Skills: week 3/4 Goniometry (exam 1)

General procedures ( Trombly)

Goniometer placement - Axis of the goniometer over the axis of the joint (anatomic landmark) - Stationary arm parallel or on the longitudinal axis of the proximal or stationary bone - Moving arm parallel or on the longitudinal axis of the distal or the movable bone - Record the range at starting point - Move the joint through the range passively or have the patient do it actively - Reposition the goniometer and record

Horizontal adduction (picture)

Horizontal adduction ( 0-45 degrees)

Full-circle goniometer

Measures 360 degrees of motion large: shoulder small: elbow

Range of Motion measurements

Non standardized -Observation -Functional task -Quick screen of UE motion Standardized -Goniometer

Recording ROM

Notate whether - Passive ROM - Active ROM Anatomical position is 0 degrees - Starting point - If restrictions in starting point then range will NOT be 0 degrees Normal Elbow Flexion : 0-150 degrees - Restriction in flexion: 0-120 degrees - Restrictions in extension: 20-150 degrees (-20 degrees) - Hyperextension: +10 to 0 degrees

Interpretation of Passive ROM

One of three conclusions can be drawn from the passive mobility tests: -The joint motion is determined to be normal (compared to norms) -The joint motion is determined as being excessive -The joint motion is determined as being reduced

Goniometric principles and procedures

*Visual Observation -Joint to be assessed -Proper exposure *Start with quick functional test (bilateral) *AROM *PROM -Move joint to end of range of motion (to assess quality of movement) -Determine end-feel at point where measurement will be taken ( at end of available range) of motion)

Interpretation of ROM

- AROM/PROM values are used to establish a baseline - Can determine improvements, worsening of joint motion with intervention - To be considered clinically significant researchers recommend changes indicating more or less ROM in the upper extremity should exceed 5 degrees when measures are taken by the same examiner. - Standard error of measurement differs for each joint.

Traditional Goniometer: Axis

- Axis of the goniometer: at the intersection of the stationary & movable arms - Placed at the Axis of the motion. - Sometimes this coincides with bony landmarks - It is acceptable to reposition the axis at the end of range if there is a change in the axis during movement

Electrogoniometer

- Can offer continuous measurements of ROM once positioned and calibrated - Can be helpful in analyzing repetitive motions in work and industry settings

Types of goniometers

- Goniometers are produced in a variety of sizes and shapes and are usually constructed of either plastic or metal - The two most common types of instruments used to measure joint angles - bubble inclinometer - universal goniometer. -electrogoniometer

Definition of the word "Goniometry"

- Instrument used to measure angles. - Within the field of PT and OT, goniometry is used to measure the total amount of available motion at a specific joint. - Goniometry can be used to measure both active and passive ROM

Bubble inclinometer/goniometer

- It has a 360° rotating dial and scale with fluid indicator . - Uses gravity rather than therapist visual skills for staring point - Testing position maybe different from traditional setting due to use of gravity

Passive Range of Motion

- Movement that is performed completely by the examiner/external force. - Assess endpoints in the range of motion (end feel) - PROM testing gives the clinician info about the integrity of the non-contractile and inert tissues, and the end-feel determines the barriers to motion

Reliability

- Patient factors -Pain, fatigue, comfort level - Environmental factors -Temperature, time of day, type of goniometer - For the most reliable pretest- post test information, same tester shoulder use the same goniometer at the same time of day - Intra-rater higher than inter-rater reliability -One therapist measuring the same joint angles over multiple trials vs. multiple therapist measuring the dame joint angle -One clinician measuring one joint over multiple trials - AROM more reliable than PROM - Position of the patient will affect ROM - Clinical relevance: record the position of testing and use the same position to retest

Active Range of Motion

- Physiological movements - Joint motion that occurs because of muscle contraction - Dynamic flexibility (antagonist muscle length adequate) Active range of motion testing gives the clinician information about: Quantity of available physiological motion -The integrity of the contractile and inert tissues Quality of physiological motion -presence of muscle substitutions -The willingness of the patient to move Symptom reproduction

Psychometric properties of Universal goniometer

- Reliability refers to the consistency - validity refers to the test results' accuracy. - An instrument should accurately and dependably measure what it ought to measure. - Its reliability can help you have a valid assessment; its validity can make you confident in making a prediction.

