Range of Motion AssessmentUpper Extremity

OT 3760

Neurokinesiology Lab

Created by Ben Atchison, PhD, OTR, FAOTA

Factors to Consider

• Norms are only guidelines. Measure non-affected extremity for intra subject comparison.

• Tableside manner is critical. Make every effort to comfort and inform. ALWAYS obtain permission to perform the procedure after you have comforted and informed

Factors to Consider

Know the biomechanics/pathomechanics of the condition that the person is diagnosed with. Ask about recent/past surgeries.

This is necessary to know to avoid unnecessary pain, discomfort and potential for structural damage.

Factors to Consider

• Perform a functional assessment first that starts from proximal and proceeds to distal.

• This enables you to observe variation between the affected vs non affected extremity AND..

• It saves time!

Factors to Consider

• ALWAYS: AROM before PROM

• ALWAYS: Follow up with PROM when a limitation is noted so you can assess restrictions through motion and “joint end feel” (firm, hard, soft)

Factors to Consider

• When a difference exists between PROM and AROM in the same joint, this is due to muscle weakness

• Prevent subsitution or compensation by positioning and stabilizing the joint proximal to the joint being measured

Factors to Consider

• Align the stationary bar parallel to the long axis of the stationary bone

• Align the moveable bar parallel to the long axis of the moveable bone

• The axis of the goniometer is aligned with the joint axis

Factors to Consider

• Measure both the starting position and the end position, or maximum range. This indicates the freedom of motion at the joint.

• Place the goniometer at the starting point and then replace at the end point. (video demo shows movement of goniometer as person moves for demo of total range)

Factors to Consider

• Indicate whether the measure is active or passive ROM

• If person cannot reach 0 degrees starting position,indicate that by stating number of degrees of motion from zero (example: 10-145 for elbow flexion)

Factors to Consider

• Record signs and symptoms that interfered with full AROM/PROM assessment that may be unrelated to the primary diagnosis.

• Examples: Old fractures resulting in joint limitations, secondary dx resulting in weakness, pain, inability to follow directions, etc…..

Factors to Consider

• Record all measures on a form, leave nothing blank (indicate NT if not tested), date, and sign the form.

VIEWING VIDEO CLIPS

Click on the picture to start the videos for each slide…

Scapular Depression/Elevation

• Not measured with a goniometer

• Compared with movement on non affected side

• Recorded as less than half/half/more than half/ or full range

Scapular Adduction

• Not measured with a goniometer

• Compared with opposite side

• Record as less than half/ half/ more than half/ or full range

Scapular Abduction

• Not measured with a goniometer

• Compared with movement on the opposite side

• Recorded as < half, half, more than half or full range

Shoulder Flexion: 0-170

• Start: Arm at side, elbow extended

• Axis: Shoulder joint below acromium

• Stationary Arm: parallel to mid axillary line of trunk

• moveable Arm: parallel to longitudinal axis of the humerus

Shoulder Extension 0-60

• Start: Arm at side with elbow extended

• Axis is shoulder joint laterally below acromium

• Stationary arm parallel to mid axillary line of trunk

• moveable arm parallel to longitudinal axis of the humerus

Shoulder Abduction: 0-170

• Start: Arm at side and elbow extended

• Axis: center of shoulder jt posterior

• Stationary arm: Parallel with midline of body

• moveable arm: Parallel with longitudinal axis of the humerus

Shoulder Adduction

• Start: Arm at side, elbow extended

• Axis: center of the shoulder jt. posterior

• Stationary arm is parallel to midline

• moveable arm is parallel to longitudinal axis of the humerus

Shoulder Horizontal Abduction 0-130

• Start: seated and shoulder flexed to 90

• Axis: Top of acromiom

• Stationary arm parallel to longitudinal axis of humerus and remains

• moveable arm parallel to longitudinal axis of humerus

Shoulder Horizontal Adduction: 0-40

• Start: seated and shoulder flexed to 90

• Axis: Top of acromiom

• Stationary arm parallel to longitudinal axis of humerus and remains

• moveable arm parallel to longitudinal axis of humerus

Shoulder Internal Rotation: 0-70

• Start: arm abducted 90 and elbow flexed 90

• Axis: center of elbow jt

• Stationary arm: parallel to mid axillary line of the thorax

• moveable arm: parallel to the longitudinal axis of the ulna

Shoulder External Rotation: 0-90

• Start: arm abducted 90 and elbow flexed 90

• Axis: center of elbow jt

• Stationary arm: parallel to mid axillary line of the thorax

• moveable arm: parallel to the longitudinal axis of the ulna

Elbow Flexion: 0-145

• Start with arm at side• Axis: center of lateral

aspect of the elbow jt• Stationary arm:

