la neta de la goniometria

GONIOMETRYa. Definition - measuring the available range of motion or the position of a joint

- typically this is a measure of PASSIVE motion. If you are documenting active range of motion, document that this is so.

b. For clarity of communication – measure one direction at a time (e.g. elbow flexion = 130o, not elbow flexion/extension 130o/0o)

GONIOMETER PARTSStandard (universal) Goniometer

Gravity Goniometer (inclinometer)

GONIOMETRY PROCEDURE a. Position joint in zero position and stabilize proximal joint component b. Move joint to end of range of motion (to assess quality of movement) c. Determine end-feel at point where measurement will be taken (at end of

available range of motion) d. Identify and palpate bony landmarks e. Align goniometer with bony landmarks while holding joint at end of range f. Read the goniometer g. Record measurement (e.g. elbow flexion = 130o)

POSITIONING

a. Start with joint at zero position - This is the reference point for the measurement. If zero position can't be achieved, this must be documented.

b. permit complete range of motion

1) If you are assessing joint ROM, be sure that some other structure (eg. a tight muscle) doesn't interfere.

2) If you are assessing some other structure (eg. a tight muscle, pain limiting the motion) document exactly what is limiting the range of motion. (eg. hamstring tightness at 65o of hip flexion)

STABILIZATION a. Poor stabilization is the most frequent cause of invlaid measurements. (eg. observe a "normal" ROM of elbow extension when movement of shoulder and arm masks a limitation - actually measuring shoulder and arm movement)

Poor Stabilization for Elbow Extension

b. Usually stabilize proximal joint components

c. Promote patient relaxation so voluntary muscle contraction doesn't interfere

VALIDITY

a. Validity is a measurement concept that asks whether a measurement system actually measures what it's supposed to (i.e., joint range of motion in the case of goniometry)

b. Goniometric measurements can be invalid; usually because of poor stabilization. (See positioning and stabilization)

RELIABILITY a. Reliability is a measurement concept that asks whether successive measurements are consistent, repeatable or reproducible. Upper extremity measurements are more reliable than lower extremity measurements.

1) Intratester reliability (same tester on different occasions)- measurement error should be less than 5 degrees

2) Intertester reliability (different testers) - measurement error probably greater than 5 degrees

http://academic.uofs.edu/faculty/kosmahle1/courses/pt350/goniomet/position.htm#stabilization

b. To maximize reliability always use the same: 1) Goniometer 2) Positioning 3) Procedure 4) Examiner

END FEEL

a. The quality of resistance at end of range

b. Each joint has a normal end feel at a normal point in the range of motion (ROM)

c. Incorrect end feel, or correct end feel at incorrect ROM indicate pathology

d. Terms: I suggest my terms for clarity of communication (to clearly identify the structure that the tester feels is limiting the ROM). Other authors use different terms - eg. hard, firm, soft, etc. I feel these "vague" terms lead to communication errors.

Capsular - indicates that the joint capsule is limiting the ROM. Feels like stretching a leather belt. Example - knee extension.

Ligamentous - indicates that ligament tightness is limiting the ROM. Feels like stretching a leather belt. Example - wrist radial deviation.

Bony - indicates that bone touching bone is limiting the ROM. Feels like pushing two wooden surfaces together. Example - elbow extension.>

Muscle Stretch - indicates that muscle tightness is limiting the ROM. Feels like stretching a bicycle tire innertube. Example - hip flexion while maintaining knee extension (straight leg raise) when hamstrings are tight.

Soft Tissue Approximation - indicates that subcutaneous tissues (muscle bulk, fat) are pushing against each other and limiting the ROM. Feels like squeezing two balloons together. Example - calf pressing against thigh during knee flexion.

Springy - indicates that a loose body is limiting the ROM. Feels "bouncy" like you are compressing a spring. Example - torn meniscal (knee) tissue limiting knee extension.

Empty - indicates that the examiner did not reach the end feel (usually the patient is not willing to allow motion to end of range because of anticipated pain). Feels like the joint has more range available, but the patient is purposefully preventing movement through the full ROM.

