ROM is the amount of motion that is available at a given joint.

-AROM is the amount of joint motion attained by VOLUNTARY JOINT MOTION (on their own)

-PROM is the amount of joint motion attained by an EXAMINER without assistance from the client

Provides info on: Muscle strength, coordination, willingness to move, ability to follow directions, level of consciousness, attention span, joint ROM

May be limited due to: Muscle weakness, PAIN, edema, restricted joint mobility

Provides info about: Integrity of articular surfaces, joint capsule, ligaments, and muscles

Additional points: PROM is usually slighty greater than AROM

Comparison of AROM and PROM is useful to determine soft tissue vs. bony vs. joint pathology

-Determining the presence of dysfunction

-Establishing a Dx

-Developing treatment goals

-Evaluating progress

-Modifying treatment if its not working

-Researching effectiveness of therapy

-Determing orthoses or adaptive equipment

-Introduction, explanation, demonstration

-Place subject in reccomended test position

-Have client/pt perform AROM and observe quality of motion

-Expose joint

-Stabilize proximal joint segment if necessary and move limb through PROM->examine and FEEL

-Palpate and identify landmarks

-Align goniometer with its axis on the joint axis

-Stationary arm is aligned parallel to the longitudinal axis of the proximal limb segment

-Moving arm is aligned parallel to the longitudinal axis of the distal limb segment

-Read and record starting position

-Stabilize proximal component

-Move distal component through full AROM/PROM

-Replace and realign goniometer. Palpate landmarks if necessary

-Record AROM/PROM

-Compare ROM to the opposite side

-Include start and end position to define the joint range

* A motion that begins at 0 and ends at 150 is recorded at 0-150

* A motion that begins at 20 and end at 120 is recorded as 20-120 (some may record as -20 degrees of extension)

* If hyperextension occurs (ex elbow) record as 20-0-150

Quality vs. Quantity

T/F

If you measured a patient's right hip flexor ROM as WNL you can assume that no abnormal stresses are occuring within the joint.

False

While their total range may be WNLs a disproportionate amount of mobility may be arising from one structure, thus leading to abnormal stresses

For instance, the roles of gastroc and hamstrings for knee flexion

-Distinct Measurements-

Range of joint measurement

-Distinct Measurements-

Range of muscle length

Number of degrees of motion in a muscle

In some cases may be measured with a tape measure for instance, distance from table

-One versus two joint muscles-

One joint muscles

- One vs. two joint muslces-

Two joint muscles

Muscle length range< joint range

May be elongated over one joint, but not over two joints

e.g. hipflexion with knee flexion > hip flexion with knee extension (affected by hamstring muscle length)

ROM/ML (muscle length)

Hip flexor ROM will be greatest in which position of the hip and knee?

Hip flexion with knee flexion 0-120

versus

Hip flexion with knee extended 0-50

ROM/ ML (muscle length)

Ankle dorsiflexion will be greatest in which position of the ankle and knee?

Ankle DF and knee flexion

and

Ankle DF and knee extension

Both will produce a DF ROM of 1-10

ROM/ ML (muscle length)

Elbow flexion ROM will be greatest in which position of the elbow and shoulder?

Elbow flexion with shoulder in neutral 0- 120

versus

Elbow flexion with shoulder in flexion 0- 90

ROM/ ML (muscle length)

Wrist supination ROM will be greatest in what position of the wrist and elbow?

Wrist supination with elbow flexion 0- 90

versus

Wrist supination with elbow extension 0- 75

A 62 year old woman comes to you complaining of low back pain. She tells you that she is currently taking pain medication and she has osteoporosis. You decide that you would like to test her ROM hip flexion and extension. What factors may you want to consider?

Precautions for ROM

-The patient mentions that she is taking pain medication which will affect her perception of pain and determination of when you have "pushed too much" increasing risk for injury

- Also, the patient mentions that she has osteoporosis. You must especially be aware of this especially during PROM, for risk of bone fractures.

No. With knee and elbow flexion, a physiological soft end feel would be noted as normal.

A hard end feel would be more commonly noted in elbow extension.

