7&T1 are prominent at the base of the

neck.
• The inferior angle of the scapula normally is at the level of the
interspace between T7&T8.
• An imaginary line connecting the highest point on each iliac crest
crosses L4 .
• An imaginary line joining the two symmetric dimples that overlie
the posterior iliac spines crosses S2.
• A lateral view shows that vertebral column has four curves (a
double S) the cervical & lambar curves are concave inward, and
the thoracic and sacrococcygeal curves are convex. The balanced
nature allows the spine to absorb a great deal of shock
 contents
1. Goniometry of the cervical vertebrae &Alternatives
2. Cervical extension and hyper-extension &Alternatives
3. Occipital Extension
4. ROM Passive & Active
5. Goniometry of shoulder joint
6. Goniometry of elbow joint
7. Goniometry of the radio-ulnar joint
8. Goniometry of wrist joint
9. Goniometry of the hip joint
10. Goniometry of the knee joint
11. Goniometry of the ankle joint
Cervical vertebrae
 Goniometry of the cervical vertebrae
Occipital Flexion Cervical Flexion
From (0-10 degrees) From (0-45 degrees)

Sagittal Line Plane

A nodding action, as in tucking the Occurs between all cervical Flexion

chin without motion in the cervical vertebrae movement
vertebra

Supine or sitting, trunk well supported and neck in the anatomical Position
position. The hands of the patient are rested on his lap and the
shoulder joint relaxed
Over the external auditory meatus Axis or Fulcrum

Parallel to the floor Stationary arm

Along a line parallel to the inferior border of the nose Movable arm

Prevent cervical flexion and stabilize Prevent trunk flexion& neck Precautions
the trunk flexion and lateral rotation
 Alternatives for Cervical Flexion

-goniometer is fixed to the head over the

ear, with the base parallel to the top of
the ear the goniometer is set at
0degree
-:-By using tape in cm
1- from the point of the chain to the mid point
of the sternal notch. The subject’s mouth
remains closed
2- from the external occipital protuberence to
the spinous process of C7
 Alternatives
• By using tape, the distance is about 7-10 inches from
complete flexion into hyper-etension of cervical vertebrae.
• patient’s position alignment : as for cervical flexion The tape
measurement is used to determine the distance in inches,
between the tip of chin and the sternal notch, or from the
external occipital protuberance .
• to the spinous process of C7
• The diference between the start and the end positions is the
range of motion.
Precaution: Prevent trunk flexion& neck flexion and lateral
rotation.
 Cervical extension and hyper-extension

 The extension motion is the return from neck

flexion (45-0 degrees).
 The hyper-extension : increases the anterior
Convexity of the cervical vertebrae (0-45
degrees).
 The motion occurs in the sagittal plan
between the articulating facets of all cervical
verterraeand at the atlanto-occipital joint.
 Occipital Extension
degrees)0-25(

• The subject extends the head by tilting the

chin upward from sitting position, trunk is
well supported, natural cervical lordotic curve
is mentioned. The cervical vertebrae is
motionless
• Precautions: stabilize the trunk and prevent
cervical extension
 Cervical side bending Cervical rotation

degrees 45 From 0 to 60 -75degrees by Goniometer The ROM

Coronal plane Transverse plane Plane

Sitting erect Sitting with trunk supported & neck in Position
anatomical position
Spinous process of C7 Over the centre of the top of the head Axis or Fulcrum