Testing End Feel for Elbow Extension

EXTREMIDAD SUPERIOR

SHOULDER FLEXION

Test Position

Subject supine Flatten lumbar spine (flex knees) Shoulder no abduction, adduction

or rotation (Note: to measure gleno-humeral

motion, stabilize scapula)

Normal Range

(For shoulder complex flexion)

167o + or - 4.7o (American Academy of Orthopaedic Surgeons)

150o (American Medical Association)

166o (mean), 4.7o (standard deviation), (Boone and Azen)

Goniometer Alignment

Axis – center of humeral head near acromion process

Stationary arm – parallel mid-axillary line

Moving arm – aligned with midline of humerus (lateral epicondyle)

Normal End Feel

Muscle Stretch

EXTENSION DEL HOMBRO

Test Position

Subject prone Shoulder no abduction, adduction

or rotation (note: to measure gleno-humeral

motion, stabilize scapula)

Normal Range

(for shoulder complex flexion)



62.3o (mean), 9.5o (standard deviation), (Boone and Azen)



Stationary arm – parallel mid-axillary line

Moving arm – aligned with midline of humerus (lateral epicondyle)

Normal End Feel

Capsular or ligamentous

ABDUCCION DEL HOMBRO

Test Position

Subject supine Shoulder 0o flexion and extension Shoulder laterally (externally)

rotated Shoulder abducted Stabilize thorax (note: to measure

gleno-humeral motion, stabilize scapula)

Normal Range

(for shoulder complex abduction)






Stationary arm – parallel to sternum

Moving arm – aligned with midline of humerus

Normal End Feel

Muscle Stretch

ROTACION INTERNA DEL HOMBRO

Test Position

Subject supine Shoulder 90o abduction Forearm neutral Elbow flexed 90o Stabilize arm

Normal Range





Axis – olecranon process of ulna Stationary arm – aligned vertically

Moving arm – aligned with ulna (styloid process)

Normal End Feel

Capsular

ROTACION EXTERNA DEL HOMBRO

Test Position

Subject supine Shoulder 90o abduction Forearm neutral Elbow flexed 90o Stabilize arm

Normal Range





Axis – olecranon process of ulna Stationary arm – aligned vertically

Moving arm – aligned with ulna (styloid process)

Normal End Feel

Capsular

FLEXION DEL ANTEBRAZO

Test Position

Subject supine Shoulder neutral (arm at side) Forearm supinated Elbow flexed Stabilize arm

Normal Range

141.0o + or - 4.9o (American Academy of Orthopaedic Surgeons)

140.0o (American Medical Association)



Axis – lateral epicondyle of humerus

Stationary arm – aligned with humerus (center of acromion process)

Moving arm – aligned with radius (styloid process)

Normal End Feel

Soft tissue approximation (capsular for thin subjects)

EXTENSION DEL CODO

Test Position

Subject supine Shoulder neutral (arm at side) Forearm supinated Elbow extended Stabilize arm

Normal Range





Axis – lateral epicondyle of humerus

Stationary arm – aligned with humerus (center of acromion process)

Moving arm – aligned with radius (styloid process)

Normal End Feel

Bone on bone

FOREARM SUPINATION

Test Position

Subject sitting Shoulder neutral (arm at side) Elbow flexed to 90o Stabilize arm

Supinate forearm

Normal Range





Axis – medial to ulnar styloid Stationary arm – parallel to

Normal End Feel

Capsular

humerus

Moving arm – aligned with ventral aspect of radius

FOREARM PRONATION

Test Position

Subject sitting Shoulder neutral (arm at side) Elbow flexed to 90o Stabilize arm

Pronate forearm

Normal Range





Axis – lateral to ulnar styloid Stationary arm – parallel to

humerus

Moving arm – aligned with dorsum of radius

Normal End Feel

Capsular

WRIST FLEXION

Test Position

Subject seated Forearm stabilized on table Flex wrist (fingers relaxed)

Normal Range





Axis – lateral wrist (triquetrum)

Normal End Feel

Stationary arm – aligned with ulna

Moving arm – aligned with fifth metacarpal

Capsular

WRIST EXTENSION

Test Position

Subject seated Forearm stabilized on table Extend wrist (fingers relaxed)

