Ms. Treto, Physical Therapy Academy Goniometry Ms. Treto, Physical Therapy Academy

Goniometry From 2 Greek words “gonia,” meaning angle and “metron,” meaning measure. Measurement of angles created at human joints by the bones of the body.

Goniometry Measurements obtained with the use of an instrument called, goniometer. May be used to determine, both a particular joint position and the total amount of motion available at a joint.

active and passive joint motion and abnormal fixed joint positions. goniometry Used to measure and document the amount of active and passive joint motion and abnormal fixed joint positions.

Goniometric data can provide a basis for: Determining the presence and absence of impairment. 2. Establishing a diagnosis. 3. Developing a prognosis, treatment goals, and plan of care. 4. Evaluating progress or lack of progress.

Goniometric data can provide a basis for: 5. Modify treatment. 6. Motivating the patient. 7. Researching the effectiveness of therapeutic techniques. 8. Fabricating orthoses and adaptive equipment.

Active Joint Motion PASSIVE JOINT MOTION To assess abnormal movements and patient’s willingness to move. PASSIVE JOINT MOTION To determine reasons for joint limitation. Assess tissue that is limiting the motion. Detect pain.

Osteokinematics Movement of shafts of bones. Described in terms of rotary motion produced, as if the movement occurs around a fixed axis of motion. Osteokinematic motions are described as taking place in one of the three cardinal planes of the body around three corresponding axes. Three axes lie at right angles to one another and to the corresponding plane.

The three planes: Sagittal Plane Divides the body to right and left halves. A median sagittal plane divides the body into equal right and left halves. Flexion and extension occur at the sagittal plane and at the axis perpendicular to the sagittal plane, which is the medial – lateral axis.

The three planes: 2. Frontal Plane: Divides the body into front and back halves. Abduction and adduction occur at the frontal plane, on the anterior – posterior axis.

The three planes: 3. Transverse Plane: Divides the body into upper and lower halves. Rotations occur on a transverse plane around a vertical axis.

Motions occurring at a single plane are measured by goniometry. A joint that allows motion in only one plane is described as having one degree of freedom of motion. Example: Interphalangeal joints: 1° of freedom Glenohumeral joints: 3° of freedom

Active range of Motion: Arc of motion attained by a subject during unassisted voluntary joint motion. Gives examiner information about: patient’s willingness to move, coordination, muscle strength and joint ROM. If pain occurs: It may be due to contracting or stretching of contractive tissues or stretching or pinching on non-contractile tissues.

Passive range of motion: Arc of motion attained by the examiner with assistance from the patient. Patient remains relaxed and plays no active role in producing the motion. Normally, passive ROM is slightly greater than active ROM.

Passive range of motion: Testing passive ROM provides the examiner information about: the integrity of the articular surfaces and the extensibility of the joint capsule, associated ligaments, muscle, fascia and skin. Pain during PROM is caused by stretching or pinching of non-contractile tissues, pain at end range of PROM is due to stretching of contractile tissues.

End-feel There are normal limitations to joint motion, such as: Joint capsules Ligaments Passive tension of muscles, fascia and skin Soft tissue approximation Contact of joint surfaces.

End-feel The feeling experienced by an examiner as a barrier to further motion, at the end of PROM. The ability to distinguish among the various end-feels helps the examiner identify the type of limiting structures.

Normal end-feels: End - feel Structure Example SOFT -soft tissue approximation -elbow flexion FIRM -muscular stretch -capsular stretch -ligamentous -hip flexion with knee straight -extension of MCP joint -forearm supination HARD -bone contacting bone -elbow extension

abNormal end-feels: End - feel Structure Example SOFT -occurs sooner or later in ROM than is usual or in a joint that normally has firm or hard end-feel -soft tissue edema - synovitis FIRM -occurs sooner or later in ROM than is usual or in a joint that normally has a soft or hard end-feel -increased muscular tone -capsular, muscular ligaments and fascial shortening

abNormal end-feels: End - feel Structure Example HARD -occurs sooner or later in ROM than is usual or in a joint that normally has soft or firm end-feel. A bony grating or bony block is felt -chondromalacia -osteoarthritis -Loose bodies in a joint - fracture EMPTY -no real end-feel because pain prevents reaching end od ROM. No resistance us felt except for patient’s protective muscle splinting as muscle spasm -acute joint inflammation -bursitis -abcess -fracture

Hypomobility: HYPERMOBILITY: Refers to a decrease in PROM that is substantially less than normal values for that joint. HYPERMOBILITY: Refers to an increase in PROM that exceeds normal values for that joint.

