goniometry by abdul ghafoor sajjad physiotherapist afirm

8/7/2019 goniometry by abdul ghafoor sajjad physiotherapist AFIRM

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GONIOMETRY

Goniometry is the measuring of angles created by the bones of the body at the joints. These joints

are measured by a goniometer. The goniometer has a moving arm, stationary arm, and the fulcrum. The

fulcrum or body is placed over the joint being measured and on it is a scale from 0 to 180. The stationary

arm will be aligned with the inactive part of the joint measured, while the moving arm is placed on the partof the limb which is moved in the joints motion. For example, when measuring knee flexion, the stationary

arm will be aligned over the thigh in line with the greater trochanter of the femur. The fulcrum is aligned

over the knee joint or lateral epicondyle of the femur, and the moving arm with the midline of the leg or

lateral malleolus.

Performing these tests is important for many reasons. First, the mobility of joints is important for

diagnosis and determining the presence or absence of dysfunction. In a chronic condition, goniometry can

measure the progression of the disorder. An example of this is the progression of rheumatoid arthritis.

Furthermore, joint motion measurement can evaluate improvements or lack of progression during

rehabilitation. This not only provides motivation for the patient when there are improvements, but also candecipher if modifications need to be made if treatment is not effective.

SHOULDER GONIOMETRY

FLEXION

Patient Instructions:

Once the goniometer is aligned properly ask the patient to lift the arm up just as if they were raising their

hand to ask a question. Be sure that the patient keeps the palm of their hand facing in toward their body.

Starting Position:

Patient is supine with arm at side and the palm of the hand facing the body.

The fulcrum of the goniometer is placed over the acromion process.

The stationary and moving arms are aligned with the midline of the humerus and lateral epicondyle.

Ending Position:

The moving arm remains in line with the lateral epicondyle and midline of the humerus. Theexaminer should be supporting the patients extremity.

The stationary arm should remain in its starting position, only now it should be in line with the

lateral midline of the thorax.

Normal ROM for glenohumeral flexion is 160 to 180 degrees; in the picture the patient is in 180 degrees of

flexion.


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EXTENSION


Ask the patient to simply lift their arm off the table as far as they can.

Starting Position:

Patient is prone with arm at side; make sure the head is facing away from the shoulder being tested.

Elbow should be bent slightly and the palm facing in toward the body.

The fulcrum is placed over the acromion process.

The stationary and moving arms are aligned with the lateral midline of the humerus and the lateral

epicondyle.

Ending Position:

The moving arm remains in line with the lateral epicondyle and the examiner should support the

patients extremity.

The stationary arm should be in line with the midline of the thorax.

Normal ROM for glenohumeral extension is 40 to 60 degrees; in the picture the patient is in 61 degrees of

extension.


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ABDUCTION


Have the patient bring their arm out to their side and as close to their head as they can. Make sure that their

palm faces upward throughout the motion.

Starting Position:

The patient is supine with arm at side; the palm should be facing anteriorly.

The fulcrum is placed at the acromion process.

The stationary and moving arms are aligned with the anterior midline of the humerus.

Ending Position:

The stationary arm should remain still and parallel to the sternum.

The moving arm should still be resting at the anterior midline of the humerus.

Normal ROM should be between 160 and 180 degrees; the patient in the picture is in 174 degrees of

abduction.

MEDIAL (INTERNAL) ROTATION


Ask the patient to rotate their arm down as far as they can.

Starting Position:

Supine with 90 degrees of shoulder abduction and the elbow is in 90 degrees of flexion. The table

should not support the elbow.

The fulcrum should be centered over the olecranon process.

The moving arm is aligned with the ulnar styloid and the stationary arm should be perpendicular tothe floor.


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Ending Position:

Same as above

Normal ROM is 60-70 degrees; the patient is in 68 degrees of internal rotation.

LATERAL (EXTERNAL) ROTATION


Ask the patient to rotate their arm up toward their head as far as they can.

Starting Position:

Supine with 90 degrees of shoulder abduction and 90 degrees of elbow flexion. The table should notsupport the elbow. (Refer to above picture)

Fulcrum should be on the olecranon process.

The moving arm should be aligned with the ulnar styloid and the stationary arm should be

perpendicular to the floor.