Normal Range





Axis – lateral wrist (triquetrum)

Normal End Feel

Capsular

Stationary arm – aligned with ulna

Moving arm – aligned with fifth metacarpal

WRIST RADIAL DEVIATION

Test Position Subject sitting with forearm resting

on table

Stabilize forearm to prevent pronation or supination

Normal Range 21o + or - 4o (American Academy

of Orthopaedic Surgeons) 20o (American Medical

Association)

21.5o (mean), 4.0o (standard deviation), (Boon and Azen)

Goniometer Alignment Axis – capitate Stationary arm – aligned with

forearm (lateral epicondyle)

Moving arm – aligned with metacarpal of middle finger

Normal End Feel Ligamentous (ulnar collateral

ligament)

WRIST ULNAR DEVIATION

Test Position

Subject sitting with forearm resting on table

Stabilize forearm to prevent pronation or supination

Normal Range



36.0o (mean), 3.8o (standard deviation), (Boon and Azen)


Axis – capitate Stationary arm – aligned with

forearm (lateral epicondyle)

Moving arm – aligned with metacarpal of middle finger

Normal End Feel

Ligamentous (radial collateral ligament)

METACARPOPHALANGEAL JOINT FLEXION

Test Position


Wrist and interphalangeal joints relaxed

Forearm neutral

Stabilize metacarpal to prevent motion

Normal Range

86o (index), 91o (long), 99o (ring), 105o (little) (American Academy of Orthopaedic Surgeons - active motion)



dorsal metacarpophalangeal joint Stationary arm – aligned with

metacarpal

Moving arm – aligned with proximal phalange

Normal End Feel

capsular

METACARPOPHALANGEAL JOINT EXTENSION

Test Position


Wrist and interphalangeal joints relaxed

Forearm neutral


Normal Range

22o (index), 18o (long), 23o (ring), 19o (little) (American Academy of Orthopaedic Surgeons - active motion)




metacarpal


Normal End Feel

capsular

METACARPOPHALANGEAL JOINT ABDUCTION

Test Position


Wrist neutral Forearm neutral


Normal Range

???



metacarpal


Normal End Feel

capsular

METACARPOPHALANGEAL JOINT ADDUCTION

Test Position




Normal Range

???



metacarpal


Normal End Feel

capsular

INTERPHALANGEAL JOINT FLEXION

Note: This page demonstrates the technique for index proximal interphalangeal joint flexion. The technique for all other interphalangeal joints is similar. Simply align the goniometer over the proximal and distal joint partners (bones) for the joint you wish to measure.

Test Position


Wrist, metacarpal, and non-tested interphalangeal joints relaxed

Forearm neutral

Stabilize proximal bone to prevent motion

Normal Range

American Academy of Orthopaedic Surgeons

PIP fingers - 102o (index), 105o (long), 108o (ring), 106o (little) ( active motion)

DIP fingers - 72o (index), 71o (long), 63o (ring), 65o (little) ( active motion)

IP thumb - 73o

American Medical Association

100o (PIP fingers), 70o (DIP fingers), 80o (IP thumb)

Normal End Feel


dorsal proximal interphalangeal joint

Stationary arm – aligned with proximal phalange

Moving arm – aligned with middle phalange

Proximal Interphalangeal Finger Joints

bone on bone (if tissues overlying palmar aspect of bones is thin)

soft tissue approximation (if tissues overlying palmar aspect of bones is thick)

Distal Interphalangeal Finger Joints and Thumb Interphalangeal Joint

capsular

THUMB CARPOMETACARPAL JOINT FLEXION

Test Position

Subject sitting with forearm supinated and resting on table

Wrist neutral

Stabilize carpals to prevent wrist motion

Normal Range

???

Goniometer Alignment Normal End Feel

Axis – carpometacarpal joint Stationary arm – aligned with

radius

Moving arm – aligned with metacarpal of thumb

Capsular

THUMB CARPOMETACARPAL JOINT EXTENSION

Test Position


Wrist neutral


Normal Range

???


