Highly detailed summary of the content for all the ROM Assessment lectures.
Includes work from lecture slides, textbook/reading annotations and external research where further explanation was needed.
ASSESSMENT OF JOINT RANGE OF MOTION
What is ROM?
o Range of Motion → amount of movement possible at joint.
o Arc of motion through which joint passes when moving w/in specific plane
What is AROM?
o Active-ROM → when joint is moved by muscles that act on the joint
What is PROM?
o Passive-ROM → when joint is moved by outside force i.e., therapist
What is Contracture?
o Any shortening of tissue
o Normal and sometimes necessary for wound healing to occur.
o However, may cause functional problems when normal, moveable tissue
around or over joint shortens.
o NB to distinguish between skin contracture & other soft tissue contracture
What is Hypomobility?
o Limited ROM → Movements are less than “normal
What is hypermobility?
o Movements are greater than “normal”.
o Hyper-mobile joints may occur in healthy people i.e., acrobats or dancers.
o Hyperextension at elbow, knee or MP-joints is common, esp. in women
What is TAROM and TPROM?
o Total ROM → total of simultaneous MP, PIP & DIP flexion in one finger
when fist is formed, minus total of simultaneous MP, PIP & DIP extension
limitations
o TAROM - Total Active Range of Motion
o TPROM – Total Passive Range of Motion
What is TROM?
o TROM - Torque Range of Motion
o Constant, given external force is applied to a joint in order to move it
What do you need to know for Joint measurement?
Causes of ROM problems
Goals of ROM measurement
Norms
o Where possible, movements being measured should be compared to
either opposite side of body or to a norm.
o Note source of the norm.
o Therapist should be familiar with normal ranges of joint being measured
, What are the principles of joint measurement?
Visual observation
o Joint to be measured should be exposed (remove clothes)
o Therapist should observe joint and area adjacent.
o Therapist asks patient to move body part through available ROM (if
muscle strength is adequate) and observes the movement.
o Look at and compare the following to the non-injured side:
compensatory movement
posture
muscle contours
skin color and condition
skin creases
Palpation
o Feeling bony landmark and soft tissue
o Use pads of index & middle fingers (nails should not contact client’s skin).
o For joint measurements, therapist must palpate to locate bony landmarks
for placement of goniometer (axis)
Positioning of Therapist and Support of Limb
o Therapist position varies dependent on joint being measured
o Limb should be supported at level of its center of gravity
o Therapist’s hands should be in a relaxed grasp that conforms to contours
of the body part
o You need to (purposefully) touch the client
What are the precautionary measures and contraindications for joint measurement?
Measuring ROM could be contraindicated or should be undertaken with extreme
caution with certain diagnosis:
o Joint dislocation
o Joint inflammation or infection
o Immediately after surgery
Meds for pain or muscle relaxants
Subluxation of a joint
What are procedures around two-joint muscles?
When ROM of joint that is crossed by a two-joint muscle is being measured, it
may be affected by position of the other joint
WHY? → Passive insufficiency – joint motion is limited by length of the muscle
What is End feel?
Normal resistance to further joint motion due to:
o Stretching of soft tissue
o Stretching of ligaments and or joint capsule
o Soft tissue approximation
o Contact of bone on bone
End feel is normally hard, soft or firm.
o Hard e.g., Elbow extension
olecranon process comes in contact with olecranon fossa
o Soft e.g., Elbow flexion
soft tissue approximation
o Firm e.g., ankle dorsiflexion with knee extension
movement is limited due to tension in gastrocnemius.
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