PTA 251: Goniometry Chp 1

Goniometry is used to measure & document the following

Active joint motion passive joint motion abnormal (fixed) joint positions

The arc of motion attained by a subject during unassisted voluntary joint motion is called

Active range of motion (AROM)

Factors affecting ROM

Age Gender whether the motion is preformed actively or passively

What end feel is associated with increased muscular tonus or capsular, muscular, ligamentous & fascial shortening?

Firm: in a joint that normally has a soft or hard end-feel.

Goniometry is derived from these two Greek words

Gonia = angle Metron = measure

The instrument used to measure angles created by human joints is

Goniometer

What end feel is associated with chondromalacia, osteoarthritis, loose bodies in the joint, myositis ossificans or a fracture

Hard: a bony grating or bony block is felt where it should normally be soft or firm end feel

A ROM measurement of 30° or more of extension at the elbow is indicative of this

Hypermobility

A non capsular pattern of restricted motion is caused by

Internal joint derangement adhesion of a part of a joint capsule ligament shortening muscle strains muscle contractures

According to Hertling & Kessler capsular patterns of restriction can be classified into these 2 general categories

Joint effusion & synovial inflammation Relative capsular fibrosis

Hypermobility is described as PROM that exceeds normal values for a given joint, it can be caused by

Laxity of soft tissue structures such as ligaments, capsules, and muscles that normally prevent excessive motion Trauma to a joint Abnormalities of a joint disorders of connective tissue

The pattern of restricted motion is a limitation of PROM that is not proportioned similarly to a capsular pattern and involves on or two motion of a joint

Non capsular pattern

Metabolic conditions like this one have been associated with limited joint motion

diabetes

To assess the length of the two joint triceps muscle, the pt must be positioned this way

elbow flexion is measured while the shoulder is positioned in flexion

This feeling, which is experienced by an examiner as a barrier to further motion at the end of a PROM, is called

end-feel

3 notations systems have been used to define ROM

0°-180° 180°-0° 180°-360°

Goniometric data used in conjunction with other information can provide a basis for the following

Determining the presence or absence of impairment Establishing a diagnosis Developing a prognosis, tx goals & POC Evaluating progress (or lack of) toward rehab goals Modifying tx Motivating the subject Researching the effectiveness of therapeutic techniques (measuring outcomes following exercises, medications & surgical procedures) Fabricating orthoses and adaptive equipment

Disorders of connective tissue that lead to hypermobility

Ehlers-Danlos syndrome Marfan syndrome Osteogenesis imperfecta

If a pt. is experiencing acute joint inflammation, bursitis, abscess, fracture or psychogenic disorder you may not be able to complete ROM because of pain. this end feel is called?

Empty: no resistance is felt except for pt. protective muscle splinting or muscle spasm.

Which allows greater ROM, PROM or AROM?

PROM, because each joint has a small amount of available motion that is not under voluntary control

When a abnormal joint motion is observed, this is indicated

PROM: should be conducted to determine the cause of the limitations

Osteokinematics take place in one of these cardinal planes & around the corresponding axes

Sagittal plane/ frontal axis (medial/lateral) Frontal plane/sagittal axis ( anterior/posterior) Transverse / vertical axis (cranial/caudal)

The types of Arthrokinematic motion are

Slide/glide Spin Roll

what end feel is associated with soft tissue edema or synovitis?

Soft: feels boggy

Factors related to the testing process that can affect ROM

Testing position Type of instrument Experience of therapist Time of day

An examiner finds a subject with muscle paralysis has full ROM passively, but not actively, how is this possible?

The joint surfaces and the extensibility of the joint capsule, ligaments, muscles, tendons, fascia, and skin are sufficient to allow full PROM. The lack of muscle strength prevents active motion at the joint

Reviewing patient records helps to obtain an accurate description of these

current symptoms functional abilities occupational, social,& recreational activities

The term hyperextension is used to describe this

a greater than normal extension ROM

Because of the limitations imposed by the uniaxial design of the goniometer only motion occurring here can be measured

a single plane

Observation of AROM allows the therapist to look for

abnormal movements & gain information about the pt's willingness to move

Pain during PROM cannot be attributed to this

active shortening (contracting) of contractile tissues

The starting position for measuring all ROM, except rotation, is this

anatomical position

ROM is the arc of motion that occurs here

at a joint of a series of joints

Why is it important to test PROM prior to performing a MMT of muscle strength ?

because the grading of MMT is based on the ability to complete joint ROM.