Axis – carpometacarpal joint Stationary arm – aligned with

radius

Normal End Feel

Capsular


THUMB CARPOMETACARPAL JOINT ABDUCTION

Test Position




Normal Range

70o (American Academy of Orthopaedic Surgeons)


Axis – radial styloid Stationary arm – aligned with

metacarpal of index finger


Normal End Feel

Muscle stretch (adductor pollicus, skin, fascia)

THUMB CARPOMETACARPAL JOINT ADDUCTION

Note: Thumb adduction is the return to neutral from thumb abduction. Thumb adduction is rarely measured, probably because it is rarely limited.

Test Position Subject sitting with forearm resting

on table Wrist neutral Forearm neutral


Normal Range 0o ???

Goniometer Alignment Axis – radial styloid Stationary arm – aligned with

metacarpal of index finger


Normal End Feel Soft tissue approximation

THUMB CARPOMETACARPAL JOINT OPPOSITION

http://academic.uofs.edu/faculty/kosmahle1/courses/pt350/goniomet/thumbab.htm

Note: Opposition of the thumb causes the pad of the thumb to face (oppose) the pads of the fingers. Opposition cannot be measured with a goniometer. The American Academy of Orthopaedic Surgeons suggests that opposition range is normal when the tip of the thumb can touch the base of the fifth finger. When range is not adequate, a ruler can be used to measure the distance between the tip of the thumb and the base of the fifth finger.

Test Position


Wrist neutral

Stabilize fifth metacarpal

Normal Range

Able to touch tip of thumb to base of fifth finger (American Academy of Orthopaedic Surgeons)


Goniometer cannot be used

Use a ruler to measure distance between tip of thumb and base of fifth finger

Normal End Feel

Capsular or soft tissue approximation

EXTREMIDAD INFERIOR

HIP FLEXION

Test Position

Subject supine Allow knee to flex (to avoid

limitation by tight hamstrings) Stabilize pelvis to prevent rotation

Flex hip

Normal Range





Axis – greater trochanter Stationary arm – aligned with

midline of plevis

Moving arm – aligned with femur (lateral epicondyle)

Normal End Feel

Capsular

HIP EXTENSION

Test Position

Subject prone Stabilize pelvis to prevent rotation Extend hip

Normal Range





Axis – greater trochanter

Normal End Feel

Stationary arm – aligned with midline of plevis

Moving arm – aligned with femur (lateral epicondyle)


HIP ABDUCTION

Test Position

Subject supine Stabilize pelvis to prevent pelvic

list Abduct hip

Normal Range





Axis – anterior superior iliac spine

Normal End Feel

(ASIS) Stationary arm – aligned with

opposite ASIS

Moving arm – aligned with femur (center of patella)


HIP ADDUCTION

Test Position

Subject supine Stabilize pelvis to prevent pelvic

list Abduct opposite hip (to allow

room for tested limb to adduct)

Adduct hip

Normal Range





Axis – anterior superior iliac spine

Normal End Feel

(ASIS) Stationary arm – aligned with

opposite ASIS

Moving arm – aligned with femur (center of patella)


HIP MEDIAL (INTERNAL) ROTATION

Test Position Subject sitting on table knee flexed Stabilize distal thigh

medially (internally) rotate hip

Normal Range 44.0o + or - 4.3o (American

Academy of Orthopaedic Surgeons)




Axis – center of patella Stationary arm – aligned vertically

Moving arm – aligned with leg (crest of tibia)

Capsular

HIP LATERAL (EXTERNAL) ROTATION

Test Position Subject sitting on table knee flexed Stabilize distal thigh hip laterally (externally) rotated

Normal Range 44.0o + or - 4.8o (American

Academy of Orthopaedic Surgeons)




Axis – center of patella Stationary arm – aligned vertically

Moving arm – aligned with leg (crest of tibia)

Capsular

KNEE FLEXION

Knee flexion should be measured with the subject supine. This position allows assessment of the joint range of motion without interference from tightness in the rectus femoris muscle. If the examiner wishes to assess length of the rectus femoris, have the patient lie prone (see 2nd illustration).

