Cram Session in Goniometry A Handbook for Students and
Clinicians, 1st Edition
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LYNN VAN OST, MEd, RN, PT, ATC
Hunterdon Medical Center
Flemington, NJ
www.slackbooks.com
ISBN: 978-1-55642-898-2
Copyright © 2010 by SLACK Incorporated
All rights reserved. No part of this book may be reproduced, stored in a retrieval system or trans-
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The procedures and practices described in this book should be implemented in a manner consis-
tent with the professional standards set for the circumstances that apply in each specific situation.
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Library of Congress Cataloging-in-Publication Data
Van Ost, Lynn.
Cram session in goniometry : a handbook for students & clinicians / Lynn Van Ost.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-55642-898-2 (alk. paper)
1. Joints--Range of motion--Measurement. 2. Angles (Geometry)--Measurement. I. Title.
[DNLM: 1. Arthrometry, Articular--methods--Handbooks. 2. Joints--physiology--Handbooks. 3.
Patient Positioning--Handbooks. WE 39 V217c 2010]
RD734.V36 2010
617.4’72--dc22
2009051843
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DEDICATION
To my parents, Marijane and Dr. William C. Van Ost, my stepmother,
Elaine, and to my best friend, Karen Manfré, for their endless support and
encouragement with all my endeavors.
CONTENTS
Dedication .............................................................................................................. v
Acknowledgments ............................................................................................... ix
About the Author ................................................................................................. xi
Preface..................................................................................................................xiii
SECTION I: CERVICAL SPINE
The Cervical Spine ............................................................................................... 2
SECTION II: UPPER EXTREMITY
Scapulothoracic Joint ......................................................................................... 12
The Shoulder (Glenohumeral Joint) ................................................................ 20
The Elbow (Humeroulnar and Humeroradial Joints) .................................. 36
The Forearm (Radioulnar) ................................................................................ 40
The Wrist (Radiocarpal and Intercarpal Joints) ............................................ 44
The Fingers—Digits II to V (Metacarpophalangeal Joints) ......................... 52
The Fingers—Digits II to V (Proximal Interphalangeal Joints).................. 60
The Fingers—Digits II to V (Distal Interphalangeal Joints) ....................... 64
The Thumb (Carpometacarpal Joint) ............................................................. 68
The Thumb (Metacarpophalangeal Joint) ...................................................... 78
The Thumb (Interphalangeal Joint) ................................................................ 82
SECTION III: THORACIC AND LUMBAR SPINE
The Thoracolumbar Spine................................................................................. 88
SECTION IV: LOWER EXTREMITY
The Hip................................................................................................................. 98
The Knee (Tibiofemoral Joint) ....................................................................... 110
Tibial Torsion......................................................................................................114
The Ankle ...........................................................................................................116
Subtalar Joint (Hindfoot)................................................................................. 120
Transverse Tarsal (Midtarsal) Joint ............................................................... 124
The First Toe (Metatarsophalangeal Joints) ................................................. 128
The First Toe (Interphalangeal Joint) ............................................................ 134
VIII CONTENTS
The Four Lateral Toes (Metatarsophalangeal Joints).................................. 138
The Four Lateral Toes (Proximal Interphalangeal Joints) ......................... 142
The Four Lateral Toes (Distal Interphalangeal Joints) ............................... 146
SECTION V: TMJ JOINT
The Temporomandibular Joint....................................................................... 152
APPENDICES
Appendix A: General Procedure for Goniometric Measurement ............ 160
Appendix B: Commonly Used Terms in Goniometry................................ 161
Appendix C: Normal Range of Motion Values in Adults .......................... 164
Appendix D: Anatomical Zero ....................................................................... 168
Bibliography ....................................................................................................... 171
ACKNOWLEDGMENTS
I would like to thank a number of individuals who have spent many
hours assisting with the production of this book. To Michael Raymond, who
served as the primary model for this book—this project could never have
been completed without you. Thank you for your flexibility and profession-
alism during our photo sessions.
Thank you to Brian Lehrer, for once again modeling for my project—you
always come through for me. My gratitude is also extended to Karen Manfré,
Michelle Bartkowski, Jennifer Mintz, and Jenine LaFevere for many hours
serving as the examiners in the photographs. Finally, another huge thank
you goes out to Samantha M. Van Ost for spending numerous weekends and
nights in front of the computer typing out the text for this manual and to
Judd Strauss for being my “technical support.” You guys are the best!
