Summary Range of Motion Assessment

ASSESSMENT OF JOINT RANGE OF MOTION
 What is ROM?
o Range of Motion → amount of movement possible at joint.
o Arc of motion through which joint passes when moving w/in specific plane
 What is AROM?
o Active-ROM → when joint is moved by muscles that act on the joint
 What is PROM?
o Passive-ROM → when joint is moved by outside force i.e., therapist
 What is Contracture?
o Any shortening of tissue
o Normal and sometimes necessary for wound healing to occur.
o However, may cause functional problems when normal, moveable tissue
around or over joint shortens.
o NB to distinguish between skin contracture & other soft tissue contracture
 What is Hypomobility?
o Limited ROM → Movements are less than “normal
 What is hypermobility?
o Movements are greater than “normal”.
o Hyper-mobile joints may occur in healthy people i.e., acrobats or dancers.
o Hyperextension at elbow, knee or MP-joints is common, esp. in women
 What is TAROM and TPROM?
o Total ROM → total of simultaneous MP, PIP & DIP flexion in one finger
when fist is formed, minus total of simultaneous MP, PIP & DIP extension
limitations
o TAROM - Total Active Range of Motion
o TPROM – Total Passive Range of Motion
 What is TROM?
o TROM - Torque Range of Motion
o Constant, given external force is applied to a joint in order to move it
What do you need to know for Joint measurement?
 Causes of ROM problems
 Goals of ROM measurement
 Norms
o Where possible, movements being measured should be compared to
either opposite side of body or to a norm.
o Note source of the norm.
o Therapist should be familiar with normal ranges of joint being measured

, What are the principles of joint measurement?
 Visual observation
o Joint to be measured should be exposed (remove clothes)
o Therapist should observe joint and area adjacent.
o Therapist asks patient to move body part through available ROM (if
muscle strength is adequate) and observes the movement.
o Look at and compare the following to the non-injured side:
 compensatory movement
 posture
 muscle contours
 skin color and condition
 skin creases
 Palpation
o Feeling bony landmark and soft tissue
o Use pads of index & middle fingers (nails should not contact client’s skin).
o For joint measurements, therapist must palpate to locate bony landmarks
for placement of goniometer (axis)
 Positioning of Therapist and Support of Limb
o Therapist position varies dependent on joint being measured
o Limb should be supported at level of its center of gravity
o Therapist’s hands should be in a relaxed grasp that conforms to contours
of the body part
o You need to (purposefully) touch the client
What are the precautionary measures and contraindications for joint measurement?
 Measuring ROM could be contraindicated or should be undertaken with extreme
caution with certain diagnosis:
o Joint dislocation
o Joint inflammation or infection
o Immediately after surgery
 Meds for pain or muscle relaxants
 Subluxation of a joint
What are procedures around two-joint muscles?
 When ROM of joint that is crossed by a two-joint muscle is being measured, it
may be affected by position of the other joint
 WHY? → Passive insufficiency – joint motion is limited by length of the muscle
What is End feel?
 Normal resistance to further joint motion due to:
o Stretching of soft tissue
o Stretching of ligaments and or joint capsule
o Soft tissue approximation
o Contact of bone on bone
 End feel is normally hard, soft or firm.
o Hard e.g., Elbow extension
 olecranon process comes in contact with olecranon fossa
o Soft e.g., Elbow flexion
 soft tissue approximation
o Firm e.g., ankle dorsiflexion with knee extension
 movement is limited due to tension in gastrocnemius.