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Goniometry Exam
OTA assessments
| Question | Answer |
|---|---|
| Shoulder flexion norm | 0 - 170 degrees |
| Shoulder extension norm | 0 - 60 degrees |
| Shoulder Abduction norm | 0 - 170 degrees |
| Shoulder Horizontal Abduction norm | 0 - 40 degrees |
| Shoulder Horizontal Adduction Norm | 0 - 130 degrees |
| Shoulder Internal rotation norm | 0 - 70 degrees |
| Shoulder External rotation norm | 0 -90 degrees |
| Elbow Flexion - Extension norm | 0 - 135 - 150 degrees |
| Forearm pronation norm | 0 - 80 - 90 degrees |
| Forearm supination norm | 0 - 80 - 90 degrees |
| Wrist flexion norm | 0 - 80 degrees |
| Wrist extension norm | 0 - 70 degrees |
| Wrist radial deviation norm | 0 - 20 degrees |
| Wrist ulnar deviation norm | 0 - 30 degrees |
| Thumb IP Flexion norm | 0 - 80 degrees |
| Thumb MP flexion norm | 0 - 50 degrees |
| Thumb Radial abduction norm | 0 - 50 degrees |
| Thumb palmar abduction norm | 0 - 50 degrees |
| Thumb opposition norm | measured in centimeters |
| Digit MCP flexion norm | 0 - 90 degrees |
| Digit PIP flexion norm | 0 - 110 degrees |
| Digit DIP flexion norm | 0 - 80 degrees |
| client factor that describes the extent of movement that occurs at a joint | Range of motion (ROM) |
| arc of motion through which the joint passe when voluntarily moved by muscles acting on the joint | Active Range of motion (AROM) |
| arc of motion through which the joint passes when moved by an outside force (another person, yourself, object) | Passive Range of motion (PROM) |
| disease processes, trauma, periarticular changes, and age | Factors that can decrease joint movement |
| normal joint movement and muscular strength | required for effortless movement in occupation |
| part of assessment of client factors in individuals (CVA, arthritis, fx, and general debility) also motivation | Purpose of measuring joint ROM |
| Improvements in ROM not significant unless | person has gained in performance skills to enhance participation in occupation |
| Role of COTA based on | competency level, legislation and restrictions |
| degree and type of motion (occurs at specific jt.), average normal ROM, positioning of self and client during measurement. | before doing goniometry the therapist must understand; |
| always establish rapport with patient | before beginning goniometry |
| ask patient to move extremity through comfortable ROM noting | amount of movement, noise, or discomfort |
| predisposition to joint limitations (RA, old fx, fused joints, etc.) | Always check medical record for |
| uninvolved extremity | some patients do not have full ROM check _________ for an idea of what is 'normal' for your patient |
| anatomic position | most measurements are performed in |
| 3 cardinal planes of movement (sagittal, frontal, horizontal) | motions occur in |
| angle | goni = |
| a measure | metron = |
| stationary arm | -Small protractor or half/full circle -Degree numbers are on this bar |
| movable arm | -Attached to center of axis -Acts as the dial -Read the degree |
| axis | 1) Rivet that acts as the fulcrum is placed over the axis of the joint 2) Makes a semi circle of movement 3) Tight enough to hold the movable arm when being measured |
| full circle-360 degree, 180, finger, small | various sizes of goniometer |
| position of pt. (sitting, supine, etc.) and if pain, spasticity, or abnormal pathology is noted (unable to stand, etc.) | examiner should note |
| scapular mobility | glenohumeral mobility depends greatly on |
| 5 degree increments you will round down or up (unless 1 degree) | ROM is measured in |
| Sitting or standing | Shoulder Flexion patient position |
| Side of patient | Shoulder Flexion Therapist Position |
| enter of humerus just distal to acromion process on lateral aspect of humerus | Shoulder Flexion Axis Location |
| Forearm and wrist in neutral | Shoulder Flexion Starting Position |
| Client’s arm is raised in front of body in a sagittal plane of movement (Palm facing head) | Shoulder Flexion Ending position |
| parallel to trunk | Shoulder Flexion Stationary arm |
| parallel to humerus | Shoulder Flexion Mobile Arm |
| Trunk bending | Things to watch for measuring Shoulder Flexion |
| Sitting or standing | Shoulder Extension patient position |
| Side of patient | Shoulder Extension Therapist Position |
| Located center on the head of the humerus (just distal to acromion process) | Shoulder Extension Axis Location |
| Forearm and wrist in neutral. | Shoulder Extension Starting Position |
