2. Goniometry
■ Definition - the measurement of angles
created at joints by the BONEY structures of
the body.
■ Historically
■ Visual approximation
■ Accurate and standardized measurements
3. Purpose
■ Component of examination
■ Determinant of joint position
■ Identifies available motion at a joint
■ A/AA/PROM
■ Joint information (an inference)
■ Normal vs abnormal
4. Types of ROM
■ PROM
■ Non-voluntary
■ produced by an external force
■ AAROM
■ Voluntary
■ External force
■ AROM
■ Voluntary
Kisner & Colby
5. AROM
■ Assessed first
■ Screening tool
■ Voluntary motion
■ Active contraction of muscle
■ Unassisted
■ Information regarding willingness to move
■ Pain status, guarding
6. PROM
■ Non-voluntary
■ Produced by an external force
■ Performed after AROM assessment
■ When abnormalities are found in AROM
assessment
■ Enables assessment of passive structures
■ Tissue limited ROM
7. AAROM
■ Combination
■ Voluntary: prime mover muscles contract
■ External force: assistance provided to
complete full arc of motion
8. PROM
■ Indications
■ Post-operative precautions/contradindications
■ Inflammatory conditions where AROM would be
harmful to the segment
■ Goals
■ Decrease complications that would occur with
immobilization
■ Maintain tissue extensibility
■ Minimize contractures
■ Improve circulation
■ Minimize pain
11. Kinematics
■ Arthrokinematics
■ Refers to the naturally occurring non-voluntary
accessory joint movements that occur in some
combination of slide (glide), spin or roll
■ Osteokinematics
■ Refers to the gross physiologic movement of
the bone segments
12. Osteokinematics
■ Motions take place in one of the following
planes:
■ sagittal, frontal, or transverse
■ And around one of the following axes:
■ medial-lateral, anterior-posterior, or vertical
13. Instrumentation
■ Goniometer
■ Universal 1900s, 1920s
■ Used for almost all joints, versatile
■ Finger
■ Small size allows ease of measurement
■ Electrogoniometer
■ Research settings
■ Fluid - bubble goniometer (phones)
■ Similar to carpenter’s level
■ Magnetic
■ Apps
16. Lab
■ Objectives
■ Identify parts of goniometer
■ i.e. LOOK AT THE ANGLE
and TELL ME WHAT YOU
read. Don’t write on the
handout No other directions
than that. TAs DON’T HELP
but get a sampling of the
data
17. Background Information
■ Things you need to know:
■ Anatomy
■ Normal values
■ Proper goniometric alignment
■ Testing positions
■ Where to stabilize
■ Joint structure and function
18. Procedures
■ Positioning
■ Start at zero position (usually related to
anatomic position)
■ May affect the amount of tension on soft tissue
structures around the joint
■ May affect stability of proximal segment
■ Stabilization
■ Proximal segment
■ Manual stabilization
■ Helps to isolate the motion
19. Procedures
■ Alignment
■ Stationary arm (SA) // to the proximal segment
■ Moving arm (MA) // to the distal segment
■ Fulcrum over the axis of rotation
■ Palpate bony landmarks for proper alignment
■ Recording
■ Side of the body, joint motion, starting
position, ending position, position of pt., type
of motion.
■ Document the total ROM of the joint
20. Psychometric Properties of
Goniometry
■ Reliability
■ Indicates degrees to which successive
measurements yield the same result
■ Validity
■ Indicates the degrees to which an instrument
measures what it is purported to measure.
21. Findings
■ ROM is a measure to test for a(n)
____________: (Pathology? Impairment?
Special test? Posture? Diagnosis?)
■ Terms often used:
■ Mobility: refers to the ability of a joint
slide/glide/translate. This is not a motion a
person can consciously create in isolation. It is a
function of joint parameters (tissue extensibility, jt.
shape/congruency etc.)
■ Hypermobility: excessive mobility at the joint
■ Hypomobility: a lack of mobility at a joint
22. Documentation
■ Recording Results
■ Essential to have common documentation
system so that values are understandable
■ Positional joint ROM method:
▪ 0-140 degrees elbow ROM
■ Documenting start and end position of motion
trying to measure
▪ 0-10 degrees elbow extension
▪ 0-140 degrees elbow flexion
▪ 10-140 degrees elbow flexion (what does that
mean?)
23. Documentation
■ Recording
■ Right elbow flexion AROM 0-120°
■ Right elbow extension AROM 0-10°
■ Right elbow, AROM, flexion 120°, sidelying
■ Right 1st digit PIP AROM flexion 90°,
measured with a finger goniometer
24. Positional ROM
■ Elbow Flexion
■ Starts at 0 (normal)
■ What you read on goniometer
■ Ends at 150 (normal)
■ What you read on goniometer
■ Document: 0-150 elbow flexion
■ Scenario: Not able to fully reach normal
start position of 0 degrees.
