Today I want to talk about range of motion measurement and manual muscle tests. So we typically use these two methods to determine is it muscle weakness or the joint problem. For range of motion, typically it's about osteokinematic motion.
So for example on hip flexion Elbow flexion, shoulder abduction. This is what we call osteokinematic motion. When we measure range of motion, we typically measure osteokinematic motion. There are two categories, passive range of motion and active range of motion. Passive range of motion is the amount of motion that is moved by an outside force and typically is moved by the therapists.
An active range of motion is the amount of motion that is controlled by the muscle. We generate that muscle contraction to produce the motion that is active range of motion. So when we measure passive range of motion and active range of motion, we can compare, is it about equal or passive range of motion greater than active range of motion and what does that mean clinically?
We are about to talk about this. So before we want to do a range of motion evaluation, there are some precautions that we need to pay attention to. So first of all, you want to review the data. you want to check the referral note see if there's any counter indications that you know we cannot we should not move the body segment for example if it's a bone fracture and if there's non-surgical procedure applied so typically they would lift you know in a cast or 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 I'm sorry, you will need to look for the referral note to see if there's a counter indications. If for example if a person just received say tendon repair, it looks normal.
It looks like you know the problem has been fixed. But it's under a limitation for movement protocol. Typically for the first weeks after the surgery, the surgeon may have a restriction of the movement. Then we need to find out. And it is typically indicated in the referral note.
If not, we can't. You can find that in the surgical note. And also if we don't know what's causing this limitation, we always avoid a passive range of motion.
If the client feels pain or you see the edema or swelling, we avoid passive range of motion. So when we move, so when we do the range of motion evaluation, you need to pay attention to the end field this is a review hard and field soft and field firm and field and empty and field of course there are other categories of end fields and you will learn more about that throughout this multi curriculum but as for now you want to pay attention to this typical end field say soft and field when we have that elbow flexion 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 abnormal or atypical end field then we want to document it okay so gomiometer is the most commonly used tool to measure range of motion You can also have A manual or electronic, you can also use electronic version of gominometer. It's good that you know can be used to measure continuous and dynamic joint motion.
And it's good especially helpful for the tasks that require repetitive movement. And the most accurate one is the 3D motion analysis. that capture the dynamic motion in real time. So now I need to, since we will mainly focus on the traditional gommiometer for this semester, so I'm going to introduce this a little bit.
So if you look at your gommiometer, you can see every gommiometer has a protractor that has the angle or numbers on that, and then Along with the extension from the protractor, you see the stationary bar or stationary arm that typically we use to put it in the proximal segment that's not moving. And then we have a movable arm that's going to move along with the segment that's typically moving. So this is the three typical parts. and you can see there are different types or model of combiometer you see this a big circle and large size that's good for a shoulder joint hip joint knee joint this kind of a bigger joint we have that half circle ones that in my opinion is good for wrist movement form pronation supination We also, you can also see a tiny one that's good for finger movement. So depending on the size of the joint, and then we choose the one that best fit.
Okay, so to do the gomiometry, we first want to identify the movement axis. So for example, the For elbow flexion, the movement axis is at the elbow joint. And typically we will put the axis, which is here, the axis of the gomiometer, in line with the axis of the motion. And in this sense, we will put it laterally, on the lateral side, by the elbow axis, right here.
and then the stationary bar or stationary arm will be parallel to the the proximal 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 is is parallel to the distal body segment that is moving so in this example it will be the radial bone or honorable depending which sign you put okay so and one more thing is we typically start we have the starting position from an anatomical position so in that sense elbow fully extension that's zero okay and what What information should we document? First of all, the date of the measurement. If you're detailed enough, you can document on what time, what room, or the room temperature. But you want to refer to the setting that you were working at. They typically have their own form and then you just follow what the form.
ask you to do but typically we need the date of the measurement are you doing active range of motion or passive range of motion is it the left side of the body or right side of the body okay if you you're not following the standard measurement position which oftentimes happened because we cannot really what the environment may not allow us to do so so So if you're not following the standard position, you need to document it so that when the next time, maybe one week later, and another therapist or you want to reevaluate 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 is one example so yeah it's kind of kind of tricky here if if we want to measure knee flexion okay You see these 135 and 150, these are norms for knee flexion and these are different norms. Okay the 135 norm is from American Academy of Orthopedic Surgeons and 151 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 norm that they use. For this course, either one is good.
If you don't know, I would encourage you to refer to the book, the Gatman's book, that they have the norm. for the upper axillary over there. If you want to refer to the physio U, they give you two norms.
So again, for the sake of the test, if you are curious, either one is good. So now here's how we document it and here's how we interpret it. Say you measure the knee flexion and you want to see the knee flexion.
you were able to measure this individual from 0 degree all the way to 150 degrees. Okay so it's kind of within the norm, kind of match the norm, so there is no limitation for the joint excel. If the starting position is 20 degrees 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 that there there there's 20 degrees lag or gap over there right so if this person can bend the knee from 0 to 120 you can kind of see that it doesn't fit to either norm right so there there is range of motion limitation inflection going on for this individual right if you if you document the number from 20 degrees to 120 degrees 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 let's complicate the situation So when we look at the passive range of motion, we just look at that, right? So when we look at the passive range of motion and compare this with active range of motion, so we get to decide, is it 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 greater than 5 degrees.
So for example, if you have a passive range of motion for shoulder flexion say 150 and then the active range of motion is 146 so it's slightly lesser right but it's within five degrees so roughly they're equal okay so if you have the passive range of motion roughly equal to accurate range of 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 this person may have a muscle weakness for example if this person can raise the arm up to 150 degrees passively so I can move this shoulder all the way to 150 when I ask this person to move This project can only move like to 120. You can kind of see that the joint has no problem because it's kind of matched the norm. However, when asked to actively move the arm, then the person cannot reach to the available range of motion. That's mostly owing to the muscle weakness.
Okay, so 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 of motion because of pain. Well, pain is always an issue, 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 need to refer to other pathological factors just to determine.