Ending Position:

Same as above

Normal ROM is between 80-100 degrees; the patient in the picture is in 93 degrees of external rotation.


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ELBOW GONIOMETRY

FLEXION


Ask the patient to bend their elbow as far as they can, try and touch their shoulder.

Starting Position:

Supine, arm should be in the anatomical position. It will be easier to align the goniometer if the arm

of the patient is resting on the edge of the table.

The fulcrum should be aligned with the lateral epicondyle of the humerus.

The stationary arm is positioned along the midline of the humerus, the moving arm is aligned with

the radial styloid process.

Ending Position:

The arm is now flexed at the elbow, the goniometer should still be aligned with the correct

anatomical landmarks as described below.

Normal ROM is between 150-160 degrees, the patient has 155 degrees of elbow flexion.

PRONATION


Have the patient turn their wrist down toward the ground.

Starting Position:

Patient sitting up with elbow bent 90 degrees and at patients side, wrist in a handshake position.

The fulcrum is placed just behind the ulnar styloid process.

The moving arm and stationary arm are parallel with the anterior midline of the humerus.


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Ending Position:

The fulcrum should remain in the same position as above.

The stationary arm will still be aligned parallel to the midline of the humerus, the moving arm will

lie across the dorsum of the forearm just behind the ulnar and radial styloid processes.

Normal ROM is 90-96 degrees, the patient has 95 degrees of pronation.

SUPINATION


Have the patient turn their palm up as if they are holding something in the palm of their hand.

Starting Position:

Patient position is the same as for pronation.

The goniometer is placed on the medial aspect of the forearm with the fulcrum at the radioulnar joint.

The arms are both aligned with the anterior midline of the humerus.

Ending Position:

The moving arm will be resting on the medial forearm at the radioulnar joint. The moving arm

should remain parallel to the midline of the humerus.

Normal ROM is 81-93 degrees, the patient has 90 degrees of supination.


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HIP GONIOMETRY

FLEXION


Ask the patient to bend their knee and bend their leg and bring it as close to their chest as is comfortable forthem.

Starting and Ending Position:

The patient should be lying supine in the anatomical position.

The fulcrum is aligned with the greater trochanter of the femur.

The stationary arm is positioned along the lateral midline of the abdomen, using the pelvis for

reference, the moving arm along the lateral midline of the femur.

Normal ROM is between 115 and 125 degrees. The patient is in 115 degrees of knee flexion.

EXTENSION


Have the patient lift their leg off the table as far as they can.


Patient is lying prone with legs together and arms at sides.

Goniometer positioning is the same as for hip flexion.

Normal ROM for hip extension is 10 to 30 degrees, patient has 25 degrees of hip extension.


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ABDUCTION


The patient should be asked to move their leg out to the side as far as they can.

Starting Position:

Patient is supine in anatomical position.

Fulcrum is placed in line with the anterior superior iliac spine.

The moving arm of the goniometer is aligned with the midline of the patella, the stationary arm with

the ASIS of the opposite side.

Note: This places the goniometer reading at 90 degrees, to determine the actual reading make sure to

read 90 as 0 and determine the measurement in that manner.

Ending Position:

Same as above

Normal ROM for hip abduction is 40 to 50 degrees; the patient has 48 degrees of hip abduction.

ADDUCTION


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Ask the patient to move their leg to the inside toward their opposite leg.

Starting Position:

Patient is supine the leg not being measured is abducted to allow full adduction of the opposite leg.

The goniometer positioning is the same as for abduction, fulcrum at the ASIS, moving arm aligned

with the midline of the patella, and the stationary arm with the ASIS of the opposite side. Also, remember

to adjust due to the goniometer starting at a reading of 90 degrees.

Ending Position:

Same as above

The normal ROM is 15 to 25 degrees. The patient has 18 degrees of hip adduction.

MEDIAL (INTERNAL) ROTATION


Have the patient bring their leg out to the side.

Starting Position:

The patient will be sitting off of the edge of the table, knees against the table, with their legs

dangling down off the table.

The fulcrum is aligned with the patella and both arms of the goniometer with the midline of the tibia.

Ending Position:

The fulcrum and moving arm remain in the same position as above.

The stationary arm should now be hanging freely but should be perpendicular to the floor.

