Range of motion of upper limb

1. Range of Motion of
Upper Limb
Dr. Mohammad Taqi Ehsani
PGY1 of Orthopedics, FMIC

2. Introduction to the Upper Limb
• The upper limb is attached to the pectoral girdle (shoulder
girdle), which comprises the scapula and clavicle
articulating at the acromioclavicular joint. The only bony
point of contact between the chest (axial skeleton) and the
upper limb is by way of the sternoclavicular joint. All
other attachments to the upper limb and pectoral girdle are
muscular.
• upper limb is segmented into the
• arm, between the shoulder and the elbow
• the forearm, from the elbow to the wrist
• the hand, which joins the forearm at the wrist (carpus).
• The upper limb is highly mobile and capable of a wide
range of controlled movements
• supported by the long bones

3. Goniometer
• A goniometer is an instrument that measures
the available range of motion at a joint.
• The art and science of measuring the joint range
in each plane of the joint are called goniometry

4. Types of Goniometer
1.Universal Goniometer
• Comes in two forms: short arm and long arm.
• The short arm goniometer is used for smaller
joints like the wrist, elbow, or ankle,
• The long arm goniometers are more accurate
for joints with long levers like the knee and hip
joints.

5. Types of Goniometer
2. Gravity Goniometer/Inclinometer
One arm has a weighted pointer that remains
vertical under the influence of gravity

6. Types of Goniometer
3. Software/Smartphone-based
Goniometer:
A smartphone as a digital goniometer has
several benefits like availability, ease of
measurement, application-based tracking of
measurements, and one-hand use.
These applications use the accelerometers in
phones to calculate the joint angles.

7. Types of Goniometer
4. Arthrodial Goniometer:
Ideal for measuring cervical rotation,
anteroposterior flexion, and lateral flexion of the
cervical spine.

8. Types of Goniometer
5. Twin Axis Electro goniometer:
The inter-rater and intra-rater reliability of
the electro goniometer is higher than the
universal goniometer but challenging to
apply in patients' clinical evaluation, hence
used more often for research purposes

9. Range of Motion of Shoulder
The range of motion of the shoulder
girdle involves six motions:
• Abduction
• Adduction
• Extension
• Flexion
• Internal rotation
• External rotation

10. Range of Motion of Shoulder
Active Range of Motion:
• The Apley “Scratch” test is the quickest active
way to evaluate a patient’s range of motion
• A: Abduction and external rotation (touch the
superior medial angle of the opposite scapula)
• B. Internal rotation and adduction (touch the
inferior angle of the opposite scapula)
• C. Internal rotation and adduction (touch the
opposite acromion)

11. Range of Motion of Shoulder
• Passive Range of Motion Tests
• If a patient is unable to perform fully any of the motions of the shoulder girdle,
passive testing should be conducted
• Causes: muscle weakness, soft tissue contracture (in the joint capsule or
ligaments, or as a result of muscle contracture), or bony blockage (bony fusion or
excrescences)
• If the joints moves through a full range of motion under passive testing, but has
restricted active motion, muscle weakness is the cause of restriction
• If restriction is consistent under passive test conditions, muscle weakness can
usually be eliminated as the direct cause, and bony (intra-articular) or soft tissue
(extra-articular) blockage is most likely
• When testing ROM of Shoulder girdle (especially in abduction), motion should
be broken down into three categories: (1) pure glenohumeral motion, (2)
scapulothoracic motion, and (3) a combination of both

12. Range of Motion of Shoulder
Abduction – 180°
• Abduction of the arm occurs in the glenohumeral joint
and scapulothoracic articulation in a two to one ratio
(2:1); for every 3° of abduction, 2° occur in the
glenohumeral joint, and 1° occurs at the scapulothoracic
articulation.
• The scapula should not move until the arm is abducted
to approximately 20° (indicating free glenohumeral
motion).
• At that point, the humerus and scapula move together in
a 2:1 ratio to complete abduction
• If the glenohumeral joint does not move in its normal
ratio
with the scapulothoracic articulation but seems to be

13. Range of Motion of Shoulder

14. Adduction – 45°
• begin moving it across the front of his body in adduction.
• Normal adduction allows the arm to swing about 45° across the
front of the body.
• Test the other shoulder and compare results.
• Adduction may be limited by bursitis or by tears in the rotator
cuff (especially in the supraspinatus).
Range of Motion of Shoulder

