Occupational Therapy Goniometry Measurement Range of Motion

1. Occupational Therapy
Goniometry Measurement of Range of Motion

2. - Goniometric measurements are used by occupational therapists to
quantify baseline limitations of motion, decide on appropriate
therapeutic interventions, and document the effective-ness of
these intervention.
- The universal goniometer (i.e, full-circle manual goniometer)
remains the most versatile and widely used instrument in clinical
practice.
- Clinical Measurement of Range of Motion Review of Goniometry
Emphasizing Reliability and Validity.
- Reliability in goniometry simply means the consistency or the
repeatability of the ROM measurements, that is, whether the
application of the instrument and the procedures produce the same
measurements consistently under the same conditions.

6. Goniometry
- Goniometry is the measurement of joint angles. And uses a
goniometer to measure joints
- The same goniometry structure is : two arms (one stationary and
one moveable) and an axis (fulcrum) that is surrounded by the body
of the goniometer, which contains a measuring scale.
- The scale is usually similar to a protractor and calibrated in degrees.
The scale can be either a 360° full-circle or a 180° half-circle
- Goniometer arms range in length from 1 in. to 14 in. Use the long-
armed goniometers to measure long bone joints such as the knee,
and the short-arm goniometers to measure smaller joints such as the
toe and finger interphalangeal joints

7. Positioning
- Position involves four factors: the patient, the joint, the goniometer,
and yourself.
- Incorrectly positioning any of these items can result in an
inaccurate measurement of joint motion.
- You should position the patient so the joint to be measured can move
through its ROM freely, without obstruction, and so you can easily
observe the joint.
- The patient should be comfortable. If you need to measure several
motions, you should plan the sequence of measurements so you will
minimally change the patient’s position

8. Positioning
- You must also carefully consider the position of the segment to be
measured, particularly when measuring active motion.
- A segment that must lift against gravity may give a false active
motion measurement if its muscles are not sufficiently strong
enough to lift through the range of motion.
-
- When measuring passive ROM, performing too many activities at
the same time such as stabilizing the part, holding the extremity
against gravity, and aligning the goniometer may lead to a gross
error of measurement.
- You should document the segment’s position during ROM testing
when recording the measurement.

9. Positioning
- Positioning the goniometer correctly is crucial; if the arms of the
goniometer are not aligned properly, the measure will be inaccurate.
Likewise, moving the axis of the goniometer off the joint line will
yield an incorrect measurement.
- Your position is just as important as the other factors in ROM
measurements.
- Once you have placed the goniometer and ensured proper
alignment, you must read the goniometer at eye level for an accurate
reading.
- If you measure hip flexion and read the goniometer in an erect
standing position, the results could differ by several degrees from
the reading you would obtain if you knelt down to read the
goniometer at eye level.

10. Stabilization
- Stabilization is isolating the motion of the joint while eliminating
unwanted motion from adjacent structures.
- You must stabilize the patient before measuring ROM or examining
end feel to assure reliable results.
- Most often, you will stabilize the proximal joint segment and move
the distal segment.
- You must isolate a joint motion to examine it accurately.
- If you allow both joint segments to move, true joint end feel may be
inaccurate.

11. Stabilization
- If you do not stabilize the proximal segment, motion of other joints
may contribute additional motion gains, exaggerating the joint’s
true motion and resulting in substitution.
- If you measure shoulder flexion without appropriately stabilizing
the shoulder, the patient can hyperextend the spine and falsely
appear to have greater shoulder motion.
- Your knowledge of possible substitutions and an awareness of the
patient’s movement will assist in recognizing substitution patterns.
- Stabilization during ROM examination ensures a truer execution of
the test and a more accurate result.

12. Measurement
- Goniometric measurement requires proper alignment of the
stationary and moveable arms and the goniometer’s axis.
- Use bony landmarks to properly place these elements.
- Place the stationary arm along the longitudinal axis of the stabilized
joint segment and the moveable arm parallel to the longitudinal axis
of the moving joint segment.
- When using a 180°-scale goniometer, you may need to reverse the
stationary and moving arms before the moveable arm will register
on the scale.
- Align the goniometer’s axis with the joint’s axis of motion. If the
goniometer arms are accurately placed, the fulcrum will be
positioned correctly.

