Factors that affect ROM

Gender
age
race
BMI
Occupation
Recreation
Testing factors
-Tester's experience
=Instruments used
=Time of day

Women tend to have ______ ROM compared to men (adults not children)

Greater

these motions below tend to be _______ in children :
Hip flexion, abduction, lateral rotation
Dorsiflexion
Elbow flexion and extension

Greater

the motions below tend to be _______ in children;
Hip extension
Knee extension
Plantar flexion

limited

Wrist flexion and extension
Hip rotation
Shoulder rotation
Vertebral mobility
are all common areas of _________ Rom in adults

decreased

0- ______ degrees of motion is noted for each motion. typically

0-180 degrees

What are the 3 main parts of the goniometer

Body (contains the fulcrum)
Stationary arm
Movement arm

When determining ROM in the testing position the Joint should be in starting position of ___ degrees

0

when Using Goniometer the Fulcrum should be at the ____ ___ _____

axis of motion

when Using the Goniometer, Stationary arm parallel to long axis of _______ _________

proximal segment

the Moving arm of the goniometer should always be parallel to long axis of ______ _______

distal segment

Ideally read goniometer while in place on the patient at ___ _____

eye level

when recording the measurement, Record starting and ending position
E.g. knee flexion

0° - 120°

If pt is unable to start at 0° then from where started
e.g. knee flexion ...

15°-120°

If hyperextend then that degree - 0° to end ROM

10° - 0° -120°

12 steps of the testing procedure are?

1. Pt. in testing position
2. Stabilize proximally
3. Distal segment to 0o; take part through ROM and get end-feel
4. Visually estimate ROM
5. Return to start position
6. Palpate bony landmarks
7. Align goniometer
8. Read & record start position
9. Stabilize proximal segment
10. Move distal through full ROM
11. Replace and realign goniometer
12. Read and record ROM

The measurement of a joint angle and the amount of motion

Goniometry

Movement of the shafts of the bones around an axis
Gross movement of shafts of bones
Occurs around a fixed axis of motion
Takes place in 1 of the 3 cardinal planes and around corresponding axis

Osteokinematics

Movement of the joint surfaces with respect to each other

Arthrokinematics

ROM

The arc of motion that occurs at a joint or a series of joints

the feeling experienced by an examiner as a barrier to further motion at the end of PROM.

end-feel

Excessive range of motion
Poor stability and control
Injury and repetitive stress
Pain?

hypermobility

Beighton Scale

this test for Excessive Hypermobility measures the ROM of the joints below:

Thumb
5th MCP joint
Elbow
Knee
Forward flexion

If you want to improve rectus femoris length, what position will you place the hip and knee in?

flexion

If you want to improve hip extension, what position will you place the knee in?

knee extension

If trying to improve length of a muscle that crosses two joints, how should that muscle be positioned?

end range

If trying to improve ROM at a joint where a two joint muscle crosses, how should the joints and be positioned?

end range

When trying to measure ROM at a joint, where should you position the muscle that crosses that joint and another?

midrange

Passive Insufficiency

Muscles can prevent full ROM from occurring at a joint if it is being lengthened over multiple joints

If a _______ ________ ________ is limited, PROM may not pick that up because PROM is measured in a position that does not fully elongate a two-joint muscle

two joint muscle

If a one joint muscle is limited,________ at that joint will be limited

PROM

Muscke Length Testing

Looks individually at a muscle's ability to elongate and is Mostly used for two-joint muscles

Empty End Feel

No real end feel due to pain. No resistance is felt except patient has muscle splinting or spasm
Acute joint inflammation; bursitis, fracture,

Abnormal Hard End Feel

Occurs sooner or later in the ROM or in a joint that is not typical to have hard end-feel.
Chondromalcia, osteoarthritis, fracture, loose joint bodies, heterotrophic ossification

Nomal Hard End Feel

Bone on Bone
(e.g. elbow extension)