| Client’s arm is to be brought in back of the body in a sagittal plane of movement | Shoulder Extension Ending position |
| Also parallel to trunk | Shoulder Extension Stationary arm |
| Also parallel to humerus | Shoulder Extension Mobile Arm |
| excessive scapular motion, spinal flexion | Things to watch for measuring Shoulder Extension |
| Sitting or Standing | Shoulder Abduction patient position |
| Behind patient | Shoulder Abduction Therapist Position |
| on acromion process on posterior surface of shoulder | Shoulder Abduction Axis Location |
| Palm up with shoulder in adduction with external rotation to prevent impingement | Shoulder Abduction Starting Position |
| Client’s arm is raised to side of body in a frontal plane of movement | Shoulder Abduction Ending position |
| parallel to trunk | Shoulder Abduction Stationary arm |
| parallel to humerus | Shoulder Abduction Mobile Arm |
| watch for lateral trunk bending | Things to watch for measuring Shoulder Abduction |
| Sitting | Horizontal Shoulder Abduction Patient Position |
| Standing behind patient | Horizontal Shoulder Abduction Therapist Position |
| over acromion process | Horizontal Shoulder Abduction Axis Location |
| shoulder in 90 degrees of abduction, palm down moving the shoulder into abduction. | Horizontal Shoulder Abduction Starting Position |
| Move arm toward back of body patient's arm is raised to side of body in frontal plane of movement. | Horizontal Shoulder Abduction Ending position |
| parallel over shoulder toward the neck | Horizontal Shoulder Abduction Stationary arm |
| Parallel to the humerus on the superior aspect | Horizontal Shoulder Abduction Mobile Arm |
| trunk bending | Things to watch for measuring Horizontal Shoulder Abduction |
| Sitting | Horizontal Shoulder Adduction Patient Position |
| Standing behind patient | Horizontal Shoulder Adduction Therapist Position |
| Also on acromion process | Horizontal Shoulder Adduction Axis Location |
| Shoulder in 90 degrees of abduction, palm down moving the shoulder into adduction | Horizontal Shoulder Adduction Starting Position |
| Arm reaching in front and across body to opposite side patient's arm is moved in front of the body in horizontal plane of movement | Horizontal Shoulder Adduction Ending position |
| Also parallel over shoulder toward the neck | Horizontal Shoulder Adduction Stationary arm |
| Also Parallel to the humerus on the superior aspect | Horizontal Shoulder Adduction Mobile Arm |
| trunk bending | Things to watch for measuring Horizontal Shoulder Adduction |
| sitting or standing | Shoulder Internal Rotation Patient Position |
| Beside patient | Shoulder Internal Rotation Therapist Position |
| on olecranon process of elbow (point of elbow) | Shoulder Internal Rotation Axis Location |
| Shoulder in 90 degrees of abduction, elbow in 90 degrees of flexion. Move into External rotation (like resting on an arm rest that is at shoulder height) | Shoulder Internal Rotation Starting Position |
| Client’s forearm is swung down gently, keeping humerus parallel to floor | Shoulder Internal Rotation Ending position |
| parallel to where forearm started | Shoulder Internal Rotation Stationary arm |
| parallel to where forearm is at | Shoulder Internal Rotation Mobile Arm |
| trunk bending, arm is straight | Things to watch for measuring Shoulder Internal Rotation |
| sitting or standing | Shoulder External Rotation Patient Position |
| Beside patient | Shoulder external Rotation Therapist Position |
| Also on olecranon process of elbow (point of elbow) | Shoulder external Rotation Axis Location |
| Also Shoulder in 90 degrees of abduction, elbow in 90 degrees of flexion. Move into External rotation (like resting on an arm rest that is at shoulder height) | Shoulder external Rotation Starting Position |
| Client’s forearm is lifted gently, keeping humerus parallel to floor | Shoulder external Rotation Ending position |
| Also parallel to where forearm started | Shoulder external Rotation Stationary arm |
| Also parallel to where forearm is at | Shoulder external Rotation Mobile Arm |
| trunk bending arm is sraight | Things to watch for measuring Shoulder external Rotation |
| sitting or standing | Elbow Extension to Flexion Patient Position |
| On side of patient | Elbow Extension to Flexion Therapist Position |
| placed over lateral epicondyle of humerus at end of elbow crease | Elbow Extension to Flexion Axis Location |
| Forearm supination with palm up (straighten as much as possible) | Elbow Extension to Flexion Starting Position |