The normal ROM for internal rotation is 35 to 50 degrees. Patient has 49 degrees of internal rotation at the

hip.


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LATERAL (EXTERNAL) ROTATION


Ask the patient to move their leg in toward the opposite leg.

Starting Position:

Patient is sitting on the edge of the table as was done for internal rotation. The leg not being

measured can either remain off the table or can be on the table depending on the ability of the patient. The

patient in the picture has her leg on the table to her side.

The goniometer positioning is the same as for lateral rotation. The fulcrum is aligned with the

patella, and both arms with the midline of the tibia.

Ending Position:

The fulcrum and moving arm are still in the same position.

The stationary arm should be hanging freely and perpendicular to the floor.

Normal ROM is between 25 to 40 degrees, the patient in the picture is at 26 degrees.


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KNEE GONIOMETRY

FLEXION


Ask the patient to bend their knee as far as they can. If the patient is able, he/she should also flex at the hipto get complete knee flexion. If the patient cannot flex at the hip this measurement can also be done in the

prone position.

Starting Position:

Patient should be supine with both legs flat on the table.

The fulcrum is aligned with the lateral epicondyle of the femur.

The stationary arm is in line with the greater trochanter and midline of the femur, the moving arm

with the lateral malleolus and midline of the fibula.

Ending Position:

Goniometer positioning is same as above.

Normal ROM is 135-150 degrees, the patient in the picture is in 146 degrees of knee flexion.

EXTENSION


The patient should simply be lying prone with a towel placed underneath the thigh or foot off the end of the

table, to gain full knee extension.


The patient should be lying prone with both legs flat on the table.

The goniometer positioning for knee extension is the same as it is for knee flexion.

Normal ROM for knee extension is between 0 and 10 degrees. The patient has 3 degrees of knee

extension.


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ANKLE GONIOMETRY

DORSIFLEXION


Ask the patient to bend the ankle and point their toes up towards the ceiling.

Starting Position:

Patient is sitting with legs off the table.

The fulcrum is aligned with the lateral malleolus.

The stationary arm is in line with the midline of the lower leg; use the head of the fibula forreference. The moving arm is parallel to the fifth metatarsal.

Note: Once again remember that the goniometer will be at 90 degrees and to adjust for that when

recording the angles.

Ending Position:

Same as above

Normal ROM for dorsiflexion is between 0 and 10 degrees. The patient has 3 degrees of dorsiflexion.

PLANTARFLEXION


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Ask the patient to point their foot down toward the ground.

Starting Position and Ending Position:

Patient is sitting with legs off table.

Goniometer alignment is the same as for dorsiflexion.

Normal ROM is 20 to 30 degrees, the patient is at 27 degrees.

INVERSION AT THE TARSAL JOINTS


Have the patient turn their foot in.


Patient sitting with legs off the table, or patient can be supine on the table with the foot resting on the

table.

The fulcrum is positioned between the two malleoli. The stationary arm with the midline of the tibia

and the moving arm with the second metatarsal.

Normal ROM is 35 to 45 degrees; patient has 40 degrees of inversion.

EVERSION AT THE TARSAL JOINTS



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Ask the patient to turn their foot out.


Patient sitting with legs off the table, or patient can be supine on the table with the foot resting on the

table.

The fulcrum is positioned between the two malleoli. The stationary arm with the midline of the tibia

and the moving arm with the second metatarsal.

Normal ROM is 15 to 25 degrees; patient is in 30 degrees of eversion.

INVERSION AT THE SUBTALAR JOINT


Ask the patient to turn their foot in.


The patient should be lying prone with foot hanging off the table.

The fulcrum is placed between the two malleoli. The stationary arm is aligned with the midline of

the leg and the moving arm with the midline of the calcaneus.

Normal ROM is 5 to 20 degrees, the patient is in 20 degrees of inversion.

EVERSION AT THE SUBTALAR JOINT



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Ask the patient to turn their foot out.


The patient should be lying prone with foot hanging off the table.

The fulcrum is placed between the two malleoli. The stationary arm is aligned with the midline of

the leg and the moving arm with the midline of the calcaneus.

Normal ROM is 5 to 15 degrees, the patient is in 15 degrees of eversion.

goniometry by abdul ghafoor sajjad physiotherapist afirm

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