Abnormal Firm End Feel

Occurs sooner or later in the ROM or in a joint that is not typical to have firm end-feel.
Increased muscle tone; tight/shortened capsule, muscle, ligaments or fascial

Normal Firm End Feel

Muscular (e.g. 90/90)
Capsule (e.g. ext. of MCP)
Ligament (e.g. forearm supination)
Nerve (e.g. SLR)

Abnormal Soft End Feel

Occurs sooner or later in the ROM or in a joint that is not typical to have soft end-feel.
Edema; Adipose, Muscle bulk

Normal Soft End Feel

Soft tissue approximation
(e.g. knee , elbow flexion)

Abnormal End Feel

an end feel not typical for the given structures; indicative of a problem at the system level (impairment or pathology)

Normal End Feel

an end feel expected given the anatomical structures

End Feel

Limitations/barriers to ROM at the end of the range

ROM Assessment

Determine active ROM
Determine PROM
Determine End feel
Determine Muscle length
Assessment
Normal motion
Hyper or hypo mobility
Capsular pattern

Minimal Detectable Change

the minimum amount of change in a patient's score/measurement that ensures the change isn't the result of measurement error.

Concave on Convex

Roll and glide in the same direction as movement of shaft

Convex on Concave

Roll in same direction as movement of shaft but glide in opposite direction

PROM

the arc of motion attained at a joint by an examiner without assistance from the subject. The subject remains relaxed and plays no active roll in producing movement.

AROM

The arc of motion attained at a joint by a subject during unassisted voluntary joint motion

Hypomobility

this term refers to an decrease in PROM that exceeds normal values for a joint, given the subjects age, gender. The end-feel occurs early in the ROM and may be different in quality from what is expected.

Which axis of motion is oriented vertically when in the anatomical position. This axis runs through the shaft of the bone. Motion on this axis occurs in the transverse plane. Typically called rotational movements. Ex. Rotation of the trunk, oe internal/external rotation of the shoulder.

Vertical

Which axis of rotation allows movement to occur along the sagittal plane, such as flexion or extension of the elbow.

Medial-Lateral

Which axis oriented in a direction, which allows movement to occur along the frontal plane, Such as Abduction or adduction of the hip.

Anterior-Posterior

These movements take place along which plane?
• Internal and external rotation
• Axial rotation

Transverse

These movements take place along which plane?
• Adduction
• Abduction
• Lateral flexion
• Ulnar and radial deviation
• Eversion
• Inversion

Frontal

These movements take place along which plane?
• Flexion
• Extension
• Dorsiflexion
• Plantar flexion
• Forward and backward bending

Sagital

pathological conditions involving the entire joint capsule that cause a particular pattern of restriction involving all or most of the passive motions of the joint.

Capsular Pattern

Knee Flexion

130-140

Knee Extnsion

0 degrees

>5 is hyperextension

Hip Flexion

120-140

Hip extension

18-30Hip extension

Hip Abduction

40-55

Hip Adduction

20-25

Hip Internal ROtation

30-45

Hip External Rotaton

32-50

Dorsiflxion (Talocrural joint)

15-20

Plantar Flexion

45-55

Inversion at the Tarsal Joint

30-35

Eversion at the Tarsal Joint

15-20

Inversion/Supination (subtalar inversion)

5 degrees

Eversion/Pronation (subtalar eversion)

5-12 degrees

MTP Joint Flexion

30-45 degrees

MTP JOint Extension

70-80 degrees

What muscle test tests the length of the rectus femoris and a positive test is anything less than 90 degrees of knee flexion?

Ely test

What test tests the tightness of the IT band and anything greater than 10 degrees is a negative test

Ober test

Normal ROM for Hip flexion of the SLR test is what>

68-80 degrees

What are the 4 joints of the shoulder complex

• Glenohumeral Joint
• Sternoclavicular Joint
• Acromioclavicular Joint
• Scapulo-thoracic Joint

What are the rotator coff mucles and where do they insert?