| Client bring palm towards shoulder Client’s forearm begins in extended position and is raised in a sagittal plane of movement. | Elbow Extension to Flexion Ending position |
| parallel to midline of humerus | Elbow Extension to Flexion Stationary arm |
| parallel to radius | Elbow Extension to Flexion Mobile Arm |
| Watch for shoulder flexion | Things to watch for measuring Elbow Extension to Flexion |
| Sitting | Forearm supination Patient Position |
| Sitting in front of patient | Forearm supination Therapist Position |
| at volar aspect of wrist just proximal to ulnar styloid | Forearm supination Axis Location |
| Shoulder Adducted, Elbow at 90 degrees flexion. start with forearm in mid position/neutral. | Forearm supination Starting Position |
| move palm toward the ceiling Client’s forearm is rotated laterally around ulna. | Forearm supination Ending position |
| pointing downward perpendicular to floor | Forearm supination Stationary arm |
| resting against volar aspect of wrist | Forearm supination Mobile Arm |
| Elbow in ribs, watch for shoulder abduction | Things to watch for measuring Forearm supination |
| Sitting | Forearm pronation Patient Position |
| Also Sitting in front of patient | Forearm pronation Therapist Position |
| At the dorsal aspect of wrist, just proximal to ulnar styloid | Forearm pronation Axis Location |
| Also Shoulder Adducted, Elbow at 90 degrees flexion . start with forearm in mid position/neutral. | Forearm pronation Starting Position |
| Patient moves palm to face the ground Client’s forearm is rotated medially around ulna. | Forearm pronation Ending position |
| Pointing downward perpendicular to floor | Forearm pronation Stationary arm |
| resting against volar aspect of wrist | Forearm pronation Mobile Arm |
| Elbow in ribs, watch for shoulder internal rotation | Things to watch for measuring Forearm pronation |
| Sitting (table) | Wrist flexion patient position |
| Sitting across patient | Wrist flexion therapist position |
| Center of Dorsal aspect of wrist (RC joint) | Wrist flexion Axis location |
| Seated with elbow on table fingers toward ceiling. | Wrist flexion Starting position |
| Palm down toward the table | Wrist flexion Ending position |
| Lies down the center of the arm between the radius and ulna | Wrist flexion stationary arm |
| along the center of the 3rd metacarpal (there will be space at the wrist bend) | Wrist flexion Mobile arm |
| Watch for pronation/supination | Things to watch for measuring Wrist flexion |
| Sitting (table) | Wrist extension patient position |
| Also Sitting across patient | Wrist extension therapist position |
| center of the volar/palmar surface of the wrist (RC joint) | Wrist extension Axis location |
| also Seated with elbow on table fingers toward ceiling | Wrist extension Starting position |
| Palm toward ceiling | Wrist extension Ending position |
| also lies down the center of the forearm between the radius and ulna | Wrist extension stationary arm |
| also along the center of the 3rd metacarpal (there will be space at the wrist bend) | Wrist extension Mobile arm |
| watch for pronation/supination | Things to watch for measuring Wrist extension |
| Sitting (table) | Ulnar Deviation Patient position |
| Sitting in front of table | Ulnar Deviation Therapist position |
| the base of the 3rd metacarpal (capitate - RC joint) | Ulnar Deviation Axis location |
| Seated with forearm pronated and palm flat on table | Ulnar Deviation Starting position |
| Pinky moved towards patients wrist Client’s hand is laterally extended in a horizontal plane of movement | Ulnar Deviation Ending position |
| Lies down the center of the forearm | Ulnar Deviation stationary arm |
| along the 3rd metacarpal (stay in line of metacarpal and not fingers) | Ulnar Deviation Mobile arm |
| Watch for pronation/supination | Things to watch for measuring Ulnar Deviation |
| Sitting (table) | Radial Deviation Patient position |
| Also Sitting in front of table | Radial Deviation Therapist position |
| the base of the 3rd metacarpal (capitate - RC joint) | Radial Deviation Axis location |
| Seated with forearm pronated and palm flat on table | Radial Deviation Starting position |
| patients thumb toward wrist Client’s hand is medially extended in a horizontal plane of movement. | Radial Deviation Ending position |
| Also Lies down the center of the forearm | Radial Deviation stationary arm |
| also along 3rd metacarpal | Radial Deviation Mobile arm |