Perpendicular to floor With acromion process of side being Stationary arm

measured
Posterior midline of skull With the tip of the nose Movable arm
With tape measurements By using the tape: from the mid line of the Alternatives
from the masoid process chin& the acromion process. The distance
to acromion process is 5 inches. Measure the distance between
the starting &ending position to find out
.the range of motion
)trunk& shoulder aree stabilized(
• Passive ROM: it is defined, movement within
the unrestricted ROM for a segment produced
entirely by an external force. There is no
voluntary muscle contraction. The external
force may be another individual, another part
of the individual own body, a machine or
gravity
• Active ROM: it is defined as, movement within
the unrestricted ROM for a segment produced
active contraction of the muscles crossing that
joint
 Active ROM (Quick tests )
is the quickest active way to evalute the :) scratch test(
patient’s range of motion
To determine To further test
To test abduction
adduction &medial adduction &medial
&lateral rotation
rotation rotation
• Ask the patient to • Instruct the patient • Have the patient
reach behind his to reach in front of reach behind his
head &touch the his head &touch back to touch the
superior medial the opposite inferior angle of
angle of opposite acromion opposite scapula
scapula
 For abduction &lateral For adduction &internal
For abduction
rotation rotation
• Instruct the patient to • Have the patient place • Ask the patient to
abduct his arm to 90 his hands behind his place both hands
degrees keeping his neck and push his behind his neck as
elbow straight. Then elbows out posteriorly high as they will go as
ask him to turn his if he is going to
palms up in supination scratch the inferior
& continue abduction scapular angle
until his hands touch
over his head. This
demonstrates full
bilateral abduction
and provide bilateral
comparison
Flexion Extension adduction abduction
(0-180)degrees )0-50)degrees posteriorly (0-180)degrees laterally
anteriorly
 Goniometry of shoulder joint
Extension Flexion
)0-50)degrees posteriorly (0-180)degrees anteriorly

Prone lying with good postural preferred position is the supine Patient’s position
ligament with the subject’s sitting. Or in crock lying position in
hand facing upward a good position

Lateral vicinity of the acromion process Axis or fulcrum

Parallel to the trunk, along the mid-axillary line of the trunk Stationary arm

Along the lateral mid of the humerus Movable arm

Avoid forward flexion of the Avoid extension of the trunk, Caution

trunk and shoulder abduction. adduction or elevation of the
Elbow may be flexed shoulder
 Goniometry of shoulder joint
Adduction Abduction
degrees laterally)0-180(

prone , standing or sitting with the back to operator. Supine lying Patient’s position
position may be used with the palm facing forward

On the anterior vicinity of the acromion process Axis or fulcrum

Parallel to the supine, at the lateral aspect of the body, in the Stationary arm
posterior axillary line

On the posterior aspect of the arm, parallel to the posterior mid line Movable arm
of the humerus, towards the alecranon process

Avoid lateral trunk flexion, shoulder flexion or extension or elevation Caution

of the shoulder girdle
 Goniometry of shoulder joint
Lateral rotation Medial rotation
degrees)0-90( degrees)0-90(

From supine lying, the arm abducted to 90 degrees and the Patient’s position
hand either facing the body or in the anatomical position

At the olecranon process Axis or fulcrum

Parallel to the lateral aspect of the body (long line of the Stationary arm
trunk )

Along the dorsal mid line of the forearm between the Movable arm
styloid process or parallel to the lateral aspect of the
forearm

The operator may place his fingers under the elbow to keep Caution
a reference point of motion, avoid flexion, extension, or
elevation of elbow
 Goniometry of elbow joint
Extension Flexion
towards 140-160 degrees 0

The patient is in supine, sitting or standing with the arm parallel to Patient’s position
the lateral mid line of the body

At the lateral condyle of the humerus Axis or fulcrum

Placed along the lateral mid line of the humerus towards the Stationary arm
acromion process of the scapula

Placed along the lateral mid line of the radius in line with the radial Movable arm
styloid process

Avoid extension of the trunk and abduction or elevation of the Caution

scapula, keep the moving arm close to the body
 Goniometry of the radio-ulnar joint
Supination Pronation

sitting or standing elbow 90 degrees and the arm held close Patient’s position
to the side of the body. The thumb is directed superior.
There should not be support under the forearm

At the base of the middle metacarpal bone Axis or fulcrum

On the dorsal surface of the wrist, parallel to the long axis Stationary arm
of the hmerus

On the stationary arm Movable arm

Keep the elbow close to the body side, Don’t allow Caution
abduction or any shoulder rotation or body deviation
wrist joint
 Goniometry of wrist joint
Extension Flexion
degrees)0-70( degrees)0-90(

The patient may be sitting or standing with the elbow Patient’s position
flexed, the forearm is in supination