No. A frozen shoulder is considered within the capsular pattern of the shoulder joint:

-Decreased external rotation

-Limited abduction

-Limitation in internal rotation

20-0-110

Include start and end position to define the joint range

If hyperextension occurs, measure motion on both sides of anatomic neutral:

amount of hyperextension (20) -> anatomic neutral (0 )-> knee felxion ROM (120)

Infection/inflammation at the joint

medications

osteoporosis

joint hypermobility

pain

hemophilia

joint in region of hematoma

Contraindications for ROM:

regions of dislocation or unhealed fractures;

immediately after surgical procedures to tendon, ligament, muscle, joint capsule; myositis ossificans

You are performing PROM on a patient at the knee in prone. You experience a firm end feel. Is this normal? What could be wrong?

You measure a patient's hip ROM.

You find that their involved side has:

flex/ext, 90-0-20;

their hip IR/ER is 15-0-45;

and their hip abd/add 20-0-30.

The uninvolved side has:

flex/ext, 120-0-30;

IR/ER, 45-0-45;

and abd/add, 45-0-30.

Is this a capsular pattern of joint range limitations?

Most End Feels can by found in normal joints, or in abnormal joints:

Soft Firm Hard

One can be found only in abnormal joints:

Empty

Firm end feel is caused when motion is limited by muscular stretch, capsular stretch or ligamentous stretch

Examples:

Straight Leg Raise (muscular stretch)

MCP extension (capsular stretch)

forearm supination (ligamentous stretch)

• marked restriction in internal rotation

• limitations in flexion and abduction

• may be slight limitation in extension

• no limitations in external rotation or adduction

• marked restriction in external rotation

• limitation in abduction

• may be slight limitation in internal rotation

Hip flexion/extension

Normal 120-0-30

Patient 90-0-20

Restriction in Flexion

Slight Restriction in extention

Hip IR/ER

Normal 45-0-45

Patient 15-0-45

Restriction in IR. ER normal

Hip ABD/ADD

Normal 45-0-30

Patient 20-0-30

Restriction in ABD. ADD normal

This pattern indicates capsular involvement

Shoulder flex/ext

Normal 180-0-60

Patient 180-0-20

Limited extension. Normal flexion (C/O pain)

Shoulder IR/ER

Normal 70-0-90

Patient 70-0-80

Normal IR. Slightly restricted ER

Shoulder ABD/ADD

Normal 180-0-30

Patient 180-0-30

Normal ABD/ADD

This pattern doesn't indicate capsular involvement

Technique used to determine if the muscle length is normal, excessive, or limited

Muscles with limited length are usually strong, promoting lengthening of the opposing muscles

Muscles with excessive length are usually weak, allowing for adaptive shortening of the opposing muscle

1) Type of joint

2) Motion of the joint

3) Test position

Straight leg raise changes with opposite leg position.

Shoulder range in sitting versus supine.

1) Standardize positions

2) Stabilize proximal body parts

3) Use bony landmarks to align goniometer

4) Use same examiner (intratester reliability)

1) Pathological conditions such as pain and inflammation

2) Fear

3) Age

4) Gender

1) infection or inflammatory process in joint

2) meds for muscle relaxation or pain 3)osteoporosis

4) joint hypermobility

5) pain

6) hemophilia (abnormal clotting system)

7) joint in region of hematoma

8) immediately after injury, where disruption of soft tissue is suspected

9) cervical sprain

1) on a region of dislocation or unhealed fracture

2) immediately after surgery on a tendon, ligament, muscle, or joint capsule

3) Myositis ossificans (condition that forms abnormal bone formation in deep muscle tissue)

Case:

 Hip Flexion with kneed flexed 0-120

Hip flexion with knee extended 0-50

Answer:

Tight Hamstrings

Case:

Ankle dorsiflexion with knee flexed 0-10

Ankle dorsiflexion with knee extended 0-10

Answer:

Joint Tightness

Case:

Elbow flexion with shoulder flexed 0-90

Elbow felxion with shoulder in neutral 0-120

Answer:

Tight Triceps

Case:

Wrist supination with elbow extended 0-75

Wrist supination with elbow flexed 0-90

Answer:

Tight Biceps

MMT Case:

Supine

Flex hip to 90 degrees

Bring knee into extension

Measure knee extention angle

Popliteal angle Hamstrings

Knee extension angle: Norm = 0-10

Case:

 Pt. Supine

One hip/knee flexed, other leg hanging down but hamstrings not touching the table.

Positive Thomas Test 

(tight hip flexors)

Measure hip flexion

Case:

Pt. sidelying

Leg into abduction, extension of hiip, and lower leg toward adduction

Hip does not pass neutral

Positive Ober TFL test

watch for pelic movement