Test Position

Subject supine Allow hip to flex

Flex knee

Normal Range



142.5o (mean), 5.4o, (standard deviation) (Boone and Azen)


Axis – lateral epicondyle of femur Stationary arm – aligned with

greater trochanter

Moving arm – aligned with lateral malleolus

Soft tissue approximation

Supine Position (Rectus Femoris Limiting)

KNEE EXTENSION

Test Position

Subject prone Stabilize femur

Extend Knee

Normal Range

minus 2.0o + or - 3.0o (American Academy of Orthopaedic Surgeons)


Axis – lateral epicondyle of femur Stationary arm – aligned with

greater trochanter

Moving arm – aligned with lateral malleolus

Normal End Feel

Capsular

ANKLE DORSIFLEXION

Pronation of the sub-talar joint can compensate for a loss of ankle joint dorsiflexion range of motion. To avoid measurement error (by accidentally including sub-talar pronation), the sub-talar joint must be stabilized in its neutral position. To assess the range of JOINT motion, flex the knee (first illustration). To assess tightness of the gastrocnemius muscle, extend the knee (second illustration).

Test Position

Subject prone Flex knee Stabilize sub-talar in neutral

Dorsiflex ankle by pushing through 5th metatarsal head

Normal Range





Axis – lateral malleolus

Normal End Feel

Capsular

Stationary arm – aligned with fibular head

Moving arm – aligned with fifth metatarsal

Assessing Gastrocnemius Tightness (muscle stretch end-feel)

ANKLE PLANTARFLEXION

Test Position

Subject supine Extend knee Stabilize leg

Plantarflex ankle

Normal Range





Axis – lateral malleolus Stationary arm – aligned with

fibular head

Moving arm – aligned with fifth metatarsal

Normal End Feel

Capsular

CALCANEAL INVERSION

Test Position

Subject prone Stabilize tibia in sagittal plane

(rotate hip or pelvis to align tibia)

Invert calcaneus

Normal Range

2/3 of total range from extreme of inversion to extreme of eversion should be inversion. About 20o inversion (and 10o eversion) on average (Seibel MO: Foot Function: A Programmed Text,p. 72, Baltimore, Williams & Wilkins, 1988)



Axis – automatically positioned by

Normal End Feel

alignment of goniometer arms Stationary arm – aligned with

midline of leg

Moving arm – aligned with midline of calcaneus

Capsular

CALCANEAL EVERSION

Test Position

Subject prone Stabilize tibia in sagittal plane

(rotate hip or pelvis to align tibia)

Evert calcaneus

Normal Range

1/3 of total range from extreme of inversion to extreme of eversion should be eversion. About 10o eversion (and 20o inversion) on average (Seibel MO: Foot Function: A Programmed Text,p. 72, Baltimore, Williams & Wilkins, 1988)



Axis – automatically positioned by alignment of goniometer arms

Stationary arm – aligned with midline of leg

Moving arm – aligned with midline of calcaneus

Normal End Feel

Capsular

MIDTARSAL INVERSION

Test Position

Subject supine Stabilize calcaneus and talus

Invert forefoot

Normal Range

???




Moving arm – aligned with plantar aspect of metatarsal heads

Capsular

MIDTARSAL EVERSION

Test Position

Subject supine Stabilize calcaneus and talus

Evert forefoot

Normal Range

???




Moving arm – aligned with plantar

Normal End Feel

Capsular

aspect of metatarsal heads

METATARSOPHALANGEAL JOINT DORSIFLEXION(Extension)

Range of first metatarsophalangeal (MTP) joint dorsiflexion is functionally important for gait. The available range of 1st MTP joint dorsiflexion depends on the position of the 1st ray. A plantarflexed 1st ray allows greater range of 1st MTP dorsiflexion. I recommend stabilizing the 1st ray in plantarflexion to measure maximum range of 1st MTP dorsiflexion. The first photo demonstrates a good method for measuring 1st or 5th MTP joint dorsiflexion by placing the goniometer alongside the bones. This technique cannot be used for the 2nd, 3rd, or 4th MTP joints. The second photo shows a technique for measuring these joints.

