1. Goniometry

2. Types of goniometer Universal goniometer Gravity dependant goniometer or inclinometer Pendular goniometer Fluid or Bubble goniometer Electrogoniometer

3. Universal goniometer

4. The traditional goniometer, which can be used for flexion and extension; abduction and adduction; and rotation in the shoulder, elbow, wrist, hip, knee, and ankle, consists of three parts: – A body. The body of the goniometer is designed like a protractor and may form a full or half circle. A measuring scale is located around the body. The scale can extend either from 0 to 180 degrees and 180 to 0 degrees for the half circle models, or from 0 to 360 degrees and from 360 to 0 degrees on the full circle models.The intervals on the scales can vary from 1 to 10 degrees – A stationary arm. The stationary arm is structurally a part of the body and therefore cannot move independently of the body – A moving arm. The moving arm is attached to the fulcrum in the center of the body by a rivet or screw-like device that allows the moving arm to move freely on the body of the device In some instruments, the screw-like device can be tightened to fix the moving arm in a certain position or loosened to permit free movement.

5. Gravity dependant Goniometers Pendular Goniometers

6. Bubble or fluid Inclinometers

7. Bubble goniometer. ADV:The bubble goniometer, which has a 360° rotating dial and scale with fluid indicator can be used for flexion and extension; abduction and adduction; and rotation in the neck, shoulder, elbow, wrist, hip, knee, ankle, and the spine. DIS:

8. Bubble or fluid Inclinometers

9. Electrogoniometers

10. ADVANTAGE RESEARCH ACCURATE DIS ADVANTAGE EXPENSIVE LONGER TIME TO ALLIGN STRAPS AND CBLES INTERFERE WITH MEASUREMENT

11. Active ranges of motion of the larger joints JOINTACTIONDEGREES OF MOTION ShoulderFlexion Extension Abduction Internal rotation External rotation 0-180 0-40 0-180 0-80 0-90 ElbowFlexion0-150 ForearmPronation Supination0-80 WristFlexion Extension Radial deviation Ulnar deviation 0-60 0-60 0-20 0-30 HipFlexion Extension Abduction Adduction Internal rotation External rotation 0-100 0-30 0-40 0-20 0-40 0-50 KneeFlexion0-150 AnklePlantarflexion Dorsiflexion 0-40 0-20 FootInversion Eversion 0-30 0-20 Active ranges of motion of the larger joints

12. Active range of motion norms for the hand and fingers MotionDegrees Finger flexionMCP:85-90; PIP: 100-115; DIP: 80-90 Finger extensionMCP:30-45; PIP: 0; DIP: 20 Finger abduction20-30 Finger adduction0 Thumb flexionCMC: 45-50; MCP: 50-55; IP: 85-90 Thumb extensionMCP: 0; IP: 0-5 Thumb adduction30 Thumb abduction60-70

13. Normal ranges of motion for the toes MotionNormal Range (Degrees) Toe flexionGreat toe: MTP, 45º; IP, 90º Lateral four toes: MTP, 40º; PIP, 35º; DIP, 60º Toe extensionGreat toe: MTP, 70º; IP, 0º Lateral four toes: MTP, 40º; PIP, 0º; DIP, 30

14. Goniometric procedure Explain/demonstrate procedure Position and drape appropriately Observe or measure uninvolved and AROM first Make visual estimation of motion Ensure proximal stabilization PROM with identification of end feel Landmark identification through palpation Align measurement device in neutral or zero position Measure end range position Document findings and compare to “normals” or uninvolved

15. Goniometric principles 1.Positioning 2.Device allignment 3.Stabilization

16. END FEELS When assessing passive movements, the examiner should apply overpressure at the end of the ROM to determine the quality of the "end-feel". The sensation that is felt in the joint as it reaches the end of the ROM. A proper evaluation of the end feel can help determine a prognosis for the condition and learn the severity or stage of the problem.

17. End Feel Normal and Abnormal

18. End feels Normal Bone-to-bone Soft tissue approximation Tissue stretch Abnormal Early muscle spasm Latemuscle spasm Hard capsule Soft capsule Bone to bene Empty Springy block

19. Normal Example Bone-to-bone Elbow extension This is a "Hard" unyielding sensation that is painless. Soft tissue approximation Knee flexion This is a yielding compression that stops further movement. Tissue stretch Ankle dorsiflexion, Shoulder ER finger extension. This is a hard or firm (springy) type of movement with a slight give. Towards the end of the ROM, there is a feeling of elastic resistance.

20. Abnormal Example Early muscle spasm Acute protective spasm associated with inflammation This end feel is invoked by movement, with a sudden arrest of movement often accompanied by pain. The end feel is sudden and hard. Early muscle spasm occurs early in the ROM, almost as movement starts. Late muscle spasm Spasm caused by instability As above, but occurs at or near then of the ROM. It is caused by instability and the resulting irritability caused by movement. As is the Apprehension Test for Shoulders. Both types of muscle spasm are the result of the subconscious efforts of the body to protect the injured join or structure.

21. Hard capsule Frozen shoulder, chronic conditions. This end feel is similar to Tissue stretch, but it does not occur where one would expect. Hard capsule end feel has a 'thick" quality to it. Limitation comes abruptly after a smooth, friction free movement. Soft capsule Synovitis, soft tissue oedema. This is similar to "normal" but with a restricted ROM. Is often found in acute conditions, with stiffness occurring early in the range and increasing until the end of range. It has a soft, boggy end feel.

22. Bone-to-bone Osteophyte formation The abnormal bone-to-bone end feel comes well before the n normal end of ROM. Empty Acute subacromial bursitis This end feel is detected when considerable pain is produced by movement. The movement is stopped by pain with no real mechanical resistance. Springy block Meniscus tear This is similar to a tissue stretch, but occurs unexpectedly. Usually occurs in joints with a meniscus. There is a "rebound" effect, and usually indicates an internal derangement.