ROM UPPER EXTREMITY

Virginia Ainurridlo Nugroho

 INTRODUCTION
Assessment of Range of Motion General Principles
- ROM testing is used to assess the integrity of a joint
- to monitor the efficacy of treatment regiment
- to determine the mechanical cause of an impairment

Assessment Techniques
- Range is measured with a universal goniometer, a device
that has a pivoting arm attached to a stationary arm
divided into 1-degree intervals (Figure 1-3).
- Joints are measured in their plane of movement with the
stationary arm parallel to the long axis of the proximal
body segment or bony landmark.
- The moving arm of the goniometer should also be aligned
with a bony landmark or parallel to the moving body
segment.
- The impaired joint should always be compared with the
contralateral unimpaired joint, if possible.
Braddom, 2016
GONIOMETER

Nancy and William, 2002

ROM SHOULDER
 SHOULDER FLEXION-EXTENTION
BRADDOM DELISSA
Average R.O.M Flexion: 0-180 Flexion: 0-180
extention : 0-60 extention : 0-60
Position of patient supine or sitting flexion : supine
extention : prone
starting position arm at side arm at side, elbow
elbow extended extended, hand in (Braddom, 2016)
prone
Stationary arm of remains at 0 parallel to
goniometer degrees midaxillary line of
trunk
axis of goniometer centered on lateral lateral to joint & just
shoulder bellow acromion
Movable arm of parallel to humerus parallel to midline
goniometer humerus
(DeLisa's, 2010)
 Shoulder Abduction & Adduction
BRADDOM DELISSA

Average R.O.M abduction: 0-180 abduction :0-180

Position of patient supine or sitting supine

starting position arm at side arm at side

elbow extended elbow extended
Stationary arm of remains at 0 degrees parallel to midline of
goniometer trunk
axis of goniometer centered on anterior to joint and (Braddom, 2016) (DeLisa's, 2010)
posterior or anterior in line with
shoulder acromion
Movable arm of abduction :parallel abduction : parallel
goniometer to humerus to midline humerus
 Shoulder internal & external rotation
BRADDOM DELISSA
Average R.O.M internal rot : 0-90 internal rot : 0-70
ext. rot :0-90 ext. rot : 0-90
Position of patient supine supine
starting position shoulder flexed shoulder flexed 90,
90, elbow flexed elbow flexed 90, hand
90, hand pronated (Braddom, 2016)
pronated
Stationary arm of remains at 0 perpendicular to floor
goniometer degrees
axis of goniometer elbow joint throught longitudinal
throught axis of humerus
longitudinal axis
of humerus (DeLisa's, 2010)
Movable arm of parallel to parallel to forearm
goniometer forearm
 ROM ELBOW
• Flexion -extention
• supination -pronation
 Elbow flexion & extention
BRADDOM DELISSA

Average R.O.M flexion : 0-150 flexion : 0-150

extention : - extention : -
Position of patient supine or sitting supine
(Braddom, 2016)
starting position arm at side arm at side
hand : supine hand : supine
Stationary arm of remains at 0 parralel middle of
goniometer degrees humerus
axis of goniometer centered on lateral lateral to joint & through
elbow epycondylus of humerus

(DeLisa's, 2010)
Movable arm of parallel to forearm parallel to forearm
goniometer
 Elbow pronation & supination
BRADDOM DELISSA

Average R.O.M pronation : 0-90 pronation : 0-80

supination : 0-90 supination : 0-80
Position of patient sitting sitting
(Braddom, 2016)
starting position elbow flexed 90 elbow flexed 90
hand : hold hand : hold pencile
pencile
Stationary arm of remains at 0 paralell middle of
goniometer degrees humerus
axis of goniometer longitudinal axis through longitudinal
of forearm axis of forearm