Below the styloid process of ulna Axis or fulcrum

Placed along the lateral mid line of the ulna, towords the Stationary arm
olecranon process

This line parallels the mid line of the fifth metacarpal Movable arm

Flexion can be measured on the lateral side of the hand, Caution

there will be great difference between the two sides of the
wrist and the cupping of the hand on little finger’s side
 Goniometry of wrist joint
Abduction (radial deviation ) Adduction (ulnar deviation )
0 towards 25 degrees 0 towards 55-65degrees

Elbow flexed and forearm in mid position between pronation and Patient’s position
supination. The forearm may rest on a table top with the hand free
and not supported

Mid point between radius & ulna Axis or fulcrum

Placed along the mid line of the dorsum of the forearm, between the Stationary arm
radius & ulna towards the lateral condyle of the humerus

Placed along the third metacarpal towards the centre of the Movable arm
metacarpophalageal joint the third digit
 Flexion Extension abduction
0 towards 0 towards 10-15 degree 0 towards 45 degrees
115-125 degrees
 Goniometry of the hip joint
Flexion Extension

ROM 0 towards 115-125 degrees 0 towards 10-15 degree

Plane Sagital plane

Caution the greater trochater must be accurately located as the hip

and the thighs musculature difficult. The measurements
may be taken with flexed knee, if there is thighr hamstrings

Patient position Supine lying or side lying Prone lying

Fulcrum Greater trochater

Stationary arm Placed parallel to a line from the greater trochante with
femur
Movable arm Lateral midline of femur with the trunk
 Goniometry of the hip joint
Abduction Adduction

ROM 0 towards 45 degrees 0 towards 10-15 degrees

Plane Coronal plane measured from the anterior aspect of the pelvis

Position of the Supine lying with good alignment

patient

Fulcrum On the anterior superior iliac spine

Stationary arm Parallel to the trunk

Movable arm With the line of the femur

 Goniometry of the hip joint
Medial rotation Lateral rotation

ROM 0 towards 45 degrees

Position of Short sitting with hip&knee flexed 90 degree and supported over the table
the patient

Fulcrum Midpoint of patella

Stationary Perpendicular to the floor

arm

Caution Avoid hip flexion ,extension, abduction or adduction. Measurements may

be taken with the stationary arm parallel to the table top and the movable
arm follows the crest of the tibia

Movable arm Parallel to the mid line of the tibia

 Extension Flexion
0 towards 120-130 degrees 0 towards 120-130
degrees
 Goniometry of the knee joint
Flexion Extension

ROM 0 towards 120-130 degrees

Plane Sagital plae

Position of the patient Prone position with knee extended

Fulcrum On the lateral condyle of the femur

Stationary arm Lateral midline of femur toward greater trochanter

Movable arm Lateral midline of fibula towards the lateral malleolus

Alternative patient position Sitting on a treatment table, with the thigh supported and
the knee flexed at the edge of the support
Flexion Extension pronation supination
0 towards 20 degrees 0 towards 45 degrees
 Goniometry of the ankle joint
Flexion Extension
0 towards 20 degrees 0 towards 45 degrees from the
from the anatomical anatomical position
position

Patient’s position The knee slight Sitting or prone with the knee slightly flexed, to
isolate the gastrocnemius muscle

stationary arm Parallel to the lateral mid line the fibula

Movable arm Parallel to tle lateral mid line of the fifth metatasal

Axis or fulcrum the reference point is shifted superorly or inferiorly until the two
arms of the instrument is parallel to the reference land marks

Caution Avoid inversion or eversion. Measurements done on the medial

aspect vary from those done on the lateral due to the presence of
the longitudinal arch of the foot
 Goniometry of the ankle joint
Invesion Eversion
0 towards 90degree

Patient’s postion No specfific is recommended, excedt that the knee must be

flexed to rule out the hip rotion

Axis or fulcrum On thr centre of heel

Stationary arm On the centre of the heel on the planter aspect of the foot,
from the centre of the heel to a line

Movable arm Kept on the stationry arm

Thank You