After the initial interview the clinician should observe the body for these

bone & soft tissue contour (skin & nail condition)

pathological conditions involving the entire joint capsule cause a particular pattern of restriction involving all or most of the passive portions of the joint, this pattern of restriction is called?

capsular pattern

You are testing a pt for joint ROM, but have no standard(normal) values to compare your pt's ROM too, what should you do?

compare the pt's opposite joint (if the opposite extremity is not impaired)

A capsular pattern at the glenohumeral joint would restrict these motions

greatest loss of lateral rotation moderate loss of abduction minimal loss of medial rotation

Decreased ROM is a common development after

immobilization after fractures scar development after burns

The osteokinematic movement of joint surfaces are usually described this way

in terms of the rotary or angular motion produced

Arthrokinematics is the term used to refer to

movement of the joint surfaces (motion occurs as a result of mvmt of one joint surface in relation to another joint surface) also called joint play or accessory motions

If pain occurs during PROM, it is often due to

moving, stretching, or pinching of inert structures

How is muscle length measured

indirectly by determining the maximal passive ROM of the joints crossed by the muscle

what information is obtained when PROM is preformed

integrity of the joint surfaces extensibility of joint capsule & associated ligaments, muscles, fascia & skin

Goniometry is an important part of a comprehensive examination of these

joints & surrounding soft tissue

Anthropometric measurements should include

leg length circumference body volume: edema/atrophy

the greatest extensibility of a muscle tendon unit is called

maximal muscle length

Arthrokinematic motions are examined for amount of these

motion tissue resistance (end feel) effect on pt's symptoms

translatory motion (also called linear motion)

motion in which all points of a moving body move uniformly in the same line or direction (all parts of the object move the same distance, in the same direction & at the same time)

All of these things affect the amount of PROM of a joint

muscle length integrity of the joint surfaces extensibility of the capsule, ligaments, fascia, & skin

0°-180° notation system is also referred to as

neutral zero method

Describe the rolling of one joint surface on another

new points on each joint surface come into contact throughout the motion example: a ball rolling across the ground, the plantar surface of the foot during walking

Passive insufficiency

occurs when a two-joint muscle cannot be stretched enough to permit full RoM at both joints a the same time Examples: biceps femoris during knee extension & hip flexion quadriceps femoris during knee flexion & hip ext.

Active insufficiency

occurs when a two-joint muscle cannot shorten enough to cause full RoM of both joints the muscle crosses Examples: triceps brachii during shoulder ext. & elbow ext. gastrocnemius during ankle extension & knee flexion

Describe the slide/glide of one joint surface on another

one point on a joint surface contacts new points on the adjacent surface; a linear mvmt of a joint surface parallel to the plane of the adjoining joint surface example: an ice-skater's blade sliding across the ice surface

Orthopedic conditions associated with Hypomobility

osteoarthritis rheumatoid arthritis adhesive capsulitis spinal disorders

A strain of the biceps muscle may result in pain and restriction at the end of the range of passive elbow extension, but this motion would not be effected

passive elbow flexion

A comprehensive examination always begins with this

patient interview: to obtain an accurate description of current symptoms

Gentle palpation should be used to determine

skin temperature quality of soft tissue deformities pain symptoms in relation to anatomical structures

To assess the length of a two joint muscle, the pt has to be positioned this way

so that the muscle is lengthened over the proximal or distal joint the muscle crosses.

A goniometer can be used to measure

specific joint position or the total amount of motion available at a joint

Pain occurring at the end of PROM may be due to this

stretching of contractile structures as well as non-contractile structures

Neurological conditions associated with Hypomobility

stroke head trauma cerebral palsy complex regional pain syndrome (CRPS)

Osteokinematics movement refers to

the gross movement of the shafts of bones rather than the movements of the joint surfaces

Goniometry is a term used to refers to this

the measurement of angles created at human joints by the bones of the body (osteokinematic movement)

Degrees of freedom at any joint are determined by

the number of planes that allow motion example: 1° of freedom=flexion/ext. 3° of freedom= flex/ext ABD/ADD & rotation

Describe the spin of one joint surface on another

the rotation of the moveable joint surface on the fixed adjacent surface example: a spinning top on a table (head of the radius spinning on the capitulum of the humerus; the humerus rotating medially & laterally in the glenoid fossa)

The type of motion available at a joint varies according to

the structure of the joint

Having a subject perform AROM provides the examiner with this information

the subjects willingness to move coordination muscle strength Joint ROM

Ideally, to determine whether a ROM is impaired, the value of the ROM should be compared with this

values from people of the same age and gender & from studies that used the same method of measurement

The purpose of testing muscle length is to ascertain this

whether hypo or hyper mobility is caused by the length of the inactive antagonist muscle or other structures