| Watch for pronation/supination | Things to watch for measuring Radial Deviation |
| Sitting (Table) | Digit MP Flexion Patient position |
| in front of table | Digit MP Flexion Therapist position |
| over lateral aspect of MP joint of index finger | Digit MP Flexion Axis location |
| Elbow on table with hand elevated in front of patient. | Digit MP Flexion Starting position |
| patient making a fist | Digit MP Flexion Ending position |
| on the digit you are measuring | Digit MP Flexion stationary arm |
| Dorsum of the hand | Digit MP Flexion Mobile arm |
| Thumb not in palm | Things to watch for measuring Digit MP Flexion |
| Sitting (table) | Digit PIP Flexion Patient position |
| In front of table | Digit PIP Flexion Therapist position |
| centered on dorsal surface of PIP joint being measured. | Digit PIP Flexion Axis location |
| Elbow on table with hand elevated in front of patient | Digit PIP Flexion Starting position |
| making a fist | Digit PIP Flexion Ending position |
| over proximal phalanx | Digit PIP Flexion stationary arm |
| over distal phalanx | Digit PIP Flexion Mobile arm |
| Thumb not in palm | Things to watch for measuring Digit PIP Flexion |
| Sitting (Table) | Digit DIP Flexion Patient position |
| In front of table | Digit DIP Flexion Therapist position |
| dorsal surface of DIP joint | Digit DIP Flexion Axis location |
| Elbow on table with hand elevated in front of patient | Digit DIP Flexion Starting position |
| making a fist . Extend MP joint enough to fit moveable arm without hitting the palm | Digit DIP Flexion Ending position |
| over middle phalanx | Digit DIP Flexion Stationary Arm |
| over middle phalanx | Digit DIP Flexion Mobile arm |
| Thumb not in palm | Things to watch for measuring Digit DIP Flexion |
| Sitting (table) | Thumb MP Flexion Patient position |
| in front of table | Thumb MP Flexion Therapist position |
| dorsal surface of MP joint | Thumb MP Flexion Axis location |
| Neutral wrist on the ulnar border (45 degrees forearm supination) | Thumb MP Flexion Starting position |
| (Reach thumb to bottom of palm) Client’s thumb distal of MP joint is flexed down | Thumb MP Flexion Ending position |
| over thumb metacarpal | Thumb MP Flexion Stationary Arm |
| over thumb metacarpal | Thumb MP Flexion Mobile arm |
| On metacarpal not tendon | Things to watch for measuring Thumb MP Flexion |
| Sitting | Thumb IP Flexion Patient position |
| in front of table | Thumb IP Flexion Therapist position |
| dorsal surface of IP joint | Thumb IP Flexion Axis location |
| Neutral wrist on the ulnar border. Measure when the MP is also flexed. | Thumb IP Flexion Starting position |
| (Reach thumb to bottom of palm) Client’s thumb distal of IP joint is flexed down | Thumb IP Flexion Ending position |
| over proximal phalanx | Thumb IP Flexion Stationary Arm |
| over distal phalanx | Thumb IP Flexion Mobile arm |
| May need to slightly elevate hand to not hit table, keeping forearm stabilized on table | Things to watch for measuring Thumb IP Flexion |
| Sitting | Thumb CMC Radial Abduction Patient position |
| Sitting across table | Thumb CMC Radial Abduction Therapist position |
| over CMC joint at base of thumb | Thumb CMC Radial Abduction Axis location |
| Palm flat on table | Thumb CMC Radial Abduction Starting position |
| Move thumb away from side of fingers Client’s thumb is abducted in a horizontal plane of movement. | Thumb CMC Radial Abduction Ending position |
| In line with 2nd metacarpal | Thumb CMC Radial Abduction Stationary Arm |
| parallel to thumb metacarpal | Thumb CMC Radial Abduction Mobile arm |
| on metacarpal not tendon | Things to watch for measuring Thumb CMC Radial Abduction |
| Sitting | Thumb CMC Palmar Abduction Patient position |
| Sitting across table | Thumb CMC Palmar Abduction Therapist position |
| 1st CMC joint (anatomical snuff box) | Thumb CMC Palmar Abduction Axis location |
| Hand and wrist on ulnar border | Thumb CMC Palmar Abduction Starting position |
| Thumb move away from index finger (in a plane perpendicular to palm) | Thumb CMC Palmar Abduction Ending position |
| in line with 2nd metacarpal | Thumb CMC Palmar Abduction Stationary Arm |
| in line with 1st metacarpal | Thumb CMC Palmar Abduction Mobile arm |
| on metacarpal not tendon | Things to watch for measuring Thumb CMC Palmar Abduction |
| measure with ruler part of goniometer between center of pulp of thumb and small finger | Thumb opposition. |
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