OCT 720: Week 3: Range of Motion and Muscle Testing (ROM/MMT)

Jul 31, 2024

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.