Flashcards in ROM, Goniometry and Joints Deck (27)
Active Range of Motion.
When joint is moved by surrounding muscles and tendons. Voluntary movement able to be done by patient.
Passive Range of Motion.
When the joint is moved by an outside force (ie: OTA) while patient is relaxed. Usually gives a greater ROM because force can provide overpressure. Significantly higher measurement can indicate problems with muscles/nerves/tendons.
When patient creates resistance to movement—pulling away, etc. Due to injury, fear, etc.
Causes for decreased ROM?
• Disease (CP, Arthritis)
• Joint trauma
• Soft tissue tightness (tight hips from sitting)
• Spasticity (nerve-based tension in muscles)
Why measure ROM?
1) Select intervention goals
2) Select treatment techniques
3) Determine availability of ROM for tasks (ie: hip to rise from seated)
4) Determine effectiveness of intervention (validates improvement)
Normal Hip ROM Requirements
• Normal hip flexion is 0˚ - 100˚
• Don't need full range for some ADLs
• Ascending stairs needs 67˚ flexion
• Descending stairs needs 32˚ flexion
• Sit-to-stand needs 100˚+ flexion
• Sitting needs 84˚ flexion
Contraindications to Measuring ROM
• New soft tissue injury
• Newly united fracture
• Recent prolonged immobilization
• Bone carcinoma or other fragile bone condition
Factors of Variability in Measuring ROM
• Age (children are hypermobile)
• Gender (females more flexible after age 14)
• Lifestyle factors (gymnast vs. desk job)
• Occupation (people who move vs. stationary ppl)
Tips for PROM
• Approach client on side to be measured
• Use good body mechanics
• Have relaxed/conformed grasp on body part
• Client relaxed and resting weight of body part in your hands
• Start movement at beginning of range, move slowly and stop when you feel resistance or there is pain
**Compare injured to non-injured side!
**Ask about previous injuries/arthritis before test!
**Monitor for crepitus and pain!
"Popping" sound in joint, or non-smooth/bumpy movement.
This is the feel when the movement reaches it's furthest point (its "end"). Three types:
HARD= Bone on bone, like in elbow extension.
SOFT= Soft tissue impedes motion, like knee or elbow flexion.
FIRM= Firm, springy sensation, limited by tension on surrounding tissue, like in ankle dorsiflexion or wrist flexion/extension.
Procedure for Measuring ROM
1) OBSERVE the motion from the patient. Look for compensatory motion, posture, muscle contours, skin color, edema. Know what that patient's normal motion looks like; compare both sides.
2) PALPATE around the joint. Feel the bony landmarks important to goniometer use. Palpate surrounding soft tissue using your index and middle finger.
3) POSITION client and self conducive to goniometer and body mechanics. Approach client on side being tested; avoid restrictions to movement.
How to Document Goniometer Measurement
• Always start measurement at 0˚ and only move mobile arm to measure.
• Write as range of motion in degrees ie: 0˚ to 140˚
• Use a plus (+) sign for hyperextension: ex: if hyperextends 20˚ and flexes 50˚, you would write "+20/50"
• If lacking full extension, use negative (-) before number: ex: if lacking full extension of 15˚, you would write “-15”
Ways to Classify Joints
1) ANATOMY of the joint (Fibrous, Cartilaginous, Synovial)
2) AMOUNT OF MOVEMENT of the joint (Uniaxial, Biaxial, Triaxial)
3) SHAPE of the joint (Saddle, Hinge, Pivot)
Anatomical Joint Classification
1) Fibrous joints: synarthrotic (w/o movement, as in skull sutures)
2) Cartilaginous joints: amphiarthrotic (slight movement, as in spine or pubic symphasis)
3) Synovial joints: diarthrotic (moves 2 ways, as in our major movers—knees, elbows)
Strongest joints; do not move; dense layer of fibrous connective tissue firmly attaches bones. (Ankle Fibula/Tibula ligament joint and Skull Sutures)
Joined by cartilage and connective tissue; only slight movement, with good stability. 2 Types: Synchondrosis (sternum/ribs) and Symphasis (pubic and spine)
Contain a synovial capsule; increase mobility of body part; more easily damaged/injured; important for movement. Synovial joint contains:
• Articular cartilage (ie: meniscus) for cushion
• Articular capsule (space with periosteum/cartilage)
• Synovial fluid (for lubricant)
• Ligament (extra support in movement, prevent dislocation, connect bone-to-bone)
7 Types of Synovial Joints
1) GLIDING/Planar joint (carpals of wrist or acromioclavicular joint); allow sliding movement
2) HINGE joint (elbow betw humerus/ulna); act as door hinge, moves in one plane
3) PIVOT joint (atlanto-axial joint, radioulnar joints); one bone rotates about another
4) CONDYLOID joint (radius/scaphoid in wrist); one concave, one convex; 2 bones fit together in odd shape
5) SADDLE joint (base of thumb); resembles a saddle, permit same movements as condyloid
6) BALL AND SOCKET joint (shoulder, hip); move in 3 planes—all except gliding
7) COMPOUND joint (knee=condyles of femur join with condyles of tibia, plus saddle joint of patella); involves more than 2 bones; not as simple as hinge-only
Movement Classifications of Joints
1) UNIAXIAL (moves in one plane/axis; hinge like elbow)
2) BIAXIAL (moves in 2 planes/axes; wrist bones)
3) TRIAXIAL (ball and socket; moves in 3 planes/axes; glenohumeral joint of shoulder, or hip joint)
Open-Pack vs. Close-Pack Joint Position
OPEN-Pack Joint Position = joint faces don't meet perfectly, loose ligaments/capsules; more motion possible, but joint is more vulnerable
CLOSE-Pack Joint Position = articulating surfaces have maximum contact, tight ligaments/capsules; difficult to distract/move in this position; stronger joint
RA vs. OA
Rheumatoid Arthritis (RA) = long-term disease that leads to INFLAMMATION of joint/tissues, which can affect other organs; affects synovial lining; possibly autoimmune cause; Also Juvenile RA, which delays bone growth.
Osteoarthritis (OA) = Most common arthritis; DEGENERATIVE disease of synovial joints; swelling, pain and loss of ROM; mostly in weight-bearing joints of LE; mostly caused by wear and tear
1) First Class (seesaw); FULCRUM is in center, effort and resistance at ends.
2) Second Class (wheelbarrow); LOAD is in center, fulcrum and effort at ends.
3) Third Class (elbow lifting weight); EFFORT is in center, fulcrum and load at ends.
(aka: Kinetic Chains)
Bones and joints moving in sequence following a specified pattern, depending on whether the chain is open or closed.
OPEN Kinematic Chain = distal segment of chain freely moves without affecting proximal joints (ie: waving hand at end of straight arm)
CLOSED Kinematic Chain = distal segment is fixed so movement in one joint will necessitate movement at connecting joints (ie: standing and bending knee—causes hip and ankles to flex, too)
Forward movement at GH joint that occurs halfway betw flexion/abduction.
Function of Levers
To increase the resistance and/or velocity that can be moved with a given effort/force.