Range of Motion Measurement and Manual Muscle Test

Purpose

• Determine muscle weakness or joint problems.
• Two key methods: Range of Motion (R) and Manual Muscle Test.

Types of Range of Motion

• Osteokinematic Motion: Movement of bones at joints (hip flexion, elbow flexion, shoulder abduction).
• Passive Range of Motion: Moved by an outside force (e.g., therapist).
• Active Range of Motion: Controlled by the muscle itself.

Comparing Range of Motion

• Compare passive and active range of motion.
• Clinical significance of differences between passive and active range of motion.

Precautions Before Evaluation

• Check referral notes for contraindications (e.g., bone fractures, surgical procedures).
• Avoid passive range of motion if there is pain, edema, or swelling.
• Always refer to referral or surgical notes for movement restrictions.

Types of End Feels

• Hard End Feel
• Soft End Feel (e.g., elbow flexion)
• Firm End Feel
• Empty End Feel
• Document any abnormal end feels.

Tools for Measuring Range of Motion

• Goniometer: Most commonly used tool.
  • Types: Manual, Electronic, 3D Motion Analysis

Components of a Goniometer

• Protractor: Has angles or numbers.
• Stationary Arm: Placed on the proximal segment that is not moving.
• Movable Arm: Moves along with the moving segment.

Goniometer Use

• Identify the movement axis (e.g., elbow flexion).
• Align goniometer axis with the movement axis.
• Place stationary arm parallel to the proximal segment.
• Place movable arm parallel to the distal segment.
• Begin from an anatomical position (e.g., elbow fully extended = zero degrees).

Documentation

• Date and time of measurement.
• Type of range of motion (active vs. passive).
• Side of the body (left or right).
• Any deviations from standard measurement positions.
• Signature of the evaluator.
• Example norms: Knee flexion (135 degrees by AAOS, 150 degrees by AMA).

Interpretation of Measurements

• Compare measurements to norms to identify limitations.
• Examples:
  • 0 to 150 degrees: No limitation.
  • 20 to 150 degrees: Limitation in extension.
  • 0 to 120 degrees: Limitation in flexion.
  • 20 to 120 degrees: Limitation in both flexion and extension.

Clinical Implications

• Greater than 5 degrees difference between passive and active range of motion is clinically significant.
• Passive range of motion greater than active range of motion indicates muscle weakness.
• Pain during range of motion indicates joint or muscle problems.
• Further pathological assessment may be required to determine the exact issue.