Factors affecting ROM: AGE GENDER Other subject characteristics Factors related to the testing process

Knowledge of the following are prerequisites for testing each joint and motion: Testing positions Stabilization required Joint structure and function Normal end-feels Anatomical bony landmark Instrument alignment

skills of the following are prerequisites for testing each joint and motion: Position and stabilize correctly Move a body part through appropriate ROM Determine the end of the ROM Palpate appropriate bony landmark Align the measuring instrument with landmarks Read measuring instrument Record measurements correctly

Positioning: Used to place joints in a zero starting position and to help stabilize the proximal segment. Affects the amount of tension on tissues surrounding a joint.

Testing Positions: Refers to positions of the body recommended for obtaining goniometric measurements. Testing positions are designed to: Place the joint in a zero starting position Permit complete ROM Provide stabilization for the proximal joint segment For testing positions, avoid moving the patient unnecessarily.

Stabilization: Stabilizing the patient’s body and proximal joint segment so that a motion can be isolated to the joint being examined. Helps to ensure that a true measurement of the motion has been obtained.

Equipment: Universal Goniometer - Instrument most commonly used in the clinical setting. Made of plastic or metal. Parts: Body – resembles a protractor. May form a half circle or a full circle. Stationary arm – a structural part of the body and can’t be moved independently from the body, Moving arm – is attached to the center of the body by a rivet or screw like device.

Equipment: Gravity-dependent Goniometer Inclinometer, pendulum goniometer, fluid (bubble) goniometer. Electrogoniometer Used more often in research than in clinical settings.

Alignment: Goniometer alignment: Refers to the alignment of the arms of the goniometer with the proximal and distal segments of the joint being evaluated. Uses BONY anatomical landmarks Usually: Stationary arm – proximal segments of the joint Moving arm – distal segment of the joint Fulcrum – axis of motion of the joint During alignment and reading the goniometer, EXAMINER MUST BE EYE LEVEL WITH THE GONIOMETER

RECORDING: Numerical tables, pictorial charts or within the written text of an evaluation. Items recommended to be recorded: Patient’s name, age, gender Examiner’s name Date and time of measurement Type of goniometer used Joint and motion measured

RECORDING: Items recommended to be recorded continued: ROM, degrees at beginning of motion and degrees at end of motion Type of motion: passive or active Discomfort or pain reported by the patient during testing Any related objective findings; protective muscle spasm, crepitus, restrictions Any deviation from recommended testing positions.

RECORDING: If patient has normal, pain free ROM: simply record WNL. Example: AROM of ® elbow flexion: 0 - 50° 0 - 70° 20° - 70° 20° - 0 - 70°

Validity and reliability: Validity – “degree to which an instrument measures what is supposed to measure; the extent to which it fulfills its purpose.” Reliability – amount of consistency between successive measurements of the same variable on the same patient under the same conditions.

Normal joint range of motions ACTION DEGREES OF MOTION SHOULDER FLEXION EXTENSION ABDUCTION 0 – 180 0 – 40 0 - 180 ELBOW 0 - 150 FOREARM PRONATION SUPINATION 0 – 80 0 - 80 WRIST RADIAL DEVIATION ULNAR DEVIATION 0 – 60 0 – 20 0 - 30

Normal joint range of motions ACTION DEGREES OF MOTION HIP FLEXION EXTENSION ABDUCTION ADDUCTION 0 – 100 0 – 40 0 - 40 KNEE 0 - 150 ANKLE PLANTARFLEXION DORSIFLEXION 0 – 20 FOOT INVERSION EVERSION 0 – 30