Test Position Subject supine Stabilize 1st metatarsal in

plantarflexion

Dorsiflex MTP

Normal Range 1st - 65o to 75o (slightly less at

lesser MTPs) is the minimum required for normal gait (Root, Orien, Weed. Normal and Abnormal Function of the Foot, pp. 60-61, Clinical Biomechanics Corp., Los Angeles, 1977.)

1st - 50o , 2nd - 40o , 3rd - 30o , 4th - 20o , 5th - 10o (American Medical Association)

Goniometer Alignment Axis – medial to center of

metararsal head Stationary arm – aligned

metatarsal


Normal End Feel Capsular

Assessing MTP Dorsiflexion by Placing Goniometer on Dorsum of Bones

(requires modified goniometer)

METATARSOPHALANGEAL JOINT PLANTARFLEXION

(Flexion)

The first photo demonstrates a good method for measuring 1st or 5th MTP joint plantarflexion by placing the goniometer alongside the bones. This technique cannot be used for the 2nd, 3rd, or 4th MTP joints. The second photo shows a technique for measuring these joints.

Test Position

Subject supine Stabilize 1st metatarsal

Plantarflex MTP

Normal Range

1st - 30o , 2nd - 30o , 3rd - 20o , 4th - 10o , 5th - 10o (American Medical Association)


Axis – medial to center of metararsal head

Stationary arm – aligned metatarsal


Normal End Feel

Capsular

Assessing MTP Plantarflexion by Placing Goniometer on Dorsum of Bones

(requires modified goniometer)

METATARSOPHALANGEAL JOINT ABDUCTION

Test Position

Foot flat on table Stabilize metatarsal

Abduct MTP

Normal Range

???


Axis – dorsum of center of metararsal head

Stationary arm – aligned with metatarsal


Normal End Feel

Capsular

METATARSOPHALANGEAL JOINT ADDUCTION

Test Position

Foot flat on table Stabilize metatarsal

Adduct MTP

Normal Range

???


Axis – dorsum of center of metararsal head

Stationary arm – aligned with metatarsal


Normal End Feel

Capsular

COLUMNA VERTEBRAL

CERVICAL SPINE FORWARD BENDING (flexion)

Test Position

Subject sitting with lumbar and thoracic spines supported

Stabilize lumbar and thoracic spines

Flex cervical spine

Normal Range

75.5o + or - 8.5o (20 - 29 yrs.), 70.5o + or - 17.5o (30 - 49 yrs.), 64.5o + or - 7o (>50 yrs.) (American Academy of Orthopaedic Surgeons)



Axis – external auditory meatus Stationary arm – vertical

Moving arm – aligned with nostrils

Normal End Feel


CERVICAL SPINE BACKWARD BENDING (extension)

NOTE: The position of the mouth influences the available range of cervical backward bending. With the mouth closed, thghtness of the infrahyoid and

suprahyoid muscles can limit range of cervical backward bending. If you wish to assess the range of the cervical spine, the mouth should be relaxed and slightly

open.

Test Position Subject sitting with lumbar and

thoracic spines supported Stabilize lumbar and thoracic

spines Mouth relaxed and slightly open

Extend cervical spine

Normal Range 75.5o + or - 8.5o (20 - 29 yrs.),

70.5o + or - 17.5o (30 - 49 yrs.), 64.5o + or - 7o (>50 yrs.) (American Academy of Orthopaedic Surgeons)


Goniometer Alignment Axis – external auditory meatus Stationary arm – vertical

Moving arm – aligned with nostrils

Normal End Feel Bony or Capsular

CERVICAL SPINE SIDEBENDING

Test Position



Sidebend cervical spine

Normal Range (unilateral)

50.5o + or - 5.5o (20 - 29 yrs.), 46.5o + or - 6.5o (30 - 49 yrs.), 40o + or - 8.5o (>50 yrs.) (American Academy of Orthopaedic Surgeons)



Axis – spinous process of C7 Stationary arm – spinous

processes of thoracic spine

Moving arm – posterior midline of head at occipital protuberance

Normal End Feel


CERVICAL SPINE ROTATION

Test Position



Rotate cervical spine

Normal Range (unilateral)

91.5o + or - 5.5o (20 - 29 yrs.), 81o + or - 6.5o (30 - 49 yrs.), 77.5o + or - 7.5o (>50 yrs.) (American Academy of Orthopaedic Surgeons)



Axis – center of superior aspect of head

Stationary arm – aligned with acromion processes

Moving arm – aligned with tip of nose

Normal End Feel


THORACO-LUMBAR SPINE FORWARD BENDING (flexion)

TEST DE SHOBER

NOTE: There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the forward bending position. Note the difference.