Movable arm of parallel to parallel to pencil (on

goniometer pencile held thumb side)
(DeLisa's, 2010)
 ROM WRIST
• Flexion-extention
• radial -ulnar deviation
 Wrist flexion & extention
BRADDOM DELISSA
Average R.O.M flexion : 0-80 flexion : 0-80
extention : 0-70 extention : 0-70
Position of patient - -
starting position elbow flexed 90 elbow flexed 90
radioulnar pronation radioulnar pronation
Stationary arm of remains at 0 degrees flexion : mid dorsum of
goniometer forearm
extention : mid ventral
surface of forearm (Braddom, 2016)
axis of goniometer centered on lateral flexion : dorsum of wrist (in
wrist over ulnar line with third metacarpal
styloid bone)
extention : ventral survace
of wrist (in line with third
metacarpal bone)
Movable arm of parallel to fifth flexion : mid dorsum of (DeLisa's, 2010)
goniometer metacarpal hand
extention : mid palmar
 Wrist Radial -Ulnar Deviation
BRADDOM DELISSA

Average R.O.M Radial dev. : 0-20 Radial dev. : 0-20

Ulnar dev.: 0-30 Ulnar dev.: 0-30
Position of patient - -
starting position elbow flexed 90 forearm pronate
forearm pronation wrist neutral position
(Braddom, 2016)
Stationary arm of remains at 0 mid dorsum of forearm
goniometer degrees
axis of goniometer centered over centered over dorsal
dorsal wrist wrist at midcarpal bone
between distal
radius & ulna
Movable arm of parallel to third third metacarpal bone
goniometer metacarpal (DeLisa's, 2010)
 ROM PHALANX
• 1st IP/MCP FLEXION
• 1st IP/MCP EXTENTION
• 1st ABDUCTION
• 1st ADDUCTION
• MCP ABDUCTION
• 2nd - 5th MCP / PIP / DIP
FLEXION
• 1st OPPOTITION
 1st IP/MCP
FLEXION
BRADDOM DELISSA

Average R.O.M - 1st IP FLEXION: 0-80

1st MCP FLEXION: -
Position of patient - -
starting position - 1st IP : elbow flexed, forearm
supinated,IP joint extended
1st MCP: elbow slighly flexed,
hand supinated, finger &
thumb extended

Stationary arm of - 1st IP: shaft parallel to midline

goniometer of proximal phalanx
1st MCP: shaft parallel to
midline of first metacarpal
bone
axis of goniometer - 1st IP:Lateral IP joint
1st MCP:Lateral MCP joint
(DeLisa's, 2010)
Movable arm of goniometer - 1st IP: shaft parallel to midline
of distal phalanx
1stMCP: shaft parallel to
midline of proximal phalanx
2nd-5th MCP/PIP/DIP FLEXION
Average R.O.M
Position of patient
starting position
Stationary arm of goniometer
axis of goniometer
Movable arm of goniometer
BRADDOM
2nd-5th MCP FLEXION:
0-90
2nd-5th PIP FLEXION: 0-100
2nd-5th DIP FLEXION: -
- -
2nd-5th MCP: elbow flexed,
radioulnar joint pronated, wrist
in neutral,fingers extended
2nd-5th PIP: elbow flexed,
radioulnar joint pronated, MCP
joint in slight flexion
2nd-5th DIP: -
2nd-5th MCP: remains at 00
2nd-5th PIP: remains at 00
2nd-5th MCP: Dorsum of each
MCP joint
2nd-5th PIP: Dorsum of each
IP joint
2nd-5th MCP: remains on
dorsum of each proximal
phalanx
2nd-5th PIP: remains on
dorsum of each middle phalanx
DELISSA
2nd-5th MCP FLEXION: 0-90
2nd-5th PIP FLEXION: -
2nd-5th DIP FLEXION: -
2nd-5th MCP: elbow flexed, hand
pronated, wrist in neutral
position
2nd-5th PIP: -
2nd-5th DIP: -
2nd-5th MCP:shaft on mid
dorsum of metacarpal bone
2nd-5th MCP: mid dorsum of
joint
2nd-5th MCP:shaft on mid
dorsum of proximal phalanx
 Reference
• Braddom’s Physical medicine and Rehabilitation. Philadelphia.2016.
W.B. Saunders Co. 5th Edition
• De Lisa’s Physical Medicine and Rehabilitation. Philadelphia .2010.
Lippincott Williams & Wilkins. Fifth Edition
TERIMA KASIH