GONIOMETRY

1. GONIOMETRY MEDICAL REHABILITATION OF 6TH HOSPITAL AFFILIATED JIAOTONG UNIVERSITY , SHANGHAI YUE--HONG BAI

2. Introduction to 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 part of the limb which is moved in the joint’s 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 can decipher if modifications need to be made if treatment is not effective.

3. ANKLE GONIOMETRY

4. Dorsiflexion Patient Instructions • 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 for reference. The moving arm is parallel to the fifth metatarsal.

5. 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 20 and 30 degrees. The patient has 3 degrees of dorsiflexion.

6. Plantarflexion Patient Instructions: 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 30 to 45 degrees, the patient is at 27 degrees.

7. Inversion at the Tarsal joints • Patient Instructions: • Have the patient turn their foot in. • Starting and Ending Position: • ·        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.

8. Eversion at the Tarsal joints • Patient Instructions: • Ask the patient to turn their foot out. • Starting and Ending Position: • ·        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

9. Inversion at the Subtalar joint • Patient Instructions: • Ask the patient to turn their foot in. • Starting and Ending Position: • ·    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

10. Eversion at the Subtalar joint • Patient Instructions: • Ask the patient to turn their foot out. • Starting and Ending Position: • ·    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

11. Knee Goniometry

12. Flexion • Patient Instructions: • Ask the patient to bend their knee as far as they can. If the patient is able, he/she should also flex at the hip to get complete knee flexion. If the patient cannot flex at the hip this measurement can also be done in the prone position. • Starting PositionPatient 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.

13. 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

14. Extension • Patient Instructions: • 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. • Starting and Ending Position: • ·   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.

15. Hip Goniometry

16. Flexion • Patient Instructions: • Ask the patient to bend their knee and bend their leg and bring it as close to their chest as is comfortable for them. • 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

18. Extension • Patient Instructions: • Have the patient lift their leg off the table as far as they can. • Starting and Ending Position: • ·   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.

19. Abduction • Patient Instructions: • 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.

20. Ending Position: • ·   Same as above • Normal ROM for hip abduction is 40 to 50 degrees; the patient has 48 degrees of hip abduction.

21. Adduction • Patient Instructions: • 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.

22. Medial (Internal) Rotation • Patient Instructions: • 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.

23. Lateral (External) Rotation • Patient Instructions: • 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.

25. Shoulder Goniometry

26. 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

27. Ending Position: • ·  The moving arm remains in line with the lateral epicondyle and midline of the humerus. The examiner should be supporting the patient’s 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.

28. Extension • Patient Instructions: • 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.

29. Ending Position: • ·        The moving arm remains in line with the lateral epicondyle and the examiner should support the patient’s 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.

30. Abduction • Patient Instructions: • 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.

31. Medial (Internal) Rotation • Patient Instructions: • 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 to the floor. • Ending Position: • ·  Same as above • Normal ROM is 60-70 degrees; the patient is in 68 degrees of internal rotation

32. Lateral (External) Rotation • Patient Instructions: • 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 not support 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.

33. Elbow Goniometry

34. Flexion • Patient Instructions: • 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.

35. 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.

36. Pronation • Patient Instructions: • Have the patient turn their wrist down toward the ground. • Starting Position: • ·        Patient sitting up with elbow bent 90 degrees and at patient’s 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. • 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

38. Supination • Patient Instructions: • 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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