15. Range of Motion of Shoulder
FLEXION 180 °
EXTENSION 45°
• Normally the arm will extend to
approximately 45°.
• Then move the arm forward through the
anatomic position into flexion.
• Normal flexion is about 180°.
• Repeat the procedures of flexion and
extension on the other side and compare
results.
• A limited range of flexion and extension may
indicate bicipital tendinitis or bursitis in the
shoulder

16. Range of Motion of Shoulder
INTERNAL ROTATION: 55 °
EXTERNAL ROTATION: 40°- 45°
• To test internal and external rotation, stand in front
of the patient and hold his elbow to his waist to
prevent the substitutions of abduction for internal
rotation and adduction for external rotation.
• External rotation should range about 40° to 45°.
Bursitis is one cause of limitation.
• move the arm into internal rotation. The arm will
normally rotate about 55°.

17. Range of Motion of Elbow
• Basically, the range of motion in the elbow
joint involves four movements:
• (1) elbow flexion,
• (2) elbow extension,
• (3) forearm supination
• (4) forearm pronation
• Flexion and extension originate primarily at
the humeroulnar and humeroradial joints,
• while supination and pronation derive from
the radioulnar articulations at the elbow and
wrist

18. Range of Motion of Elbow
FLEXION —135°+
• Instruct the patient to bend his elbow and to try to touch the front of his
shoulder with his hand.
• Flexion is limited by the muscle mass of the anterior arm, but the patient
should normally be able to touch his shoulder
EXTENSION—0°/ —5°.
• Extension of the elbow joint is motored by the triceps muscle. Extension
limits are defined by the point at which the olecranon strikes the olecranon
fossa.
• Ask the patient to straighten his elbow as far as he can. Most males can
achieve the normal 0° extension; those who are unusually muscular may not
be able to extend the elbow to 0° because of biceps muscle tension.
• Females are normally able to extend the arm to a minimum of 0° and many
are able to hyperextend the elbow as much as 5° beyond the straight position

19. Range of Motion of Elbow
SUPINATION—90°:
• The limits of supination are defined by the degree to
which the radius can rotate around the ulna.
PRONATION—90°:
• Pronation can be limited by pathology at the elbows,
at the wrist radioulnar articulations, or within the
forearms

20. Range of Motion of Wrist
Those movements pertaining to wrist
function are:
1) flexion
2) extension
3) radial deviation
4) ulnar deviation
5) supination (of the forearm)
6) pronation (of the forearm)

21. Range of Motion of Wrist
WRIST FLEXION AND
EXTENSION
• Instruct the patient to flex and
extend his wrist.
• Normal flexion allows him to move
his wrist to about 80° from the
neutral or straight position (0°).
• The normal limit for extension is
approximately 70°

22. Range of Motion of Wrist
WRIST ULNAR AND RADIAL DEVIATION
Ask the patient to move his wrist from side to side into ulnar
and radial deviation. Ulnar deviation is the greater of the
two, since the ulna does not extend distally as far as the
radius and does not articulate directly with the carpus. Ulnar
deviation
has a range of approximately 30°, while the range
of radial deviation is about 20°
SUPINATION AND PRONATION.
Discussed in previous slides

23. Range of Motion of Wrist
Movements to be tested in the fingers are:
1) finger flexion and extension at the metacarpophalangeal joints
2) finger flexion and extension at the interphalangeal joints
3) finger abduction and adduction at the metacarpophalangeal joints
4) thumb flexion and extension at the metacarpophalangeal joint and the
interphalangeal joint (transpalmar abduction and radial abduction)
5) thumb abduction and adduction at the carpometacarpal joint (palmar abduction)
6) opposition

24. Range of Motion of Hand
FINGER FLEXION AND EXTENSION:

25. Range of Motion of Hand
FINGER ABDUCTION AND ADDUCTION
Ask the patient to spread his fingers apart and
back together again.
Clinically, abduction and adduction are measured
from the axial line of the hand which runs
longitudinally down the middle finger. In abduction,
the fingers should separate in equal amounts of
approximately 20°; in adduction, they should come
together and touch each other

26. Range of Motion of Hand
• THUMB FLEXION
• THUMB Extension (Radial
Abduction)
• Palmar Abduction
• OPPOSITION:
Normally, the patient should be able to
touch the tip of his thumb to each of the
other fingertips

27. Thanks
for your attention