Supraspinatus- greater tubercle of the humerus

Infraspinatus- greater tubercle of the humerus

Teres Minor- greater tubercle of the humerus

Subscapularis- lesser tubercle of thee humerus

what is the main rols of the rotator cuff muscles?

provides dynamic stabilzation to the humeral head

What muscles function as a group to control the active arthrokinematics of the GHJ by stabilizing the head of the humerus within the glenoid fossa during abduction?

The rotator cuff

Describe the degrees of freedom at the Shoulder

flexion-0extensio n

abduction-adduction

internal-external rotation

In order to achieve 90 degrees of ABD there must be 60 degrees of GH motion and ____ degrees of Scapulothoracic motion

30

What should you stabilize when measuring shoulder motion

the scapula

CapsulaR Pattern for the GHJ of limited ROM is>

External rotation>abduction>internal rotation

Frozen shoulder

joint capsule of the GHJ is inflammed adhering to the joint structure, limitations will follow a capsular pattern

what are the 3 stages of frozen shoulder

Freezing, frozen, thawing

What stage of frozen shoulder presents as constant pain ( especially at night), and gradual loss of ROM in 2-9 months

freezing

what stage of frozen shoulder presents with stiffening of joint structures with continues loss of ROM (4-12 months)

frozen

What stage of frozen shoulder presents as restoration of motion and function (5-26 months)

Thawing

Describe the loss of ROM you would expect to find after 5-6 months of adhesive capsulitis? which motions are the most? which are the least?

Flexion limited to: 85-90

abduction limited to 85-90

ER limited to 50

which side is considered the "normal side" when the differences in ROM between R&L in the general population are noted?

dominant or nondominant

Non-Dominant

AS we age, elderly start to lose internal rotation at the shoulders? T or F?

True

Combing hair requires ___ degrees of flexion and ____-____ degrees of ERT at the shoulder

110

60-80

Toileting requires ___-___ degrees extension and ___ degrees IR at the shoulder

35-50

100

Feeding calls for ___-___ degrees of flexion and ___-___ of IR at the shoulder

35-85

20-60

Sternoclavicular joint

• medial clavicle with menubrium and 1st rib cartilage
• strong joint capsule
• reinforced by
  • anterior and posterior SC ligaments
  • costoclavicular ligaments
  • interclavicular ligament

Sternoclavicular Motion

• 3 degrees of freedom
• clavicle on the sternum
• elevation/depression
• protraction/retraction
• anterior/posterior

The sternal end of the clavical is convex/concave in cephalad-caudal direction and convex/concave in the anterior-posterior direction

convex

concave

Why are the capsule and ligaments so strong and thick at the SC joint with little motion?

it is the only attachment to the axial skeleton for the UE

Tibial femoral joint

femoral condyles on the tibia's condyles

reinforced by anterior and piosterior cruciate ligaments and the MCL and LCL

Patellofemoral joint

posterior patella and the femoral patellar surface

joint capsule

large, loose posterior

reinforced by ligaments, tendons, and muscles

Anterior Knee Stabilization

• Quadriceps Tendon
• Patellar Tendon
• Expansion from knee extensors
• ACL & PCL

What ligament is tested with the varus stress test?

LCL

What component of the Knee is tested with the Ober's test?

IT Band

What ligament of the knee is tested with the Valgus Stress Test *with pain?

Medial Collateral Ligament

what muscles share a common insertion at the knee at the Pes Anserine

Semitendonosis, Sartorius, and Gracilis insertion

What muscles posteriorly stabilize the knee?

