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