Test Position

Subject standing

Flex thoracic and lumbar spines

Normal Range

10 cm (Norkin and White)

Tape Measure Alignment

Spinous processes of C7 and S1

Normal End Feel


THORACO-LUMBAR SPINE BACKWARD BENDING (extenion)

NOTE: There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established

for any method). The method illustrated here is a good compromise. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the backward bending position. Note the

difference.

Test Position

Subject standing

Extend thoracic and lumbar spines

Normal Range

???

Tape Measure Alignment

Spinous processes of C7 and S1

Normal End Feel

Capsular or ligamentous (sometimes bony)

THORACO-LUMBAR SPINE SIDEBENDING

NOTE: There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise.

Test Position Subject standing Stabilize pelvis

Sidebend thoracic and lumbar spines

Normal Range (unilateral) RIGHT :

o 20 - 29 yrs 37.6o + or - 5.8o o 30 - 39 yrs 35.3o + or - 6.5o o 40 - 49 yrs 27.1o + or - 6.5o o 50 - 59 yrs 25.3o + or - 6.2o o 60 - 69 yrs 20.2o + or - 4.8o o 70 - 79 yrs 18.0o + or - 4.7o o (Fitzgerald, Wynveen,

Rheault et al) LEFT:

o 20 - 29 yrs 38.7o + or - 5.7o o 30 - 39 yrs 36.5o + or - 6.0o o 40 - 49 yrs 28.5o + or - 5.2o

o 50 - 59 yrs 26.8o + or - 6.4o o 60 - 69 yrs 20.3o + or - 5.3o o 70 - 79 yrs 18.9o + or - 6.0o o (Fitzgerald, Wynveen,

Rheault et al)


Goniometer Alignment Axis - S1 spinous process Stationary arm - vertical

Moving arm - C7 spinous process

Normal End Feel Capsular or ligamentous

ROTACION DEL TRONCONOTE: There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise.

Test Position Subject sitting Stabilize pelvis Do not allow sidebending, forward

Normal Range (unilateral) 45o (American Medical

Association)

bending or backward bending

Rotate thoracic and lumbar spines

Goniometer Alignment Axis - center of superior aspect of

head Stationary arm - aligned with

anterior superior iliac spines

Moving arm - aligned with acromion processes

Normal End Feel Capsular or ligamentous

TEMPEROMANDIBULAR JOINT OPENING

Ruler Method

Alternate Method

Test Position

Subject sitting Stabilize cervical spine

Open Mouth

Normal Range

35 to 50 mm (Magee)

two and 1/2 flexed PIPs (Friedman and Weisberg)

Ruler Alignment

Use a ruler to measure the distance between the upper and lower incisors

Alternate method - have the subject flex the proximal interphalangeal joints (PIPs) of the fingers and assess how many PIPs can fit between the teeth

Normal End Feel


TEMPEROMANDIBULAR JOINT PROTRUSION

Test Position


Protrude mandible forward

Normal Range

3 to 5 mm (Magee)

Ruler Alignment

Use a ruler to measure the distance between the upper and lower incisors

Normal End Feel


TEMPEROMANDIBULAR JOINT LATERAL DEVIATION

Test Position


Deviate mandible laterally

Normal Range

10 to 15mm (Magee)

Ruler Alignment

1 - Identify points on the upper and lower teeth that are aligned when the mouth is in resting position (upper and lower incisors in this illustration)

2 - Deviate the mandible laterally and use a ruler to measure the distance between the two points (upper and lower incisors in this illustration)

Normal End Feel


la neta de la goniometria

Technology

joint range of motion

position joint

joint rom

incorrect end feel

testing end feel

example elbow extension

range of motion romc

end of rangeb