ABOUT THE AUTHOR
Lynn Van Ost, MEd, RN, PT, ATC, graduated in 1982 with a bachelor’s
degree in nursing from West Chester State College, West Chester, PA;
NATABOC certified in athletic training in 1984; graduated in 1987 from
Temple University, Philadelphia, PA, with a master’s degree in sports medi-
cine/athletic training; and received a second bachelor’s degree in physical
therapy in 1988 from Temple. In addition to treating the general orthopedic
population as a physical therapist, she has worked with both amateur and
professional athletes and has more than 11 years’ experience as an athletic
trainer working with Olympic-level elite athletes at numerous international
events, including the 1992 and 1996 Summer Olympic games. She cur-
rently works as a clinical specialist in sports medicine at Hunterdon Medical
Center in Flemington, NJ.
PREFACE
Although there are a number of published texts that include informa-
tion regarding goniometric theory and application, there are few texts
or manuals available that are solely dedicated to goniometric application
and procedure. This manual was developed with the intent of addressing
the “meat and potatoes” of goniometry. It does not address the theory of
goniometry and does not support or refute its validity or reliability as a pro-
cedure for measuring the joints of the body. This manual is intended only
as a user-friendly reference manual for the experienced clinician or student,
not necessarily as a teaching tool or introductory text on the subject of
goniometry. The target audience of this text is primarily physical therapists,
occupational therapists, and athletic trainers, but its contents are valuable to
all disciplines dealing with musculoskeletal disorders.
This text has been organized by body region in a “head to toe” fashion
to make referencing easier and more efficient. Each region is broken down
into a description of type of joint, capsular pattern, average range of motion
for each movement, patient positioning, goniometric alignment, alternative
methods of measurement, and patient substitutions. More than 190 photo-
graphs accompany the text, illustrating the initial and final position of the
joint being measured, the goniometric alignment, alternative positioning,
and patient substitutions. Although body part stabilization is described in
the text, it is not always pictured to allow for better visualization of joint
movement in the photographs. Also included in this book are four appendi-
ces describing procedure for measurement, goniometric terminology, aver-
age values of adult joint range of motion, and anatomical zero.
The author took care to present this manual in a clear, concise manner. If
it makes the task of taking goniometric measurements during an examina-
tion easier and more accurate for the clinician, then the goal of this manual
will have been achieved.
SECTION I
Cervical
Spine
L. Van Ost
Cram Session in Goniometry:
A Handbook for Students & Clinicians (pp. 1-9)
© 2010 SLACK Incorporated
2 SECTION I
THE CERVICAL SPINE
Type of joint: The cervical spine is made up of a series of joints allowing for
3 degrees of freedom of the neck. The goniometer is only capable of measur-
ing gross movements of the cervical spine; individual types of joints (eg, the
atlantoccipital or atlantoaxial joints) will not be addressed in this section.
Capsular pattern: Lateral flexion = rotation/extension.
Cervical Flexion
Planes/axis of movement: Movement occurs in the sagittal plane around a
coronal axis. It includes all segmental movements of the occiput, cervical,
and thoracic vertebrae to approximately T7.
Range of motion:
n 0 degrees to 45 degrees with the goniometer
n 1.0 to 4.3 cm with tape measure
Preferred starting position: See Figure 1-1.
End position: See Figure 1-2.
Goniometric alignment:
n Axis: Center over the external auditory meatus
n Stationary arm: Align perpendicular to the floor
n Moving arm: Align parallel to the base of the nose
Stabilization: The trunk should be stabilized against the back of a chair.
Substitutions: The examiner must watch to make sure the subject does not
flex the trunk or laterally bend/rotate the head during testing. These substi-
tutions are commonly seen if the tested motion causes pain.
Alternate method/position for testing: See Figure 1-3.
CERVICAL SPINE 3
Figure 1-1. The subject should be sitting
with the thoracic spine stabilized against
a chair. The head is in neutral position. The
hands should be in the subject’s lap.
Figure 1-2. The cervical spine should be in
a position of maximal flexion at the end of
the movement.
A B C
Figure 1-3. A tape measure may be used in place of a goniometer. The distance is measured between the chin
and sternal notch. The subject’s mouth should be closed during testing. (A) Alternate starting position. (B) End
position. (C) A fluid goniometer may also be used with the base resting on top of the ear.
