In the name of ALLAH,
the beneficent,
the merciful.
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Measurement
of Range of motion
Dr. M. JAWWAD BAIG CHUGHTAI
SENIOR LECTURER
IIRS, IUKC
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Range of Motion (ROM)
“The amount of motion that
is available at a joint.”
The degree of movement
that can occur in a joint.
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Range of Motion (ROM)
• The angle through which a joint moves from
the anatomical position to the extreme limit of
its motion in a particular direction.
• It is measured in degrees.
• For example, the ROM for flexion at the
elbow is the difference between the angle at
the elbow in the anatomical position (fully
extended) and the angle at the elbow when it
is in maximum flexion.
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• The complete range of motion of a joint is divided into
three equal parts: the inner range, middle range, and
outer range.
Range of muscle work
• the full range in which a muscle works refers to the muscle
changing from a position of full stretch and contracting to a
position of maximal shortening.
Outer range
• A position where the muscle is on full stretch to a position
halfway through the full range.
Inner range
• A position halfway through the full range to a position
where the muscle is fully shortened.
Middle range
• A position b/w the midpoint of the outer range to a position
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of the midpoint of inner range.
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• Normal Active Range
• Range of motion of a joint during activities which are a
normal part of everyday life. Compare maximum active
range.
• Maximum Active Range
• Range of motion through which a joint can go under the
direct pull of the muscles. It is greater than the normal active
range, but less than the maximum passive range.
• Maximum passive range
• The greatest range of motion that can be produced by any
means before significant joint damage occurs. It is always
greater than the maximum active range.
• Movement
• The act of moving; change of place or posture . 8
Types of ROM
• Active Range of Motion
• Passive Range of Motion
• Active first, and if found abnormal, then proceed to
passive
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AROM
• The movement which is done by the patient
himself (herself, own) is said to be Active
Movement.
• Active movement are the voluntary action of the
muscles.
• AROM is movement within the unrestricted ROM
for a segment that is produced by an Active
Contraction of the muscles crossing that joint.
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AROM refers to the amount of joint motion attained
by a subject during un-assisted voluntary joint
motion.
• Having a subject perform AROM provides the
examiner with information about subject’s:
I. Willingness to move
II. Coordination
III. Muscle strength
IV. Joint ROM
• If AROM is limited, painful,or awkward then
the physical examination should be include 12
additional testing to clarify the problem.
PROM
• “The movement which is within the un-
restricted ROM for a segment that is produced
entirely by an external force, there is little to or
no voluntary muscle contraction.”
• External Force (mechanical / manual)
• Gravity
• A machine
• An other individual
• An other part of the individual’s own body
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PROM is the amount of motion attained by an
examiner without assistance from the subject.
• The subject remains relaxed and plays NO active
role in producing the motion.
• Normally the PROM is slightly greater than the
AROM because each joint has a small amount of
available motion that is not under voluntary
control.
• This additional PROM that is protect joint
structures because it allows the joint absorb
extrinsic force.
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Factors affecting the joint ROM
Soft tissue tightness
Adhesion formation
Injuries OR Inflammation around the joint
Muscle bulk
Sex
Age
Nervous system
Active & Passive insufficiency
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• In order to assess for ROM the therapist must
have :
An understanding of the anatomy of the area
involved.
The boney configuration of the joint.
The soft tissue in the area.
The movements that take place at the joint.
The limiting factors of the joint.
(Clarkson, 2000)
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Goniometer
• The instrument, which is used for measuring the
ROM of the joint.
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Goniometry
• Greek word
GONIO = Angle
METRON = Measurement
Goniometery refers to measure the angles in
particular, the measurement of angles created at
Human joints by the bones of the body.
• Goniometer may be used to determine both a:
Particular joint position.
The total amount of motion available at a joint.19
GONIOMETRY
• Within the field of Physical Therapy,
Goniometry is used to measure the total
amount of available motion at a specific joint.
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Types of Goniometer
1. Universal (Traditional) Goniometer
2. Gravity dependent Goniometer
or Fluid bubble Goniometer (Inclinometers)
3. Pendulum Goinometer
4. Electro Goniometer
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Measurement Instruments
1. Universal Goniometer
• body
• stationary arm (proximal)
• moving arm (distal)
• size
2. Gravity-Dependent Goniometers
Inclinometer
Pendulum Goniometer
Fluid (bubble) Goniometer
3. Electrogoniometer
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Universal Goniometer
• Designed by Mr. Moore
• Very commonest variety
• Constructed of metal or plastic,many sizes&
shapes
• It is having :
1. Body
2. Stable Arm
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3. Movable Arm
Body
• BODY of the goniometer resembles like half or
full circle protector.
Normally, the half circle protector contains 0 to
180 or 180 to 0 degree of readings.
Full circle protector body consists of 0 to 360
and 360 to 0 degree readings.
• Axis and Fulcrum is present in the middle of the
body, it connects the stationary and movable
arm.
• Axis of goniometer placed over the Axis of the
joint, which has to be measured.
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Stable Arm
• This is the extension from the body of the
goniometer.
• Stable Arm does not have any motion.
• This will be aligned with the proximal segment of
the measuring joint.
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Movable Arm
• This is the additional attachment with the Body
of the goniometer in the Axis.
• Movable Arm is aligned with the distal segment
of the measuring joint.