parallel to longitudinal axis of the humerus

• moveable arm: parallel to longitudinal axis of the radius

Elbow Extension: 145-0

• Start with arm at side• Axis: center of lateral

aspect of the elbow jt• Stationary arm:

parallel to longitudinal axis of the humerus

• Stationary arm: parallel to longitudinal axis of the radius

Forearm Supination: 0-90

• Start: arm adducted and elbow flexed to 90. The forearm is midway between pronation and supination

• Axis: centered at the ulnar styloid

• Stationary arm parallel to longitudinal axis of humerus

• moveable arm is on volar surface of the wrist

Forearm Pronation: 0-90

• Start: arm adducted and elbow flexed to 90 forearm midway between pronation and supination

• Axis: centered at the ulnar styloid

• Stationary arm parallel to longitudinal axis of humerus

• moveable arm is on dorsal surface of the wrist

Wrist Flexion: 0-80

• Start: Arm at side, elbow flexed and forearm neutral

• Axis: midcarpal joint• Stationary arm: dorsal

and parallel to longitudinal axis of radius

• Moveable arm dorsal and parallel to longitudinal axis of the 3rd metacarpal

Wrist Extension: 0-70

• Start: Arm at side, elbow flexed and forearm neutral

• Axis: radiocarpal joint• Stationary arm: volar

and parallel to longitudinal axis of radius

• moveable arm volar and parallel to longitudinal axis of the 3rd metacarpal

Wrist Radial Deviation: 0-20

• Start: Elbow flexed, forearm pronated and wrist neutral

• Axis: intercarpal jt

• Stationary arm is dorsal and parallel to midline of forearm

• moveable arm is parallel to midline of the 3rd metacarpal

Wrist Ulnar Deviation: 0-30

• Start: Elbow flexed, forearm pronated and wrist neutral

• Axis: intercarpal jt

• Stationary arm is dorsal and parallel to midline of forearm

• moveable arm is parallel to midline of the 3rd metacarpal

Finger MP Flexion: 0-90

• Start with wrist and forearm in neutral

• Axis is MP joint• Stationary arm is

dorsal and parallel to metacarpal

• moveable arm is dorsal and parallel to proximal phalynx

Finger PIP Flexion: 0-110

• Start with wrist and forearm in neutral

• Axis is PIP joint• Stationary arm is

dorsal and parallel to proximal phalynx

• moveable arm is dorsal and parallel to middle phalynx

Finger DIP Flexion: 0-80

• Start with wrist and forearm in neutral

• Axis is DIP joint• Stationary arm is

dorsal and parallel to middle phalynx

• moveable arm is dorsal and parallel to distal phalynx

Finger MP Extension

• Start with wrist and forearm in neutral

• Axis is MP joint• Stationary arm is

dorsal and parallel to metacarpal

• moveable arm is dorsal and parallel to proximal phalynx

Finger IP Extension

• Start with wrist and forearm in neutral

• Axis is IP joint• Stationary arm is dorsal

and parallel to proximal phalynx to the joint tested

• moveable arm is dorsal and parallel to the phalynx distal to the joint tested

Finger Abduction

• Start with wrist neutral, forearm pronated and IP’s extended

• Use a ruler to measure distance between fingertips

Finger Adduction

• Start with wrist neutral, forearm pronated and IP’s extended

• Use a ruler to measure distance between fingertips

Small (5th) Finger Opposition

May be done with a ruler to measure distance between thumb tip to small finger tip

This is an overall assessment of opposition and not a specific test of small finger opposition