Neutral zero method (American Academy of orthopedic surgeons)

- The Anatomical position is considered to be at 0. - Or if the given starting position is different form the anatomical position, it is defined as 0. - If start positions cannot be achieved , the actual start position is recorded to indicate limitation in movement

Traditional Goniometer: Moving arm

- The moving arm is attached to the fulcrum in the center of the body by a rivet or screw-like device that allows the moving arm to move freely on the body of the device. - In some instruments , the screw-like device can be tightened to fix the moving arm in a certain position or loosened to permit free movement. - Usually placed along the longitudinal axis of the movable segment

Traditional Goniometer: Stationary arm

- The stationary arm is structurally a part of the body and therefore cannot move independently of the body - Usually placed parallel with the longitudinal axis of the fixed body segment

Universal Goniometer

- The universal goniometer, is widely used in clinical practice. - It is easy to handle, has low cost and provides rapid measurements - dependent on status of joint to be assessed, examiner experience and technique employed - Composed of three parts: The body/protractor, movable arm and stationary arm - types: full circle, half circle, finger

Thumb radial abduction

- start with wrist and forearm in neutral - axis is the intersection of lines parallel to 1st and 2nd metacarpal - stationary arm is parallel to 2nd metacarpal along dorsal aspect - moveable arm is parallel to 1st metacarpal along the dorsal aspect

Thumb Palmar Abduction

- start with wrist and forearm in neutral - axis is the intersection of lines parallel to 1st and 2nd metacarpal - stationary arm is parallel to 2nd metacarpal along radial aspect - moveable arm is parallel to 1st metacarpal along the radial aspect

Finger DIP Flexion: 0-80

- start with wrist and forearm in neutral - axis is DIP joint - stationary arm is dorsal and parallel to middle phalynx - moveable arm is dorsal and parallel to distal phalynx

Thumb IP Extension

- start with wrist and forearm in neutral - axis is IP joint - stationary arm is dorsal and parallel to proximal phalynx - moveable arm is dorsal and parallel to distal phalynx

Thumb IP Flexion: 0-90

- start with wrist and forearm in neutral - axis is IP joint - stationary arm is dorsal and parallel to proximal phalynx - moveable arm is dorsal and parallel to distal phalynx

Thumb MP Flexion: 0-50

- start with wrist and forearm in neutral - axis is MP joint - stationary arm is dorsal and parallel to 1st metacarpal - moveable arm is dorsal and parallel to proximal phalynx of the thumb

Thumb MP extension

- start with wrist and forearm in neutral - axis is MP joint - stationary arm is dorsal and parallel to 1st metacarpal - moveable arm is dorsal and parallel to proximal phalynx of the thumb

Finger MP Extension

- start with wrist and forearm in neutral - axis is MP joint - stationary arm is dorsal and parallel to metacarpal - moveable arm is dorsal and parallel to proximal phalynx

Finger MP Flexion: 0-90

- start with wrist and forearm in neutral - axis is MP joint - stationary arm is dorsal and parallel to metacarpal - moveable arm is dorsal and parallel to proximal phalynx

Finger PIP flexion: 0-110

- start with wrist and forearm in neutral - axis is PIP joint - stationary arm is dorsal and parallel to proximal phalynx - moveable arm is dorsal and parallel to middle phalynx

Finger PIP extension

- start with wrist and forearm in neutral - axis is PIP joint - stationary arm is dorsal and parallel to proximal phalynx to the joint tested - moveable arm is dorsal and parallel to the phalynx distal to the joint tested

Half-circle goniometer

-Measures 0-180 deg of motion -Ideal for wrist and forearm ROM

finger goniometer

-Short movable arms -Flat surfaces fit comfortably over finger joints

The pattern of motion restriction

Cyriax gave us the terms capsular and non-capsular pattern of restriction -Capsular: a limitation of pain and movement in a joint specific ratio, which is usually present with arthritis, or following prolonged immobilization -Non-capsular: a limitation in a joint in any pattern other than a capsular one. May indicate the presence of either a derangement, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion

Horizontal abduction

Subject position Sitting, standing , supine Horizontal abduction (0- 135 degrees) Goniometer alignment Axis: On top of acromion Stationary arm: Perpendicular to thorax Movable arm: parallel to longitudinal axis of the humerus

Initial Position ER / IR (at 90 degree abduction)

Supine for PROM. Can be sitting for AROM. Watch for substitutions

Shoulder extension

Test Position - Subject prone / standing / seated Goniometer Alignment - Axis: center of humeral head lateral aspect - Stationary arm: parallel mid-axillary line - Moving arm: aligned with midline of humerus (lateral epicondyle) Shoulder extension(0~60°)

