today I want to talk about um range of motion measurement and manual muscle test so uh we typically use this two method U to determine is it muscle weakness or the joint problem for R of motion um typically it's about uh osteokinematic motion so for example uh hip flexion elbow flexion shoulder abduction U this is what we call Osteo kinematic motion and uh when we measure range of motion we typically measure Osteo kinematic motion and there are two categories passive range of motion and active range of motion and passive range of motion is the amount of motion that is moved U by an outside force and typically it's uh moved by the therapists an active range of motion is uh the amount of motion that is controlled by the muscle okay or U we generate that muscle contraction to uh produce uh the motion that is active R of motion so when we measure uh passive R motion and active R of motion we can compare uh is it that you know about equal or um passive range of motion greater than active range of motion and what does that mean uh clinically U we are about to um talk about this um so before um we want to do a range mention evaluation there are some precautions that we need to be um we need to pay attention to so first of all you want to re uh you want to check the referral note see if uh there's any cont indications that you know we cannot we should not move um the body segment for example uh if it's a a bone fracture and um if there's non surgical procedure um applied so typically they would lift U you know in a cast or uh schedule for a surgery so at this moment we are not supposed to touch them and how do we find out we will need to refer um I'm sorry we will need to look for the referral notes to see if there's a counter indications if for example if a person um just received uh say uh tendon repair it looks normal it looks like you know um the the problem has been fixed but but it's under uh a limitation for U movement protocol that typically for the first weeks U after surgery um um the surgeon may have a restriction of movement then we need to find out and it is typically indicated in the referral note if not uh you can find that in the surgical notes and also if we don't know what's causing this un limitation we always avoid the passive ration uh if the client uh feel pain or you see the edema or swelling we uh avoid passive R of motion so when we move so when we do the range of motion evaluation uh you need to pay attention to the end view um this is a a review hard and field soft nfield firm nfield and empty nfield of course there are other uh categories of n fields and you will learn more about that um throughout this MTI curriculum but as for now you want to pay attention to this typical nfield say uh soft endfield when we have that elbow faction you you feel it's odd if it's firm right or hard because typically it should be soft okay so that's something that we want to document okay if there's an abnormal or atypical ELD then we want to document it okay so um gometer is the most commonly used Tool uh to measure range of motion um um you can also have uh a manual or um electronic you can also use electronic version of gometer it's good that you know can be used to to measure continuous and dynamic joint motion and it's good especially helpful for U the task that require um repetitive uh movement and the most accurate one is the 3D motion analysis that capture the dynamic Motion in real time so now I need to uh since we will manyu focus on the traditional gometer for this semester so uh I'm going to uh introduce uh this a little bit so if you look at your gometer you can see every gometer has a a protractor that has on the angle or numbers on that and then along with the uh uh extension from the protractor you see the stationary bar or stationary arm that typically we use uh uh for to to put it in the proximo segment that's not moving and then we have a movable arm that's going to move along with the segment um that's typically moving so this is the three uh typical parts and you can see there are different um types or model of gometer um you see this a big circle and and large size that's good for a shoulder joint hip joint knee joint these kind of a baker joint we have that half circle ones that's in my opinion is good for uh wrist movement form uh uh peration superation we also you can also see a tiny one that's for finger movement so depending on the size of the joint and then we choose the one that the best fit okay so um to do the gometry we first want to identify the movement axis so for example uh the for elbow flection the move from axis is at um the elbow joint and typically we will put um the axis which is here the axis of the gometer um in line with the axis of the motion and in this sense we will put laterally on the lateral side by the elbow axis right here and then the stationary bar or stationary arm will be parallel to the uh the pr maximal body segment that is not moving so in the elbow flexion the stationary arm will be in align with the upper arm okay and the movable arm uh is is parallel to the distal body segment that is moving so in this example it will be um the radio bone or ownable um depending which side you put Okay so uh and one more thing is we typically start we have the starting position uh from an anatomical position so in that sense elbow fully extension that's zero okay um and what what information should we document first of all um the date of the measurement uh if you're detailed enough you can document on what what what time and what room or the room temperature but uh you want to refer to um the the setting that you are um working at they typically have their own uh form and then you just follow what what the form ask you to do but typically we need know the date of the measurement um are you doing um active rer motion or passive rer motion is it the left side of the body or right side of the body okay if you you're not foll the standard um U measurement position which uh often times happen because we cannot really well the environment may not allow us to do so so if you're not following the standard position you need to document it so that uh when the next time maybe well week later and another therapist or you want to re-evaluate you have a good Baseline to refer to and most importantly you have to have your signature ready at in the form okay so here's uh is one example so yeah it's kind of kind of tricky here if if we want to measure uh knee flexion okay uh you see these uh 135 and 150 these are norms for knee flexion and these are different Norms okay the 135 Norm is from American Academy of orthopedic surgeon and the Y 51 is from American Medical Association you may ask which one should I choose well you want to refer to the clinic that you are working at to see what what Norm that U that they used for the for this course um for this course either one is good either one is good if you don't know you I would I would encourage you to refer um to the book the um the dman uh book that U they have the norm uh for the upper exity over there um and if you want to refer to the fys U they they give you two Norms okay so again uh for the sake of the test if you are curious either one is good okay so now here's how we document it and here's how we interpret it say you uh you measure the knee fraction and you you were able to measure uh uh this individual from 0 degree to all the way to 150° okay so it's kind of within the norm kind of match the norm so there's no limitation for the joint Exel right if the starting uh position is 20° and then this person can bend all the way up to 150 so you can kind of see that he or she has no problem bending the knee but has a little bit limitation in extending the knee because there there there's 20° lag or Gap over there right so if this person can bend the KN from 0o to 120 you can kind of see that it doesn't fit to either um Norm right so there there is uh R of motion limitation inflection going on for this IND indidual right if you if you document the number from 20° to 120° you can kind of see that this person have difficulty extending the knee and bending the knee okay so these are the joint problem that when we look at the range of motion right so now uh let's complicate uh the situation so when we look at the pass R motion or we just look at that right so when we uh look the passive Ral motion and compare this with active Ral motion so so we get to decide is a joint problem or a muscle problem so clinically if we want to say there's a difference in range of motion it has to be like greater than five degrees so for example if you have a pass range of motion for shoulder faction say uh 150 and then the active R motion is 46 so it's slightly lesser right but it's within 5 degrees so roughly they're equal okay so if you have the passive range motion roughly equal to active R motion it's okay there's no limitation if the passive range of motion is greater than active range of motion so that being said that uh uh that this person may have a muscle weakness for example if U this person can raise the arm up to 150° uh passive so I can move I can move this shoulder all the way to 150 when I ask this person to move uh this person can only move like to 120 you can kind of see that the joint has no problem because it's kind of match the norm however when when ask actively move the arm then and then the person cannot reach to the available range of motion that's mostly um um owing to the muscle weakness okay so that's that's how we see when the passive range of motion is greater than active range of motion okay if you cannot make it with the full available range ofion because of pen well pen is always a right so there's definitely going on for the joint and or for the muscle weakness so and that's kind of tricky okay and we will need to refer to other um um pathological uh factors just to determine