Joint Range of Motion

 

Joint Range of Motion •

01/31/2015

 Joint ROM – the amount of movement that is possible at a  joint. It is the arc of motion through motion through which a joint passes when moving within a specic plane. Active range of motion (AROM) – when the joint is moved •

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by the muscles act on the joint. – when the joint is moved Passive rangethat of motion (PROM) by an outside force such as the therapist. In normal individuals, PRO is slightly greater than !RO because of the slight elasticity of soft tissue.  "he additional PRO that is available at the end of normal !RO helps protect joint structures because it allows the  joint to give and absorb e#trinsic forces. forces. If PRO is signicantly greater than !RO for the same  joint motion, it is li$ely li$ely that muscle wea$ness is present. %ecreased RO can cause limited function and interfere with performance in areas of occupation.  "he primary concern of the O" is whether RO is ade&uate for the client to engage in meaningful occupations. 'imitations in RO may occur as a result of injury to or disease in the joint itself or the surrounding joint tissue structures, joint trauma, or joint immobili(ation. joint may adversely a*ect both speed and In)e#ibility at a joint may speed and strength of strength of movement. ! client who constantly has to wor$ to overcome the resistance of an in)e#ible joint will probably demonstrate •

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decreased endurance and fatigue during activity activity..  "he functional motion test test,, screening tests tests,, and measurement of joint RO with a goniometer can goniometer can all be used to assess RO. ethods used to screen limitations in RO involve the observation of !RO and PRO. o  "o  "o screen for !RO, the therapist as$s the client to perform all the active movements that occur at the  joint. o  "o  "o screen for PRO, the therapist moves the joint passively through all of its motions. •

 

 "he purpose of this is to estimate RO, detect limitations, and observe the &uality of movement, end+feel, and the presence of pain.  "he therapist can then decide at which joints precise RO measurement in indicated.  JOINT MEASUREMENT ody function is function is a client factor that the occupational therapist must consider when classifying the client-s underlying abilities. abilities.  Joint measurement – an assessment tool often used for physical disabilities that cause limited joint motion. o uch disabilities include/ s$in contracture caused contracture caused by adhesions or scar tissue0 arthritis0 arthritis 0 fractures0 fractures0 burns burns,, brocartilage  or and hand trauma0 trauma0 displacement of brocartilage or the presence of other foreign bodies in the joint0 bony obstruction or destruction0 and soft tissue obstruction or destruction0 o

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contractures,, such as tendon, muscle, or ligament contractures shortening. o 'imited RO can also be secondary to spasticity, spasticity, wea$ness,, pain, pain, and edema. edema. muscle wea$ness RO measurements help the therapist/ select intervention goals o o appropriate intervention modalities o positioning techni&ues o and other strategies to reduce limitations. pecic purposes for measuring RO are to/ determine limitations that interfere with function or may produce deformity o determine additional range needed to increase functional capacity or reduce deformity o determine the need for splints and assistive devices o measure progress objectivity o record progression or regression.  "he use of formal joint measurement will assist assist in determining the e1cacy of intervention modalities and may also serve as evidence in assisting the client to see the outcome of the intervention through &uantiable data. 2ormal RO varies from one person per son to another. o

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 "he O" can establish norms for each individual by by part if  if possible. measuring the analogous uninvolved part Otherwise, the therapist uses average ranges listed in the literature as a guide.  "he therapist should chec$ records and records and interview the client to client  to detect the presence of fused joints and other limitations caused by old injuries.  3oints should not be forced when resistance is met met on PRO. Pain may limit RO, and crepitation may be heard with movement in some conditions.  "herefore, before beginning joint measurement measurement procedures, the therapist must e#plain what will be done and done and as$ the client if he or she is e#periencing any joint pain and, pain and, if so, where is it located and located  and how severe it is is.. 

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 "o  "o not cause undue pain, the O" further e#plains to the client the importance of indicating any changes in pain throughout the procedure.. procedure PRINCIPLES  PROCE!URES IN JOINT J OINT MEASUREMENT efore measuring RO, the therapist should be familiar with/ o average normal RO ranges o  joint structure and function o normal end+feel o recommended positioning for self and the client o bony landmar$s related to each joint and joint a#is  "he therapist should be s$illed in correct/ correct/ Positioning and stabili(ation for measurements o o Palpation o !lignment and reading of the goniometer o !ccurate recording of measurements 4or the most reliable measurements, the same therapist should asses and reassess the client at the same time of day with the same instrument and the same measurement protocol. "ISUAL O#SER"A O#SER"ATION TION •

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 "he joint to be measured should be e#posed e#posed,, and the therapist should observe the joint and adjacent areas. o  "he therapist as$s the client to move the part through the available RO, if muscle strength is ade&uate, and observes the movement.  "he therapist should loo$ for/  compensatory motions posture muscle contours s$in color and condition and s$in creases and compare the joint with the non+injured part, if possible. o  "he therapist should then move the part through its range to see and feel how the joint moves and to estimate RO. PALPATION o 4eeling the body landmar$s and soft tissue around the joint is an essential s$ill gained with practice and e#perience. o  "he pads of the inde# and middle ngers are are used for palpation. o  "he thumb is sometimes used. o  "he therapist-s ngernails should not ma$e ma$e contact with the client-s s$in. o