The knee flexors

Which ligament of the Knee

• resists anterior translation of the tibia relative to a fixed femur (open chain)
• resists posterior translation of the femur relative to a fixed tibia (closed chain)
• resists varus and valgus deformations and excessive horizontal plane rotations

Anterior Cruciate ligament

Meiniscal Tear

MOI usually involves weight bearing during trauma (slip and fall) or external force

sx= joint line tenderness

this type of pain is caused by the patella not moving well in the intercondylar groove

Patellofemoral Pain

Bike

1/2 x BW or 100 lbs of compressive forces on the knee

The _________ ligament does the following:
• Limits eversion
• A triangular shaped ligament originating off of the medial malleolus.
• The ligament has 3 sets of fibers;
o tibionavicular
o tibiocalcaneal
o tibiotalar

Deltoid Ligament

The _________ ligament does the following:
• Limits inversion
• Consists of 3 different ligaments
o Anterior talofibular
o Calcaneofibular
o Posterior talofibular
o The most frequently injured ligament is the anterior talofibular ligament, typically as a result of excessive inversion and plantar flexion

LCL

name the ligaments of the ankle going clockwise

Anterior talofibular
Calcaneofibular
Posterior talofibular

What are the lateral ligaments of the ankle?

Anterior and posterior talofibular ligaments
Calcaneofibular ligaments

What are the medial ligaments of the ankle

Deltoid Ligaments

Anterior & Posterior Talotibial

Tibionavicular

tibiocalcaneal

the ___________ joint is Formed by the articulations between the convex head of the more proximal phalanx and the concave base of the more distal phalanx

interphalngeal

the __________ joint Formed by the articulation between the convex metatarsal head and the concave base of each corresponding phalanx

metatarsal-phalangeal

the _____________ joint is formed by the articulation between the distal surfaces of the 3 cuneiforms and the cuboid with the base of all 5 metatarsals

Tarsometatarsal joint

The _______ _______ joint Consists of 2 articulations, the talonavicular joint and calcaneocuboid joint

Transverse tarsal

Between the 3 inferior facets of the talus and the matching superior facets of the calcaneus describes which joint?

Subtalar

Trochlea of the talus articulates with the rigid concavity formed by the distal tibia and the fibula describes which joint?

Talocrural joint

Which ligament of the knee,

o Resists posterior translation of the tibia relative to a fixed femur (open chain)
o Resists anterior translation of the of the femur relative to a fixed tibia (closed chain)
o Resist extremes of knee flexion
o Resist valgus or varus deformations and excessive horizontal plane rotations

Mech of injury
-Hyperflexion
-Dashboard injuries
-Sever hyperextension
-Large valgus or varus producing force with a planted foot
-Any of t

PCL

Which ligament of the knee,
Resist valgus deformation of the knee
Resist excessive knee extension

Injury caused by;
Valgus producing force with foot planted
-Sever hyperextension

MCL

Which ligament of the knee,

Resist varus deformation of the knee
Resist excessive knee extension

Injury caused by;
Varus producing force with foot planted
-Sever ehyperextension

LCL

Donning socks: ___- ___ degrees of knee flexion

115-120

Sit to stand: _____ - ______ degrees of knee flexion

90-95

Descending stairs: ____ - ______ degrees of knee flexion

85-100

Ascending stairs: _____ - _____ degrees of knee flexion

85-100

Walking on level surfaces: Requires ____ - ____ degrees of knee flexion

60-65

Obesity is often associated with loss of knee ROM and pain

As much as _____ degree of loss of flexion for each unit of increase to BMI

1

standing = _____ BW at the knee?

1xBW

Squatting =~ ___ x BW or 1400 lbs of compressive force on the knee

7

Stair Descend ___ x BW 0r 1000 lbs of compressive force on the knee

5

Stair Ascend= ___ x BW or 660lbs

3.3

Bike = ____ x BW or 100 lbs of compressive force on the knee

1/2

this type of knee pain is caused by the patella not moving well in the intercondyler groove

Patellofemoral Pain

MOI usually weight bearing during trauma i.e. slip and fall, or external force

sx = Joint Line Tenderness

meniscal tear

Which ligament of the knee,

o Resists anterior translation of the tibia relative to a fixed femur (open chain)
o Resists posterior translation of the femur relative to a fixed tibia (closed chain)
o Resist valgus and varus deformations and excessive horizontal plane rotations

Mech of injury
Hyper extension

Large valgus or varus producing force with a planted foot

Either of the above combined with torsion

ACL

function of the meniscus

to absorb compressive forces across the knee caused by muscular contraction and body weight

