PT 160

GONIOMETRY, PART 2



  1. Review of sequence of goniometric testing



    1. introduction of self, procedure, and equipment



    2. demonstration on self or patient, if appropriate



    3. position patient (do all tests for one position before moving to the next position)



    4. stabilize proximal segment



    5. perform PROM, determine end feel, estimate measurement



    6. measure starting position (anatomical zero, exceptions listed below)



    7. perform PROM measure end position (some sources recommend keeping goniometer on the joint while moving, others recommend measuring only at the beginning and end of range)



    8. record ROM measurement in degrees (should include a starting and ending position)



  2. Remember to be consistent



    1. always position the goniometer fulcrum and arms along the same landmarks for a specific joint for the same patient



    2. measure at a specific time if possible; i.e., before treatment or exercise or after



    3. remove extraneous clothing form areas to be measured



  3. Exceptions to starting in anatomical zero



    1. shoulder medial and lateral rotation



    2. forearm supination and pronation



    3. wrist flexion, extension, radial and ulnar deviation



    4. thumb and finger motions



    5. hip medial and lateral rotation



  4. Use of (-) in recording



    1. Norkin and White text does not use (-) sign because of confusion within the literature



    2. some sources use the (-) sign to denote hyperextension or extension beyond anatomical zero



    3. other sources use a (-) sign to denote patient's inability to achieve anatomical zero



    4. follow Norkin and White for the purposes of this course, but realize that there may be discrepancy in the field



    5. if you always use a range (starting and ending measurement) in recording measurements instead of just the measurement at the end of range this will make more sense



    6. for example: for a joint that is lacking full extension by 10 degrees, but has full flexion to 90 degrees, the goniometric recording should read 10-90



    7. for example: for a joint that goes beyond the anatomical zero by 10 degrees and has flexion to 90 degrees, the recording should read 10-0-90



    8. most joints will start at zero and end at a reading less than 90 degrees



  5. Some exceptions in goniometric testing



    1. ankle inversion/eversion:



      1. ankle inversion: combination movement of supination, adduction, and plantarflexion



      2. ankle eversion: combination movement of pronation, abduction, and dorsiflexion



      3. goniometer held over the dorsum of the foot and axis is A-P with frontal plane movement being measured



      4. inversion/eversion of the subtalar joint can be measured from behind (hindfoot movement)



      5. transverse tarsal inversion/eversion can be measured by stabilizing the calcaneus and talus



    2. spinal movements can be measured with a tape measure



      1. cervical motions:



        1. distance between chin and sternum for flex/ext



        2. distance between mastoid process and acromion process for lateral flex



        3. distance between chin and acromion process for rotation



      2. thoracic and lumbar spine:



        1. distance between C7 and S1 for flexion and extension



        2. distance between end of middle finger and the floor for flexion (does not isolate spinal motion from hip flexion)



        3. distance between end of middle finger and the floor for lateral flexion



      3. TMJ motions: measure distance between central incisors or cuspids with arm of goniometer or ruler



      4. for finger (and sometimes toe) motions, tracings or photocopies may be useful