13. Measurement
- The axis is placed at the joint, the stationary arm is along the
longitudinal aspect of the stabilized segment, and the moveable arm
is placed in alignment with the moving segment.
- To correctly align the goniometer arms, position yourself so your
line of vision is at the same level as the goniometer.
- Checking both arms more than once before reading the scale also
assures correct alignment.
- Often, you will align the stationary arm and then unwittingly move it
again when adjusting the moveable arm; even highly experienced
clinicians make a habit of checking and rechecking the goniometric
arm and axis positions before reading the measurement.

14. Measurement
- Before measuring range of motion, you should explain to the patient
what you will do.
- Take measurements at the start and end positions of the joint
motion.
- If you are only interested in the end of the ROM, it is assumed that
the start position is 0° and has been verified by visual determination.
- ROM examination is usually performed on the uninvolved extremity
before the injured extremity.
- Performing the examination in this sequence provides you with an
idea of what to expect when you examine ROM of the injured
segment

15. Measurement
- You should record the date, the patient’s position (seated, prone), the
type of motion (active or passive), and the side of the body and joint
measured.
- Note any pain or other abnormal reactions that occur during the
examination.
- If the patient lacks full motion, record the degrees as a range.
- If a patient lacks 20° of knee extension and has full knee flexion
motion, record ROM as 20-145°.
- If the patient has excessive motion, or hypermobility, use a minus to
indicate excessive mobility.

16. Measurement
- If the patient has 15° of hyperextension of the knee and normal
flexion motion, record -15-145°.
- Avoid using a visual estimate to determine range of motion.
- The visual estimate may be off and can easily vary among clinicians,
and it is not an objective measure.
- Especially avoid estimating if you use the measurement to identify a
deficiency, record progress, or determine a patient’s readiness to
return to normal activity levels.

17. Shoulder Flexion
Test Position Normal Range
 Subject Supine
 Flatten lumbar spine (flex knees)
 Shoulder no abduction, adduction or rotation
 (note: to measure gleno-humeral motion, stabilize scapula)
(for shoulder complex flexion)
 167° ± 4.7° (American Academy of Orthopaedic Surgeons)
 150° (American Medical Association)
 166° (mean), 4.7° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – center of humeral head near acromion process
 Stationary arm – parallel mid-axillary line
 Moving arm – aligned with midline of humerus (lateral epicondyle)
 Muscle Stretch

18. Shoulder Extension
Test Position Normal Range
 Subject Supine
 Shoulder no abduction, adduction or rotation
 (note: to measure gleno-humeral motion, stabilize
scapula)
(for shoulder complex flexion)
 62° ± 9.5° (American Academy of Orthopaedic Surgeons)
 50° (American Medical Association)
 62.3° (mean), 9.5° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – center of humeral head near acromion process
 Stationary arm – parallel mid-axillary line
 Moving arm – aligned with midline of humerus (lateral
epicondyle)
 Capsular or ligamentous

19. Shoulder Abduction
Test Position Normal Range
 Subject Supine
 Shoulder 0° flexion and extension
 Shoulder laterally (externally) rotated
 Shoulder abducted
 Stabilize thorax (note: to measure gleno-humeral motion, stabilize
scapula)
(for shoulder complex abduction)
 184° ± 7.0° (American Academy of Orthopaedic Surgeons)
 180° (American Medical Association)
 184° (mean), 7.0° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – center of humeral head near acromion process
 Stationary arm – parallel to sternum
 Moving arm – aligned with midline of humerus
 Muscle Stretch

20. Shoulder Medial (Internal) Rotation
Test Position Normal Range
 Subject Supine
 Shoulder 90° abduction
 Forearm neutral
 Elbow fixed 90°
 Stabilize arm
 69° ± 4.6° (American Academy of Orthopaedic Surgeons)
 90° (American Medical Association)
 68.8° (mean), 4.6° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – olecranon process of ulna
 Stationary arm – aligned vertically
 Moving arm – aligned with ulna (styloid process)
 Capsular

21. Shoulder Lateral (External) Rotation
Test Position Normal Range
 Subject Supine
 Shoulder 90° abduction
 Forearm neutral
 Elbow fixed 90°
 Stabilize arm
 104° ± 8.5° (American Academy of Orthopaedic Surgeons)
 90° (American Medical Association)
 103° (mean), 8.5° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – olecranon process of ulna
 Stationary arm – aligned vertically
 Moving arm – aligned with ulna (styloid process)
 Capsular

22. Elbow Flexion
Test Position Normal Range
 Subject Supine
 Shoulder neutral (arm at side)
 Forearm supinated
 Elbow fixed
 Stabilize arm
 141° ± 4.9° (American Academy of Orthopaedic Surgeons)
 140° (American Medical Association)
 142.9° (mean) 5.6° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – lateral epicondyle of humerus
 Stationary arm – aligned humerus (center of acromion process)
 Moving arm – aligned with radius (styloid process)
 Soft tissue approximation (capsular for thin subjects)

