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1. Goniometry
K DIVAKAR
BPT-2nd year,Batch:2019
Vapms college of physiotherapy

2. Introduction
 The term goniometry is derived from two Greek words, gonia, meaning angle,
and metron, meaning measure.
 Therefore, goniometry refers to the measurement of angles, in particular the
measurement of angles created at human joints by the bones of the body.
 The examiner obtains these measurements by placing the parts of the measuring
instrument, called a goniometer, along the bones immediately proximal and distal
to the joint being evaluated.
 Goniometry may be used to determine both a particular joint position and the total
amount of motion available at a joint.
 Goniometry is an important part of a comprehensive examination of joints and
surrounding soft tissue.

3.  A comprehensive examination typically begins by interviewing the subject and
reviewing records to obtain an accurate description of current symptoms;
functional abilities; occupational, social, and recreational activities; and medical
history.
 Observation of the body to assess bone and soft tissue contour, as well as skin and
nail condition, usually follows the interview.
 Gentle palpation is used to determine skin temperature and the quality of soft tissue
deformities and to locate pain symptoms in relation to anatomical structures.
Anthropometric measurements such as leg length, circumference, and body
volume may be indicated.
 The purpose of goniometry is to measure the arc of motion of a joint
 The goniometer is the most commonly used instrument to measure the joint range of
motion.
 These are Many shapes and sizes.

4.  All goniometers Have a body and two arms.
 The body is full or semicircles with a Centre point called the axis or fulcrum.
 One arm is called stationary arm and the other is movable arm.

5. Types of goniometer
1.Universal goniometer
2.Finger goniometer
3.Gravity dependent goniometer or fluid goniometer
4.Pendulum goniometer
5.Electro goniometer

6. Universal goniometer:
 This is a very commonest variety. it has stationary arm, movable arm, and
body
Finger goniometer:
 A finger goniometer measures range of motion of finger joints (M.C.P,I.P)and
other small joints
Gravity dependent goniometer or fluid goniometer:
 It has gravity effecting pointer and the fluid filled Chamber with the air
bubbles.
 It is mostly used for measuring the pelvic tilt or Drop.

7. Pendulum goniometer:
 It is designed by fox and vanbreemen in 1934
 It consists of 360 degrees protractor with the weighted pointer.
Electrogoniometer:
 It has two arms. One is attached with the proximal segment and another is
attached with the distal segment of the measuring joint.
 The potentiometer is connected with these two arms.
 Changes in the joint position show the angulations In the potentiometer.

8. Principles of goniometry
The examiner must have knowledge of the following principles for each joint
and motion:
 Joint structure and function
 Normal end-feels
 Testing positions
 Stabilization required
 Anatomical bony landmarks
 Instrument alignment
 Instruct the patient to avoid any sort of trick movement while taking
measurment.

9. The examiner must also have the skill to perform the following for each joint
and motion:
 Position and stabilize correctly
 Move a body part through the appropriate range of motion (ROM)
 Determine the end of the ROM and end-feel
 Palpate the appropriate bony landmarks
 Align the measuring instrument with landmarks
 Read the measuring instrument
 Record measurements correctly

10. Procedure
 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.

11.  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.
 Repeat the measurment 3 times and record the average as the goniometric
values,for the joints ROM.
 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.

12.  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.

13. Example:
 The left upper extremity of a subject in the supine position is shown. The
parts of the measuring instrument have been placed along the proximal
(humerus) and distal (radius) segments and centered over the axis of the
elbow joint. When the distal segment has been moved toward

14. Factors affecting ROM
 Soft tissue tightness: muscle, ligaments, capsule, cartilage, synovial
membrane spasm.
 Adhesion formation: lack of mobility of the joint reduce the flexibility and
the nourishment circulation around the joint structure.
 Injuries or inflammation: injuries or inflammation around the joint eg. OA,
RA, TB
 Muscle bulk: increase muscle bulk may cause the reduction of
PROM/AROM
 Sex: female is more flexible
 Nervous system: paralysis,hypomobility

15. Indications
 Joint injury
 Edemapain
 Skin tightness
 Spasticity
 Adaptive shortening
 Poor muscle
 Muscle weakness
 Joint stiffness
 Muscle tightness,contracturs.

16. Contraindications
 Dislocation of a joint
 Diagnosis of mucositis ossificans
 Infection of joint
 Unstable joint
 Infection or inflammatory conditions
 Recent surgical procedure
 Open wounds
 Unhealed scar

17. Precautions
The therapist must take extra care when performing active or passive ROM
assessment where motion to the part might aggravate the condition, such as
in: -
 Patients under medications for pain or muscle relaxants.
 Patients with hemophilia.
 Presence of an infection or inflammatory process in a joint.
 Region of marked osteoporosis.
 Region of hematoma (notably at the elbow, hip or knee).
 Hyper-mobile or subluxed joint.
 Painful conditions,
 where the assessment technique might reinforce the severity of symptoms.

