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Goniometry

Types of goniometer
Universal goniometer
Gravity dependant goniometer or
inclinometer
Pendular goniometer
Fluid or Bubble goniometer
Electrogoniometer
Universal goniometer
The traditional goniometer, which can be used for flexion
and extension; abduction and adduction; and rotation in
the shoulder, elbow, wrist, hip, knee, and ankle, consists of
three parts:
A body. The body of the goniometer is designed like a protractor
and may form a full or half circle. A measuring scale is located
around the body. The scale can extend either from 0 to 180
degrees and 180 to 0 degrees for the half circle models, or from
0 to 360 degrees and from 360 to 0 degrees on the full circle
models.The intervals on the scales can vary from 1 to 10 degrees
A stationary arm. The stationary arm is structurally a part of the
body and therefore cannot move independently of the body
A moving arm. The moving arm is attached to the fulcrum in the
center of the body by a rivet or screw-like device that allows the
moving arm to move freely on the body of the device In some
instruments , the screw-like device can be tightened to fix the
moving arm in a certain position or loosened to permit free
movement.
Gravity dependant Goniometers
Pendular Goniometers
Bubble or fluid
Inclinometers
Bubble goniometer.
ADV:The bubble goniometer, which has a 360
rotating dial and scale with fluid indicator can be
used for flexion and extension; abduction and
adduction; and rotation in the neck, shoulder,
elbow, wrist, hip, knee, ankle, and the spine.
DIS:
Bubble or fluid
Inclinometers
Electrogoniometers
Electrogoniometers
ADVANTAGE DIS ADVANTAGE
RESEARCH EXPENSIVE
ACCURATE LONGER TIME TO ALLIGN
STRAPS AND CBLES
INTERFERE WITH
MEASUREMENT
Active ranges of motion of the larger joints
JOINT ACTION DEGREES OF MOTION

Shoulder Flexion 0-180


Extension 0-40
Abduction 0-180
Internal rotation 0-80
External rotation 0-90
Elbow Flexion 0-150
Forearm Pronation 0-80
Supination 0-80
Wrist Flexion 0-60
Extension 0-60
Radial deviation 0-20
Ulnar deviation 0-30
Hip Flexion 0-100
Extension 0-30
Abduction 0-40
Adduction 0-20
Internal rotation 0-40
External rotation 0-50
Knee Flexion 0-150
Ankle Plantarflexion 0-40
Dorsiflexion 0-20
Foot Inversion 0-30
Eversion 0-20
Active range of motion norms for the
hand and fingers
Motion Degrees
Finger flexion MCP:85-90; PIP: 100-115;
DIP: 80-90

Finger extension MCP:30-45; PIP: 0; DIP: 20

Finger abduction 20-30


Finger adduction 0
Thumb flexion CMC: 45-50; MCP: 50-55; IP:
85-90

Thumb extension MCP: 0; IP: 0-5


Thumb adduction 30
Thumb abduction 60-70
Normal ranges of motion for the toes
Motion Normal Range (Degrees)

Toe flexion Great toe: MTP, 45; IP, 90

Lateral four toes: MTP, 40; PIP, 35; DIP, 60

Toe extension Great toe: MTP, 70; IP, 0

Lateral four toes: MTP, 40; PIP, 0; DIP, 30


Goniometric procedure
Explain/demonstrate procedure
Position and drape appropriately
Observe or measure uninvolved and
AROM first
Make visual estimation of motion
Ensure proximal stabilization
PROM with identification of end feel
Landmark identification through palpation
Align measurement device in neutral or zero position
Measure end range position
Document findings and compare to normals or uninvolved
Goniometric principles
1.Positioning
2.Device allignment
3.Stabilization
END FEELS
When assessing passive movements, the
examiner should apply overpressure at the
end of the ROM to determine the quality of
the "end-feel". The sensation that is felt in
the joint as it reaches the end of the ROM.
A proper evaluation of the end feel can help
determine a prognosis for the condition and
learn the severity or stage of the problem.
End Feel

Normal and
Abnormal
End feels
Normal Abnormal
Bone-to-bone Early muscle spasm
Soft tissue Latemuscle spasm
approximation Hard capsule
Tissue stretch Soft capsule
Bone to bene
Empty
Springy block
Normal Example
Bone-to-bone Elbow extension
This is a "Hard" unyielding sensation that is
painless.

Soft tissue approximation Knee flexion


This is a yielding compression that stops further
movement.

Tissue stretch Ankle dorsiflexion,


Shoulder ER
finger extension.
This is a hard or firm (springy) type of movement with a
slight give. Towards the end of the ROM, there is a
feeling of elastic resistance.
Abnormal Example

Early muscle spasm Acute protective spasm associated with inflammation

This end feel is invoked by movement, with a sudden arrest of movement often
accompanied by pain. The end feel is sudden and hard. Early muscle spasm occurs
early in the ROM, almost as movement starts.

Late muscle spasm Spasm caused by instability

As above, but occurs at or near then of the ROM. It is caused by instability and the
resulting irritability caused by movement. As is the Apprehension Test for Shoulders.
Both types of muscle spasm are the result of the subconscious efforts of the body to
protect the injured join or structure.
Hard capsule Frozen shoulder, chronic
conditions.
This end feel is similar to Tissue stretch, but it does not occur where
one would expect.
Hard capsule end feel has a 'thick" quality to it. Limitation comes
abruptly after a smooth, friction free movement.

Soft capsule Synovitis, soft tissue oedema


.
This is similar to "normal" but with a restricted ROM. Is often found in
acute conditions, with stiffness occurring early in the range and
increasing until the end of range. It has a soft, boggy end feel.
Bone-to-bone Osteophyte formation

The abnormal bone-to-bone end feel comes well before the n


normal end of ROM.
Empty Acute subacromial bursitis

This end feel is detected when considerable pain is produced by


movement. The movement is stopped by pain with no real
mechanical resistance.

Springy block Meniscus tear

This is similar to a tissue stretch, but occurs unexpectedly. Usually


occurs in joints with a meniscus. There is a "rebound" effect,
and usually indicates an internal derangement.