Wrist flexion

Test Position - Subject seated - Forearm stabilized on table or perpendicular to table - Flex wrist (fingers relaxed) Goniometer Alignment - Axis: lateral wrist (triquetrum) or base 3rd metacarpal - Stationary arm: aligned with ulna or dorsal surface of forearm - Moving arm: aligned with fifth metacarpal or dorsum of 3rd MC Wrist flexion (0~80°)

Wrist extension

Test Position - Subject seated - Forearm stabilized on table or perpendicular to the table - Extend wrist (fingers relaxed) Goniometer Alignment - Axis: lateral wrist (triquetrum) or volar surface - Stationary arm: aligned with ulna /midline volar surface of forearm - Moving arm: aligned with fifth metacarpal / long axis of 3rd MC Wrist extension (0~70°)

Forearm pronation

Test Position - Subject sitting - Shoulder neutral (arm at side) - Elbow flexed to 90 - Stabilize arm - Pronate forearm Goniometer Alignment - Axis: lateral to ulnar styloid - Stationary arm: perpendicular to the floor - Moving arm: aligned with dorsum of radius Forearm pronation (0~80°)

Forearm supination

Test Position - Subject sitting - Shoulder neutral (arm at side) - Elbow flexed to 90o - Stabilize arm -Supinate forearm Goniometer Alignment - Axis: medial to ulnar styloid - Stationary arm: perpendicular to the floor - Moving arm: aligned with ventral aspect of radius Forearm supination (0~80°)

Ulnar deviation

Test Position - Subject sitting with forearm resting on table - Stabilize forearm Goniometer Alignment - Axis: capitate - Stationary arm: aligned with forearm (lateral epicondyle) - Moving arm: aligned with metacarpal of middle finger Ulnar deviation (0~30°)

Radial deviation

Test Position - Subject sitting with forearm resting on table - Stabilize forearm to prevent pronation or supination Goniometer Alignment - Axis: capitate - Stationary arm: aligned with forearm - Moving arm: aligned with metacarpal of middle finger Radial deviation (0~20°)

Shoulder abduction

Test Position - Subject standing/sitting/supine - AROM: upright preferred - PROM: supine preferred Goniometer Alignment - Axis: center of humeral head (anterior/posterior aspect - Stationary arm: parallel to sternum / trunk - Moving arm: aligned with midline of humerus Shoulder abduction (0~180°)

Shoulder internal rotation

Test Position - Subject supine - Shoulder 90 abduction - Forearm neutral - Elbow flexed 90 - Stabilize arm Goniometer Alignment - Axis: olecranon process of ulna - Stationary arm: aligned vertically - Moving arm: aligned with ulna (styloid process) Shoulder internal rotation (0~70°)

Shoulder external rotation

Test Position - Subject supine - Shoulder 90 deg abduction - Forearm neutral - Elbow flexed 90 deg - Stabilize arm Goniometer Alignment - Axis: olecranon process of ulna - Stationary arm: aligned vertically / perpendicular to floor - Moving arm: aligned with ulna (styloid process) Shoulder external rotation (0~90°)

Elbow flexion

Test Position - Subject supine / seated - Shoulder neutral (arm at side) - Forearm supinated - Elbow flexed - Stabilize arm Goniometer Alignment - Axis: lateral epicondyle of humerus - Stationary arm: aligned with humerus (center of acromion process) - Moving arm: aligned with radius (styloid process) Elbow flexion (0~150°)

Elbow extension

Test Position - Subject supine / sitting - Shoulder neutral (arm at side) - Forearm supinated - Elbow extended - Stabilize arm Goniometer Alignment - Axis: lateral epicondyle of humerus - Stationary arm: aligned with humerus (center of acromion process) - Moving arm: aligned with radius (styloid process) Elbow extension (150~0°)

Shoulder Flexion

Test Position - Subject supine, standing or sitting - AROM : prefer upright - PROM: prefer supine Goniometer Alignment - Axis: center of humeral head near acromion process 1" below - Stationary arm: parallel mid-axillary line - Moving arm: aligned with midline of humerus (lateral epicondyle) Shoulder flexion(0~180°)

Origins of the word "Goniometry"

The term goniometry is derived from two Greek words, -Gonia meaning angle - Metron, meaning measure.

Positioning

Therapist -Contingent on jt. being treated -Good body mechanics * Use larger joints * Base of support Patient - AROM against gravity, gravity assisted, gravity eliminated - Take precautions to avoid substitutions

Principles

Two joint muscles - ROM affected by length of the muscles - Passive insufficiency * Finger flexors and wrist extension * Finger extensors and wrist flexion