23. Elbow Extension
Test Position Normal Range
 Subject Supine
 Shoulder neutral (arm at side)
 Forearm supinated
 Elbow fixed
 Stabilize arm
 0.3° ± 2.0° (American Academy of Orthopaedic Surgeons)
 0.0° (American Medical Association)
 0.6° (mean) 3.1° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – lateral epicondyle of humerus
 Stationary arm – aligned humerus (center of acromion process)
 Moving arm – aligned with radius (styloid process)
 Bone on bone

24. Forearm Supination
Test Position Normal Range
 Subject sitting
 Shoulder neutral (arm at side)
 Elbow fixed at 90°
 Stabilize arm
 Supinate forearm
 81° ± 4.0° (American Academy of Orthopaedic Surgeons)
 80° (American Medical Association)
 82.1° (mean) 3.8° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – medial to ulnar styloid
 Stationary arm – parallel to humerus
 Moving arm – aligned with ventral aspect of radius
 Capsular

25. Forearm Pronation
Test Position Normal Range
 Subject sitting
 Shoulder neutral (arm at side)
 Elbow fixed at 90°
 Stabilize arm
 Supinate forearm
 75° ± 5.3° (American Academy of Orthopaedic Surgeons)
 80° (American Medical Association)
 75.8° (mean) 5.1° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – lateral to ulnar styloid
 Stationary arm – parallel to humerus
 Moving arm – aligned with dorsum of radius
 Capsular

26. Wrist Flexion
Test Position Normal Range
 Subject sitting
 Forearm stabilized on table
 Flex wrist (fingers relaxed)
 75° ± 6.6° (American Academy of Orthopaedic Surgeons)
 60° (American Medical Association)
 76.4° (mean) 6.3° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – lateral wrist
 Stationary arm – aligned with ulna
 Moving arm – aligned with fifth metacarpal
 Capsular

27. Wrist Extension
Test Position Normal Range
 Subject sitting
 Forearm stabilized on table
 Extended wrist (fingers relaxed)
 74° ± 6.6° (American Academy of Orthopaedic Surgeons)
 60° (American Medical Association)
 74.9° (mean) 6.4° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – lateral wrist (triquetrum)
 Stationary arm – aligned with ulna
 Moving arm – aligned with fifth metacarpal
 Capsular

28. Wrist Radial Deviation
Test Position Normal Range
 Subject sitting with forearm resting on table
 Stabilize forearm to prevent pronation or supination
 21° ± 4.0° (American Academy of Orthopaedic Surgeons)
 20° (American Medical Association)
 21.5° (mean) 4.0° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – capitate
 Stationary arm – aligned with forearm (lateral epicondyle)
 Moving arm – aligned with metacarpal of middle finger
 Ligamentous (ulnar collateral ligament)

29. Wrist Ulnar Deviation
Test Position Normal Range
 Subject sitting with forearm resting on table
 Stabilize forearm to prevent pronation or supination
 35° ± 3.8° (American Academy of Orthopaedic Surgeons)
 30° (American Medical Association)
 36.0° (mean) 3.8° (standard deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 Axis – capitate
 Stationary arm – aligned with forearm (lateral epicondyle)
 Moving arm – aligned with metacarpal of middle finger
 Ligamentous (radial collateral ligament

30. Metacarpophalangeal Joint Flexion
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist and interphalangeal joints relaxed
 Forearm neutral
 Stabilize metacarpal to prevent motion
 86° (index), 91° (ring), 105° (little) (American Academy of Orthopedic
Surgeons - active motion)
 90° (American Medical Association)
Goniometer Alignment Normal End Feel
 Dorsal metacarpophalangeal joint
 Stationary arm - aligned with metacarpal
 Moving arm – aligned with proximal phalange
 capsular

31. Metacarpophalangeal Joint Extension
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist and interphalangeal joints relaxed
 Forearm neutral
 Stabilize metacarpal to prevent motion
 22° (index), 18° (long), 23° (ring), 19° (little) (American Academy of
Orthopedic Surgeons - active motion)
 20° (American Medical Association)
Goniometer Alignment Normal End Feel
 Dorsal metacarpophalangeal joint
 Stationary arm - aligned with metacarpal
 Moving arm – aligned with proximal phalange
 capsular