18. GONIOMETRY MEASUREMENTS OF
UPPER LIMB
SHOULDER CLIENT POSITION ENDFEEL NROM
Humeral flexion: supine/sitting firm 0-180degress
Humeral extension: prone/sitting firm 0-60 degrees
Humeral abduction: sitting/standing firm 0-180 degrees
Humeral adduction: Sitting/standing Soft 80-0degrees
Humeral external rotation: prone firm 0-90 degrees
Humeral internal rotation: Prone firm 0-70 degrees
Humeral horizontal abduction: Sitting firm 0-45degrees
Humeral horizontal adduction: Sitting firm/soft 0-135 degrees

19. ELBOW CLIENT POSITION ENDFEEL NROM
 Elbow flexion supine soft 0-135degrees
 Elbow extension supine firm 135-0degrees
FOREARM
 Supination Sitting firm 0-90 degrees
 Pronation Sitting hard 0-90 degrees

20. WRIST JOINT CLIENT POSITION ENDFEEL NROM
 Wrist flexion sitting firm 0-80degrees
 Wrist extension sitting firm 0-70degrees
 Wrist radial deviation sitting hard 0-20degrees
 Wrist ulnar deviation sitting firm 0-30 degrees

21. DIGIT AND THUMB: CLIENT POSITION ENDFEEL NROM
 Metacarpal flexion sitting hard 0-90degrees
 Metacarpal extension Sitting firm 90-0degrees
 Metacarpal hypertension sitting firm 0-30degrees

22. DIGIT: CLIENT POSITION ENDFEEL NROM
 PIP flexion sitting hard 0-100degrees
 PIP extension sitting firm 90-0degrees
 DIP flexion sitting firm 0-90degrees
 DIP extension sitting firm 90-0degrees
THUMB:
 IP flexion sitting firm 0-90degrees
 IP extension sitting firm 90-0degrees
 MCP abduction sitting soft As compared to the unaffected extremity

23. THUMB: CLIENT POSITION ENDFEEL NROM
 CMC flexion sitting soft 0-20degrees
 CMC extension sitting firm 0-45degrees
 CMC Abduction sitting firm 0-70degrees
 CMC Adduction sitting soft -
HAND
 Opposition of 1st and 5th sitting soft zero centimeters
digits

24. GONIOMETRIC MEASUREMENTS OF
LOWER LIMB
HIP CLIENT POSITION ENDFEEL NROM
 Hip flexion supine soft 0-120 degrees
 Hip extension prone firm 0-30 degrees
 Hip abduction Supine firm 0-45 degrees
 Hip addiction Supine firm 30-0 degrees
 hip external rotation sitting firm 0-45 degrees
 Hip internal rotation sitting firm 0-45 degrees

25. KNEE CLIENT POSITION ENDFEEL NROM
 Knee flexion supine soft 0-135 degrees
 Knee extension supine firm 135-0 degrees

26. ANKLE CLIENT POSITION ENDFEEL NROM
 Ankle dorsiflexion Sitting Firm 0-20 degrees
 Ankle plantar flexion Sitting Firm 0-50 degrees
 Ankle inversion(forefoot) Sitting Firm 0-35 degrees
 Ankle eversion(forefoot) Sitting Hard 0-15 degrees
 Ankle inversion(hindfoot) Prone Firm 0-5 degrees
 Ankle eversion(hindfoot) Prone Firm/Hard 0-5 degrees

27. FOOT:(MTP) CLIENT POSITION ENDFEEL NROM
 Metatarsophalangeal flexion supine Firm Great toe 0-45˚ 2-5 (0-40˚)
 Metatarsophalangeal extension supine Firm Great toe 45˚-0˚ 2-5(40-0˚)
 Metatarsophalangeal abduction supine Firm compare to opposite side
 Metatarsophalangeal addiction supine Firm compare to opposite side

28. FOOT: PIP CLIENT POSITION ENDFEEL NROM
 PIP flexion supine soft/firm great toe 0˚-90˚,toes 2-5 (0-35˚)
 PIP extension supine firm great toe 90˚-0,toes 2-5(35˚-0˚)
FOOT :DIP
 DIP flexion supine firm 0-60 degrees
 DIP extension supine firm compare to opposite side

29. GONIOMETRIC MEASUREMENTS OF THE TRUNK
TRUNK CLIENT POSITION NROM
 Spinal flexion standing 0-80 degrees/4inches
 Spinal extension standing 0-25 degrees
 Spinal lateral flexion standing 0-35 degrees
 Spinal rotation sitting/standing 0-45 degrees

30. Goniometry measurements of Neck
NECK CLIENT POSITION NROM
 Cervical flexion sitting 0-45 degrees
 Cervical extension sitting 0-45 degrees
 Cervical lateral flexion sitting 0-45 degrees
 Cervical rotation sitting 0-60 degrees