Lecture on Range of Motion Measurement and Manual Muscle Testing

Overview

• Two main methods to determine muscle weakness or joint problems:
  • Range of Motion (ROM) Measurement
  • Manual Muscle Testing (MMT)

Types of Range of Motion

• Osteokinematic Motion: Movements such as hip flexion, elbow flexion, shoulder abduction.
• Passive Range of Motion (PROM): Motion moved by an outside force (e.g., therapist).
• Active Range of Motion (AROM): Motion controlled by the muscle contraction.

Comparison of PROM and AROM

• Compare PROM and AROM to identify issues.
• Equal PROM and AROM: Generally no issue.
• PROM > AROM: Indicates possible muscle weakness.

Precautions Before ROM Evaluation

• Referral Notes: Check for contraindications (e.g., bone fractures, surgical procedures).
• Pain, Edema, Swelling: Avoid passive ROM if these are present.

End Feels in ROM

• Types of End Feels: Hard, soft, firm, empty.
• Example: Soft end feel in elbow flexion; firm or hard end feel indicates abnormality.

Tools for Measuring ROM

• Goniometer: Most commonly used tool.
  • Components: Protractor (angle/number marked), stationary arm, movable arm.
  • Types: Big circle for large joints, half circle for wrist, tiny for fingers.
• Electronic Goniometer: For continuous and dynamic joint motion.
• 3D Motion Analysis: Most accurate, captures dynamic motion in real-time.

Using the Goniometer

• Identify Movement Axis: Align with the axis of motion (e.g., lateral side of the elbow for elbow flexion).
• Starting Position: Typically from an anatomical position (e.g., elbow fully extended = 0°).
• Documentation:
  • Date of measurement
  • Type of ROM (active or passive)
  • Side of the body (left or right)
  • Deviation from standard position
  • Signature
• Norms for Joint Movements: Different norms for various joints (e.g., knee flexion norms from AAOS and AMA).
• Interpreting Measurements:
  • 0° to 150°: Normal knee flexion
  • 20° to 150°: Limited knee extension
  • 0° to 120°: Limited knee flexion
  • 20° to 120°: Limited in both extension and flexion

Clinical Significance of ROM Differences

• Clinical Difference: Greater than 5° difference is significant.
• Examples:
  • PROM 150°, AROM 146°: No significant limitation.
  • PROM 150°, AROM 120°: Possible muscle weakness (joint is fine but muscle can't achieve full ROM).
• Pain: Always a factor; indicates a problem in joint or muscle.

Conclusion

• Combining PROM and AROM assessments helps determine if the issue is muscular or joint-related.
• Further pathology may need to be considered for comprehensive diagnosis.