Thumb MP Flexion: 0-50

• Start with forearm and wrist in neutral

• Axis is MP joint

• Stationary arm is dorsal and parallel to first metacarpal

• moveable arm is dorsal and parallel to the proximal phalynx of the thumb

Thumb IP Flexion: 0-90

• Start with forearm and wrist in neutral

• Axis is the IP joint• Stationary arm is

dorsal parallel to the proximal phalynx

• moveable arm is dorsal parallel to the distal phalynx

Thumb MP Extension

• Start with forearm and wrist in neutral

• Axis is MP joint

• Stationary arm is dorsal and parallel to first metacarpal

• moveable arm is dorsal and parallel to the proximal phalynx of the thumb

Thumb IP Extension

• Start with forearm and wrist in neutral

• Axis is the IP joint• Stationary arm is

dorsal parallel to the proximal phalynx

• moveable arm is dorsal parallel to the distal phalynx

Thumb Palmar Abduction

• Start with wrist and forearm in neutral

• Axis is the intersection of lines parallel to 1st and 2nd metacarpal

• Stationary arm is parallel to 2nd metacarpal along radial aspect

• moveable arm is parallel to 1st metacarpal along the radial aspect

Thumb Radial Abduction

• Start with forearm pronated and wrist neutral

• Axis is the intersection of lines parallel to 1st and 2nd metacarpal

• Stationary arm is parallel to 2nd metacarpal along dorsal aspect

• Moveable arm is parallel to 1st metacarpal along the dorsal aspect

Thumb Opposition

A ruler is used to measure the distance between IP jt of volar surface of the thumb to third metacarpal at the distal palmar crease

Competency Assessment

• Final step in this ROM Assessment Unit is to complete a Competency Evaluation.

• Competency requirements are provided in class.

Manual Muscle Testing

OT 375

Fall 2004

What is MMT?

Objective measure of the strength of muscle groups within grades of resistance from

antigravity through full, manual resistance

Indications

• Persons with musculoskeletal disorders

• Persons with progressive neurological disorders

• Persons with spinal cord injuries

Contraindications

• Persons with brain injury that results in hypertonicity/spasticity

• Persons with active state of pain such as arthritis (exacerbated state), myositis, cellulitis, etc.

• Severe cardiopulmonary conditions

Limitations

• Tests only static strength vs dynamic

• Functional endurance

• Reliability/Validity

Procedures

Start Position

Stabilize

Observe

Position

Palpate

Resist

Grade

Start Position

• Beginning point of range of motion

Stabilize

• Refers to method of supporting body part in assessment

• Often times by position, per se, of the body or specific handling by evaluator

Observe

• Patient ability to understand directions

• Comfort…………………Apprehension

• Substitution patterns

Position

• Your position is important for your own comfort and efficient handling

• Placement of hand proximal to joints vs on the joint or too distal

Palpate

• Primarily for grades 0-3

• Assess for abnormalities as well

Resistance

• Resistance of muscle against gravity to full resistance by gravity

• Refers to the amount of force applied to inhibit motion

• Is manually applied in opposite line of ms pull

Grading

• Assign a term or numerical rating to indicate

• Use opposite extremity for “norms”

MMT Grading

Normal 5

Good 4

Fair 3

Poor 2

Trace 1

Zero 0

MMT Grade Criteria

• Normal (5): Holds test position against maximal resistance

• Good (4): Holds test position against moderate resistance

• Fair (3): Holds test position against gravity

MMT Grade Criteria

• Poor (2) Able to move through full ROM with gravity eliminated

• Trace (1) No visible movement; palpable or observable tendon prominent/flicker

• Zero (0) No palpable or observable muscle

Functional Motion Test

• Purpose

• Procedure

Scapular Depression

Scapular Elevation

Scapular Adduction

(Retraction)

Scapular Abduction

(Protraction)

Shoulder Flexion

Shoulder Extension

Shoulder Abduction

Shoulder Adduction

Shoulder Horizontal Abduction

Shoulder Horizontal Adduction

Shoulder Internal Rotation

Shoulder External Rotation

Elbow Extension

Elbow Flexion

Forearm Supination

Forearm Pronation

Wrist Flexion

Wrist Extension

Radial and Ulnar Deviation not part of the

MMT protocol since those muscles are tested via Wrist Flexion and

Extension

Finger MP Flexion

Finger PIP Flexion

Finger DIP Flexion

Finger MP Extension

Finger IP Extension

Finger Abduction

Finger Adduction

Opposition of Thumb

and 5th Finger

Thumb MP Flexion

Thumb IP Flexion

Thumb MP Extension

Thumb IP Extension

Thumber Palmar

Abduction

Thumb Radial

Abduction

Thumb Adduction