range of motion

Joint Range of Motion


Introduction
Joint flexibility is defined as the range of motion (ROM) allowed at a joint. A joint's ROM is usually measured by the number of degrees from the starting position of a segment to its position at the end of its full range of the movement. The most common way this is done is by using a double-armed goniometer. A stationary arm holding a protractor is placed parallel with a stationary body segment and a movable arm moves along a moveable body segment. The pin (axis of goniometer) is placed over the joint. When anatomical landmarks are well defined, the accuracy of measurement is greater. If there is more soft tissue surrounding the joint area, measurement error can be more frequent.

Purposes
The purpose of this Lab is to practice measuring the ROMs of the major joints in our body using a double-armed goniometer. Students need to memorize the terms used to describe different joint motions allowed at the major joints of the body.

Procedures (10 pts.)
Stage 1: Shoulder Girdle Movements & ROM
Stand behind a subject who has removed clothing from the waist up. Palpate the inferior angle and the vertebral border of the scapula (Figure 1).
Have the subject slowly abduct his/her arm at the shoulder joint.
1. Record the number of shoulder joint abduction at the point the scapula starts moving.
2. How many degrees will the scapula move if the arm continues in abduction (Figure 1)?
3. What is the name of this scapula movement?

FIGURE 1. Scapula Movements (Adapted from Luttgens & Hamilton, 1997)
FIGURE 2. Lateral Motion of the Scapula (Adapted from Luttgens & Hamilton, 1997)

Now, have the subject slowly flex his/her arm at the shoulder joint to 90° flexion.
4. Record the number of degrees of shoulder joint flexion at the point the scapula starts moving.
5. Have the subject move to 90° of shoulder joint flexion. How many centimeters will the scapula (inferior edge) move laterally (Figure 2)?
6. What is the name of this scapula movement?

Stage 2: Shoulder Joint ROM
7. With the shoulder joint abducted to 90° and the elbow flexed, determine the ranges of internal and external rotations (Figure 3).
8. Determine the amount of hyperextension.

Figure 3. Medial & Lateral Rotation of the Shoulder (Adapted from Luttgens & Hamilton, 1997)

Stage 3: Elbow Joint ROM
9. Determine the range of motion (flexion) at the elbow (Figure 4).
10. How many degrees of hyperextension of the elbow?

FIGURE 4. Elbow Joint Motions (Adapted from Luttgens & Hamilton, 1997)

Stage 4: Wrist Joint ROM
11. How many degrees of wrist flexion (Figure 5)?
12. How many degrees of wrist hyperextension?
13. How many degrees of wrist radial deviation?
14. How many degrees of ulnar deviation?

FIGURE 5. Wrist Joint Motions (Adapted from Luttgens & Hamilton, 1997)

Stage 5: Hip Joint ROM
15. Determine the amount of (right) hip flexion. You will place the goniometer pin on the greater trochanter of the femur (Figure 6). Measurement is most accurate with the subject lying supine and flexing the right hip by raising one leg in the air (both knees remains in extension).
16. Determine hip flexion when the moveable segment has 90° of knee flexion.
17. Determine the amount of hip hyperextension. The subject will assume a prone position for this measurement.

FIGURE 6. Hip Joint Motions (Adapted from Luttgens & Hamilton, 1997)

Stage 6: Knee Joint ROM
18. Determine the amount of knee flexion. The easiest measurement technique is to again have the subject be prone (Figure 7).
19. Determine the amount of knee hyperextension. Have the subject sitting on a bench with the legs out in front. Elevate the feet so that the leg is not resting on the surface.

FIGURE 7. Knee Joint Motions (Adapted from Luttgens & Hamilton, 1997)

Stage 7: Ankle Joint ROM
20. Determine the amount of dorsal flexion and plantar flexion (Figure .

FIGURE 8. Ankle Joint Motions (Adapted from Luttgens & Hamilton, 1997)

Summary
Improving joint flexibility is essential for injury prevention. On may increase joint flexibility (range of motion) by regular stretching. What are the factors affecting flexibility of a joint? Table 1 summarizes the average ROMs published. Compare your measurements with these values. Are they in similar ranges or not? If not, why?
TABLE. 1 Average ROMs (Adapted from Luttgens & Hamilton, 1997)
Joint/Segment Movement Source 1* Source 2* Source 3* Source 4*
Elbow Flexion 140 145 145 145
Hyperextension 0 0 0 0-10
Forearm Pronation 80 90 90 80
Supination 80 85 90 90
Wrist Extension (Dorsiflexion) 60 70 70 50
Flexion (Palmar flexion) 60 90 - 60
Radial Deviation 20 20 20 20
Ulnar Deviation 30 30 35 30
Shoulder Flexion 180 170 130 180
Hyperextension 50 30 80 60
Abduction 180 170 180 180
Adduction 50 - - -
Shoulder
w/ Abducted Arm Internal Rotation 90 90 70 60-90
External Rotation 90 90 70 90
Horizontal Adduction - - - 135
Horizontal Adduction - - - 45
Hip Flexion 100 120 125 120
Hyperextension 30 10 10 30
Abduction 40 45 45 45
Adduction 20 - 10 0-25
Extended Hip Internal Rotation 40 35 45 40-45
External Rotation 50 45 45 45
Knee Flexion 150 120 140 130
Ankle Plantar flexion 20 45 45 50
Dorsiflexion 30 15 20 20
Cervical Spine Flexion 60 - - 40
Hyperextension 75 - - 40
Lateral Flexion 45 - - 45
Rotation 80 - - 50
Lumbar-thoracic Spine Flexion 45-50 - - 45
Hyperextension 25 - - 20-35
Lateral Flexion 25 - - 30
Rotation 30 - - 45