32. Metacarpophalangeal Joint Abduction
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist neutral
 Forearm neutral
 Stabilize metacarpal to prevent motion
 ???
Goniometer Alignment Normal End Feel
 Dorsal metacarpophalangeal joint
 Stationary arm - aligned with metacarpal
 Moving arm – aligned with proximal phalange
 capsular

33. Metacarpophalangeal Joint Adduction
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist neutral
 Forearm neutral
 Stabilize metacarpal to prevent motion
 ???
Goniometer Alignment Normal End Feel
 Dorsal metacarpophalangeal joint
 Stationary arm - aligned with metacarpal
 Moving arm – aligned with proximal phalange
 capsular

34. Interphalangeal Joint Flexion
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist, metacarpal, and non-tested interphalangeal joints relaxed
 Forearm neutral
 Stabilize proximal bone to prevent motion
American Academy of Orthopedic Surgeons
 PIP fingers - 102° (index), 105° (long), 108° (ring), 106° (little) (active
motion)
 DIP fingers - 72° (index), 71° (long), 63° (ring), 65° (little) (active
motion)
 IP thumb - 73°
American Medical Association
 100° (PIP finger), 70° (DIP fingers), 80° (IP thumb)
Goniometer Alignment Normal End Feel
 Dorsal proximal interphalangeal joint
 Stationary arm - aligned with proximal phalange
 Moving arm – aligned with middle phalange
Proximal Interphalangeal Finger Joints
 bone on bone (if tissues overlying palmar aspect of bones is thin)
 soft tissue approximation (if tissues overlying palmar aspect of bones is
thick)
Distal Interphalangeal Finger Joints and Thumb Interphalangeal Joint
 capsular

35. Interphalangeal Joint Extension
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist, metacarpal, and non-tested interphalangeal joints relaxed
 Forearm neutral
 Stabilize proximal bone to prevent motion
American Academy of Orthopedic Surgeons
 PIP fingers - 7° (index), 7° (long), 6° (ring), 9° (little) (active motion)
 DIP fingers - 8° (all finger DIPs)
 IP thumb - 5°
 0° (American Medical Association)
Goniometer Alignment Normal End Feel
 Dorsal proximal interphalangeal joint
 Stationary arm - aligned with proximal phalange
 Moving arm – aligned with middle phalange
 capsular

36. Thumb Carpometacarpal Joint Flexion
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist neutral
 Stabilize carpals to prevent wrist motion
 ???
Goniometer Alignment Normal End Feel
 Axis - carpometacarpal joint
 Stationary arm - aligned with radius
 Moving arm – aligned with metacarpal of thumb
 capsular

37. Thumb Carpometacarpal Joint Extension
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist neutral
 Stabilize carpals to prevent wrist motion
 ???
Goniometer Alignment Normal End Feel
 Axis - carpometacarpal joint
 Stationary arm - aligned with radius
 Moving arm – aligned with metacarpal of thumb
 capsular

38. Thumb Carpometacarpal Joint Abduction
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist neutral
 Forearm neutral
 Stabilize carpals to prevent wrist motion
 70° (American Academy of Orthopedic Surgeons)
Goniometer Alignment Normal End Feel
 Axis - radial styloid
 Stationary arm - aligned with metacarpal of index finger
 Moving arm – aligned with metacarpal of thumb
 Muscle stretch (adductor pollicus, skin, fascia)

39. Thumb Carpometacarpal Joint Adduction
Test Position Normal Range
 Subject sitting with forearm resting on table
 Wrist neutral
 Forearm neutral
 Stabilize carpals to prevent wrist motion
 0° ???
Goniometer Alignment Normal End Feel
 Axis - radial styloid
 Stationary arm - aligned with metacarpal of index finger
 Moving arm – aligned with metacarpal of thumb
 Soft tissue approximation

40. Thumb Carpometacarpal Joint Opposition
Test Position Normal Range
 Subject sitting with forearm supinated and resting on table
 Wrist neutral
 Stabilize fifth metacarpal
 Able to touch tip of thumb to base of fifth finger (American Academy
of Orthopedic Surgeons)
Goniometer Alignment Normal End Feel
 Goniometer cannot be used
 Use a ruler to measure distance between tip of thumb and base of
fifth finger
 Capsular or Soft tissue approximation

41. Abduction Goniometry

42. Horizontal Abduction and Adduction Goniometry

43. Flexion and Extension Goniometry

44. Internal and External Rotation Goniometry