The length of the ARMS varies among
instruments from approximately 3 to 18 inches.
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Extendable goniometers allow varying ranges from 9 ½ inches to 26 inches,
the longer armed goniometers, or the bubble inclinometer are recommended
when the landmarks are further apart, such as when measuring hip, knee, shoulder
,elbow movements.
Finger Goniometer
Extendable Goniometer 32
Gravity Dependent Goniometer
• Otherwise called as Pelvic Inclinometer.
• Designed by Schenkar in 1956.
• It is having
Gravity Affecting pointer.
Fluid filled circular chamber with air bubbles.
• Resembles like the Carpenter’s Level Meter but
cicular, has a 360 degree scale.
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• Mostly used for measuring the Pelvic Tilt or Drop
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Pendular goniometer
• Designed by Fox and Van Breemen in 1934
• Consists of 360 Degree protector with the
weighed pointer hanging from the center of the
protractor.
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Ship's
Pendulum
Pendulum Clinometer
Clinometer
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Electrogoniometer
• Designed by Karpovich in 1959
• It has two Arms :
One is attached with the proximal segment
Other is attached with the distal segment of the
measuring joint.
• The Potentiometer is connected with these Two
Arms.
• Change in the joint position show Angulations in
the Potentiometer.
• Mostly used for the RESEARCH purposes. 38
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Other joint ROM measurement
methods
Radiographs
Photographs
Film
Videotapes
MEASURING METER (TAP)
Visual Estimation (Observational) Method
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Goniometry
Goniometry is an important part of a
comprehensive evaluation of joints & surrounding
soft tissue.
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• To measure a ROM of a particular joint the
Physical Therapist should have the thorough
knowledge on :
Osteokinematics & Arthrokinematics of the joint.
Axis & Plane of movement.
Types of ROM.
ROM of an individual joint.
End-Feel
Capsular & Non-Capsular Pattern 46
Arthrokinematics
• movement of joint surfaces
Osteokinematics
• movement of shafts of the bones .
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PLAN AXIS MOVEMENT
Sagittal Coronal Flexion/Extension
(divides body into (medial-lateral
Rt & Lt sections) axis)
Coronal/frontal Sagittal Adduction/Abduct
(divides body into (anterio-posterior ion
Ant & Post axis)
sections)
Transverse/Horiz Vertical Medial/Lateral
ontal (Superio -inferior Rotation
(divides body into axis
Sup & Inf
sections 48
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Degree of Freedom
• Joints are described in relation to the
number of planes that they can move in
(Brunnstrom 1983).
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AXIS DEGREE OF PLANES MOVEMENT
FREEDOM
UNI-AXIAL 1 1 Flexion/Extension
BI-AXIAL 2 2 Flexion/Extension
Abd/Add
MULTI-AXIAL 3 3 Flexion/Extension
Abd/Add
Rotation
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Joints Degree of freedom
DIP 1
PIP 1
MCP 2
WRIST 2
RADIO-ULNAR 1
ELBOW 1
SHOULDER 3
ACROMIO- 3
CLAVICULAR
STERNO-CLAVICULAR 3
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TOTAL D.F 17
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
SHOULDER
Flexion 180
Extension 60
ER>ABD/FLEX>IR
Abduction 180
Adduction 0
Internal rotation 70
External rotation 90
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN OF
LIMITATION
ELBOW
Flexion 150
FLEXION> EXTENSION
EXTENSION 0
PROXIMAL RADIOULNAR
JOINT
PRONATION 80
SUPINATION 80 PRONATION=SUPINATION
DISTAL RADIOULNAR
JOINT
PRONATION 80
SUPINATION 80
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN OF
LIMITATION
WRIST
EQUAL LIMITATION IN
FLEXION 80
ALL DIRECTIONS
EXTENSION 70
RADIAL DEVIATION 20
ULNAR DEVIATION 30
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN OF
LIMITATION
CARPOMETACARPAL
FLEXION 15
ABDUCTION>EXTENSION
RADIAL ABDUCTION 20
(EXTENSION)
PALMAR ADDUCTION ----
PALMAR ABDUCTION 70
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN OF
LIMITATION
MCP
FLEXION 90 FLEXION>EXTENSION
EXTENSION 45 HYPEREXTENSION
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
PIP
FLEXION 80
FLEXION>EXTENSION
EXTENSION 100
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
DIP
FLEXION 90
EXTENSION 10 HYPEREXTENSION FLEXION>EXTENSION
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
HIP
Flexion 120
Extension 30
IR/ER>ABD>FLEX>EXT
ENTION>ADDUCTION
Abduction 45
Adduction 30
Internal rotation 45
External rotation 45
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
KNEE
FLEXION 135
FLEXION>EXTENSION
EXTENSION 0
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
TALOCRURAL
PLANTERFLEXION 50
PLANTERFLEXION>DO
RSIFLEXION
DORSIFLEXION 20
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
SUBTALAR
INVERSION 5
SUPINATION>PRONATI
ON
EVERSION 5
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JOINT/MOTION AAOS ROM VALUES CAPSULAR PATTERN
OF LIMITATION
MTP
FLEXION 45
EXTENSION>FLEXION
1ST MTP
EXTENSION 70
FLEXION>EXTENSION
2ND-5TH MTP
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THANK YOU
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