Goniometry, Joint Range of Motion

1. GONIOMETRY
GONIA - Angle
METRON - Measure

2. BASIC CONCEPTS
Goniometry refers to the measurement of
angles created at human joints by the
bones of the body.
Goniometry is used to measure and
document the amount of active and
passive joint motion.

3. USES
Goniometric data used in conjunction with other
information to:
1. Determine the presence or absence of impairment
2. Establish diagnosis
3. Develop prognosis, treatment goals and plan of care
4. Evaluate progress or lack of progress of treatment
5. Modify treatment
6. Motivate the subject
7. Research the effectiveness of techniques
8. Choose orthoses or adaptive equipment

4. JOINT MOTION
Arthrokinematics
It is a term used to refer to the movement of
joint surfaces. They are,
1. Slides/glides: Is a translatory motion
2. Spins/roll : Is a rotary motion
Osteokinematics
These are movement of shafts of bones.

5. JOINT MOTION (cont )
Planes and axis
OKs motions are described as taking place in three
cardinal Planes and Axis.
Planes
1. Sagittal : From ant. to post. of the body. Flexion and
extension occurs in this plane in med. Lat. Axis.
2. Frontal : Runs from one side of body to another
dividing it to front and back halves. Abduction and
adduction occurs in anteroposterior axis.
3. Transverse : Horizontal and divides the body into
upper and lower halves. Rotation motion occurs in
vertical axis

6. RANGE OF MOTION
ROM is a motion that occurs at a joint or
series of joints.
The starting position for ROM is
anatomical position except rotations in
transverse plane.
3 notation systems have been used to
design ROM:0-180˚, 180-0˚, 360˚
0-180 system of notation is called neutral
zero method.

7. ACTIVE RANGE OF MOTION
AROM is the arc of motion attained by a
subject during unassisted voluntary joint
motion.
This provides the examiner with
information about the subject’s willingness
to move, coordination, muscle strength
and joint range of motion.

8. PASSIVE ROM
PROM is the arc of motion attained by an
examiner without assistance from the
subject.
Normally PROM is slightly greater than
AROM.
This provides the examiner with
information about the integrity of the
articular surfaces and the extensibility of
soft tissues around the joint.

9. END FEEL
The type of structure that limits a ROM
has a characteristic feel that may be
detected by the examiner.
The examiner should be able to detect
Normal end feel
Abnormal end feel

10. NORMAL END FEEL
End feel Structure
Soft Soft tissue approximation
Firm 1. Muscular stretch
2. Capsular stretch
3. Ligamentous stretch
Hard Bone to bone

11. ABNORMAL END FEEL
End feel Examples
Soft: Before complete ROM.
Feels boggy.
Soft tissue edema.
Synovitis.
Firm: Before complete ROM Hypertone,soft
tissue shortening.
Hard: Bony grating/bony block #,OA,MO,loose
bodies.
Empty: No end feel, pain
prevents full ROM
#,Inflammation.

12. HYPOMOBILITY
This is decrease in ROM.
Cyriax proposed that pathological conditions
involving the entire joint capsule cause a
particular pattern of restriction involving most of
the passive motions of the joint. This pattern is
called a capsular pattern.
Restriction caused by condition involving
structures other than the entire joint capsule is
called noncapsular patterns of movement.
Noncapsular pattern of movement is not
proportioned similar to capsular pattern.

13. CAPSULAR PATTERN OF JOINTS
Joints Restricted motion
glenohumeral Lat.rotn., abd.,med.rotn.
elbow Flxn.extn.
forearm Supn., pron., flxn., extn.
wrist Flxn. extn.=, deviations
CMC digit 1 Abd.
CMC digit 2-5 All motions =
MCP & IP Flxn., extn.

14. CAPSULAR PATTERN OF JOINTS
joints Restricted motion
hip Med.rotn. flxn.abd.extn.
knee Flxn. extn
ankle Plantar flxn. dorsi flxn.
subtalar Inversion
midtarsal Add., med.rotn.
MTP digit 1 Extn.flxn.
MTP digit 2-5 Flxn.extn.
IP Extn.flxn.

15. HYPERMOBILITY
This refers to an increase in passive ROM
that exceeds normal values.
This is due to the laxity of soft tissues
around the joint.
Causes are,
1. Injuries
2. Hereditary disorders

16. MUSCLE LENGTH TESTING
Muscle length is the greatest extensibility of a
muscle tendon unit.
It is the maximal distance between the proximal
and the distal attachments of a muscle to bone.
Muscle length is measured indirectly by
determining the end of the ROM of the joints
crossed by that muscle.
Muscle length is tested to ascertain cause of
change in ROM.

17. MUSCLE LENGTH TESTING
(cont )
Muscles are categorized by the number
of joints they cross,
1. One joint muscle
2. Two joint muscle
3. Multi joint muscle

18. One Joint Muscles
Cross and therefore influence the motion of only
one joint.
No difference exists between the indirect
measurement of the length of a one joint muscle
and the measurement of joint ROM in the
direction opposite to the muscle’s active motion.
If there is shortness in muscle length, PROM
opposite to the muscles action is decreased.
The end feel is firm due to muscle stretch.

19. Two joint muscles
To asses the length of a two joint muscle, the
subject is positioned so that the muscle is
lengthened over the proximal or distal joint that
the muscle cross.
This joint is held in position while the examiner
attempts to further lengthen the muscle by
moving the second joint through full ROM.
The end feel is firm.

20. Multi joint muscle
The subject is positioned and held so that the
muscle is lengthened over all the joints that the
muscle crosses except for one last joint.
The examiner attempts to further lengthen the
muscle by moving the last joint through full
ROM.
PASSIVE INSUFFICIENCY: The length of two &
multi joint muscles are usually not sufficient to
allow full passive ROM to occur simultaneously
at all joints crossed by these muscles.

21. INSTRUMENTS
1. Universal goniometer
2. Gravity dependent
goniometer/inclinometers, pendulum,
fluid or bubble goniometer.
3. Electrogoniometer

22. Alignment
Is based on anatomical land marks
Stationary arm is in parallel to longitudinal
axis of the proximal segment of the joint
Moving arm in parallel to the longitudinal
axis of the distal segment

23. PROCEDURES
The examiner must
have knowledge of
1. Testing positions
2. Stabilization required
3. Joint structure and
function
4. Normal end feel
5. Anatomical bony
landmarks
6. Instrument alignment
The examiner must
have the skill to
1. Position and stabilize
correctly
2. Move a body part
through proper ROM
3. Determine the end
ROM i.e. end feel
4. Palpate bony landmarks
5. Align measuring
instrument with
landmarks
6. Read measuring
instrument
7. Record measurements
correctly

24. Positioning & stabilization
Testing positions are designed to
1. Place the joint in a starting position of 0˚
2. Permits complete ROM
3. Provide stabilization for the proximal
joint segment
4. Positional stabilization may be
supplemented by manual stabilization
provided by the examiner

25. Recording
Recordings are done in numerical tables, pictorial
charts or within the written text of evaluation.
Recordings should include the following
1. Subject’s name age and sex
2. Examiner’s name
3. Date and time
4. Make and type of goniometer
5. Side of body, joint and motion being measured
6. ROM at the beginning of motion and at the end of
motion
7. Type of motion i.e. passive or active
8. Subjective information such as pain, discomfort etc
9. Objective information like muscle spasm, crepitus,
capsular or noncapsular pattern etc
10. Description on any deviation from recommended
testing position

26. Factors Affecting ROM
Soft tissue tightness
Adhesion formation
Injuries or inflammation around the joint
Muscle bulk
Sex
Age
Nervous system