■ Record start position-end position
■ Flexion 20-150 degrees
25. Positional ROM
■ Elbow Extension
■ Starts at 0 (normal)
■ Ends at 10 (normal)
■ Document
■ 0-10 Elbow Extension
■ Difficult to interpret.
▪ Means they should start at 0 and
end at 10 degrees extension
position
26. Positional ROM: Example: Hip
■ Flexion
■ 0 (normal starting position)
■ 120 (normal ending position)
■ Document
■ 0-120 Hip Flexion (normal)
■ Scenario: unable to get to start position:
■ 45-120 degrees flexion
■ Patient is starting at 45 degrees flexion position
and moving to 120 degrees flexion position
■ What if documentation states 45-100
flexion?
27. Positional ROM: Example: Hip
■ Extension
■ 0 (normal starting position)
■ 20 (normal ending position)
■ Document:
■ 0-20 Hip Extension (normal)
■ Unable to get to start position:
■ 5-20 degrees Extension
■ Do you expect normal hip flexion ROM?
■ Unable to get to normal start position and
normal end position
■ 5-10 degrees Extension
28. Documentation (Positional ROM)
Right HIP PROM Left
0-100 Flexion 5-90
0-5 Extension unable
0-30 Abduction 0-20
0-10 Adduction 0
0-20 Internal Rotation 0-20
32. Examples: Sagittal
Hip:
■ S: 20-0-120 (normal)
■ Do they get to normal start position for both
extension and flexion?
■ S: 0-5-120 (abnormal)
■ Interpretation?
■ Starts at____
■ Ends at ____
■ Is there any extension beyond 5 degrees
flexion (or their starting position)?
33. Positional vs SFTR (normal values)
Motion Positional ROM SFTR
Hip flexion 0-120 degrees S: 20-0-120
Hip extension 0-20 degrees
Hip abduction 0-40 degrees F: 40-0-30
Hip adduction 0-30 degrees
Hip IR 0-45 degrees R: 45-0-45
Hip ER 0-45 degrees
Knee flex 0-135 degrees S: 10-0-135
Knee ext 0-10 degrees
Ankle DF 0-10 degrees S: 10-0-50
Ankle PF 0-50 degrees
Hindfoot Inversion 0-20 degrees R: 10-0-20
Hindfoot Eversion 0-10 degrees
34. Positional vs SFTR (abnormal values)
Motion Positional ROM SFTR
Hip flexion 20-120 degrees
Hip extension none/unable
Hip abduction 0-20 degrees
Hip adduction 0-30 degrees
Hip IR none/unable
Hip ER 5-45 degrees
Knee flex 0-135 degrees
Knee ext 0 degrees
Ankle DF 0-3 degrees
Ankle PF 0-50 degrees
Hindfoot Inversion 0-5 degrees
Hindfoot Eversion 0-3 degrees
35. General Guidelines
■ Be consistent (Think of the next PT.)
■ Fully document: pain, position of patient,
type of motion (PROM, AROM, AAROM)
etc…
■ Do not use prefixes hyper- or hypo- for
normal motion.
■ Example: “10 degrees hyperextension” for
normal 10 degrees elbow extension
■ Do not use negative signs: often
misinterpreted
36. ROM Limitations
■ Factors affecting ROM
■ Age
■ under 2 and older adults
■ Sex
■ may vary
■ Active movement
■ ability/willingness to move
■ coordination
■ muscle strength
■ muscle hypertrophy, obesity
■ joint motion, edema
37. ROM Limitations
■ Factors Affecting ROM
■ Passive motion
■ integrity of the articular surfaces
■ joint capsule extensibility
■ ligamentous tissue
■ muscular tissue
■ end feels
■ Occupation or culture
38. Real World Procedures: See lab
packet
1. Position patient as per guidelines
2. Perform PROM to assess end feel and
approximate available ROM
3. Place patient at start position per lab packet
4. Palpate landmarks
5. Stabilize proximally at start position with SA
6. Move into ROM of interest
7. Re-align goniometer if needed
8. Take measurement (with goniometer facing out)
39. References
■ Norkin, Cynthia C. & White, Joyce D.
Measurement of Joint Motion: A Guide to
Goniometry. , 5th Ed. F. A. Davis,
Philadelphia 2016.
■ Reese Berryman, Nancy & Bandy, William D.
Joint Range of Motion and Muscle Length
Testing. W. B. Saunders, Philadelphia, 2002.
■ (SFTR Method)