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Pressure Pressure is  is muscle, applied gently but gently  butorrmly to detect underlying tendons, bony enough structures. 4or joint measurement, the therapist must palpate to o locate bony landmar$s for landmar$s for placement of the goniometer.. goniometer POSITIONIN$ O% T&ERAPIST AN! SUPPORT SUPPORT O% LIM#S o  "he therapist-s position varies, depending on the  joints being measured. measured. 5hen measuring nger or wrist joints joints,, the therapist may sit ne#t to or opposite the client. client . o

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If sitting ne#t to the client, the therapist should measure the wrist and nger joints on that side and then move to the other side to measure the joints on the client-s opposite side.  "his procedure ma$es ma$es the client more more comfortable 6eliminating comfortable  6eliminating the need to stretch across the midline7 and ensures more accurate placement of the goniometer.. goniometer 5hen measuring the larger joints of the upper or lower e#tremity, e#tremity, the therapist may stand ne#t to the client on the side being measured. measured .  "he client may be seated or lying down.  "he therapist needs to use good body mechanics in mechanics  in posture and in lifting and 

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moving heavy limbs.  "he therapist should use a broad base of support and stand with the head upright while $eeping the bac$ straight.  "he feet should be shoulder width apart, with the $nees slightly )e#ed.  "he therapist-s stance should be in line with the direction of movement.  "he limb should be supported at the •

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level of its center of gravity, appro#imately appro #imately where the upper and middle thirds of the segment meet.  "he therapist-s hands should be in a rela#ed grasp that conforms to the contours of the part.  "he therapist can provide additional support by resting the part on his or her forearm. PRECAUTIONS AN! CONTRAIN!ICATIONS •

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In some instances, measuring joint RO is contraindicated or  or should be underta$en with contraindicated caution. e#treme caution. It is contraindicated if/ contraindicated if/ there is a joint dislocation or unhealed fracture immediately after surgery on any soft tissue structures surrounding joints in the presence of myositis ossicans or when ectopic ossication is a possibility.  3oint measurement must !'5 !'5!8 be done carefully. carefully.  "he following situations call for e#treme caution/  "he client has joint in)ammation or an infection.  "he client is ta$ing either medication for pain or muscle rela#ants.  "he client has osteoporosis, hypermobility, hypermobility, or sublu#ation of a joint.  "he client has hemophilia.  "he client has a hematoma.  "he client ahs just sustained an injury to soft tissue.  "he client has a newly united fracture.  "he client has undergone prolonged immobili(ation. ony an$ylosis is suspected.  "he client has carcinoma of the bone or any fragile bone condition. 

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EN!'%EEL o PRO is normally limited by the structure of the joint and surrounding soft tissues.  "hus, ligaments, the joint capsule, muscle and tendon tension, contact of joint surfaces, and soft tissue appro#imation may limit the end of a particular RO. 9ach of these structures has a di*erent end+feel as the therapist moves the joint passively through its RO. 

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En'fee – is the normal resistance to further joint motion because of stretching of soft tissue, stretching of ligaments and joint capsule, appro#imation appro #imation of soft tissue, an and d contact of bone on bone. 9nd+feel is normal when normal when full RO is achieved and the motion is limited by normal anatomic structures. !bnormal end+feel occurs end+feel occurs when RO is increased or decreased or when RO is normal but structures other than normal anatomy stop the RO. Practice and sensitivity are re&uired for the therapist to detect di*erent end+feels and to distinguish normal from abnormal. 9nd+feel is normally hard, soft, or rm. !n e#ample of hard end+feel end+feel is  is bone contacting bone when the elbow is passively e#tended and 

the olecranon process comes into contact with the olecranon fossa. oft end+feel can end+feel can be detected on $nee )e#ion when there is soft tissue apposition of the posterior aspects of the thigh and calf cal f. ! rm end+feel end+feel has  has a rm or springy sensation that has some give, as when the an$le is dorsi)e#ed with the $nee in e#tension and RO is limited by tension in the gastrocnemius muscle. o In pathologic states, end+feel is abnormal when PRO is increased or decreased or when PRO is normal but movement is stopped by structures other than normal anatomy. anatomy. T*O'JOINT MUSCLES o 5hen the RO of a joint that is crossed by two+joint muscle is measured, the RO of the joint being measured may be a*ected by the position of the other joint because of passive insu1ciency insu1ciency.. In other words, joint words, joint motion is limited by length of the muscle. 

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! two+joint muscle feels taut when it is at its full length over both joints that it crosses and before it reaches the limits of the normal RO of both joints. 4or e#ample, when the wrist is in full e#tension, passive nger e#tension is normally limited because of passive insu1ciency of the nger )e#ors that cross the wrist and nger joints. 5hen joints crossed by two+joint muscles are being measured, it is necessary to place the joint not being measured in a neutral neutra l or rela#ed position to position to place the two+joint muscle on slac$. 4or e#ample, when nger e#tension is being bein g measured, the wrist should be placed in neutral position to avoid full stretch of the nger )e#ors over all of the joints that they cross. imilarly, when hip )e#ion is being measured, 

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the $nee should also be )e#ed to place the hamstrings in the slac$ened position. MET&O!S O% JOINT MEASUREMENT T&E +,-'!E$REE S.STEM o In the :;