When the knee is flexed at 120 degrees and the patella is liding distally, where on the patella is the femur making contact

on the posterior superior aspect

- palpable bony projections on the medial and lateral femoral condyles. Respectively these serve as the attachments for the MCL and LCL

medial and lateral epicondyles

the large rounded projections of the distal femur that articulate with the medial and lateral condyles of the tibia

medial and lateral condyles

Which ligament of the knee,

o Resists posterior translation of the tibia relative to a fixed femur (open chain)
o Resists anterior translation of the of the femur relative to a fixed tibia (closed chain)
o Resist extremes of knee flexion
o Resist valgus or varus deformations and excessive horizontal plane rotations

Mech of injury
-Hyperflexion
-Dashboard injuries
-Sever hyperextension
-Large valgus or varus producing force with a planted foot
-Any of the above combined with torsion

PCL

- the smooth rounded area between the femoral condyles that articulates with the posterior surface of the patella.

• Intercondylar groove

Compared to the 2 non-weight-bearing exercises, the squat exercise produced significantly higher PFJ stress at ____, _____, and ____ of knee flexion.

90°, 75°, and 60°

as you extend the knee, patellar femoral joint compression increase during which type of movement

OKC

greater compression of the patellar femoral joint during knee flexion on decent ( increased flexion= increase pressure) occurs during which type of movement?

CKC

What are the osteokinematic motions of the tibiofemoral (KNEE) joint?

• 2° of freedom;
-flexion/extension
-internal/external rotation

Describe the vascularity of the meniscus

Inner one third = Essentially avascular

Middle third = Poor blood supply

Outer third = Good blood supply

_____________ ______ __________ ____________ are crescent shaped fibro cartilaginous discs located at the top of the medial and lateral condyles of the tibia.

• medial and lateral menisci

-Improve overall congruency of the tibiofemoral joint
-Dissipate compression and shear forces across the knee

Injury caused by

Extreme valgus or varus producing forces at the knee
Extreme rotations of the knee especially under large compression forces

Medial and lateral menisci

-Resist excessive knee extension

Injury caused by severe hyper extension

Posterior Capsule

Which ligament of the knee,

Resist varus deformation of the knee
Resist excessive knee extension

Injury caused by;
Varus producing force with foot planted
-Sever hyperextension

LCL

Which ligament of the knee,
Resist valgus deformation of the knee
Resist excessive knee extension

Injury caused by;
Valgus producing force

MCL

Conversely, the 2 non-weight-bearing exercises produced significantly higher PFJ stress at ____, _____, and _____ of knee flexion when compared to the squat exercise

30°, 15°, and 0°

Which ligament of the knee,

o Resists anterior translation of the tibia relative to a fixed femur (open chain)
o Resists posterior translation of the femur relative to a fixed tibia (closed chain)
o Resist valgus and varus deformations and excessive horizontal plane rotations

Mech of injury
Hyper extension

Large valgus or varus producing force with a planted foot

Either of the above combined with torsion

ACL

• While a lateral angle greater than 175° is called genu varum or the term genu ____________ is to say that the shaft of the tibia is positioned (tilts) medially towards midline, making the knees bow apart

Varum

A lateral angle of less than 175° is called excessive genu____________. Or to say that the shaft of the tibia is positioned (tilts) laterally away from midline, making the knees knock together.

Valgum

• During normal patellar femoral joint motion the Patella glides _____________ as knee is extended

Proximally

• During normal patellar femoral joint motion the Patella glides___________ as the knee is flexed

Distally

• Function of the patellar

o Act as a transmitter of quadriceps force across the knee
o Enhancing the leverage (internal moment arm) of the quad muscle

-protrusion of bone located on the anterior aspect of the proximal tibia, serves as an attachment for the quad muscle.

Tibial tuberosity

• Intercondylar eminence

-dbl pointed projection of bone separating the medial and lateral condyles of the tibia. Serves as an attachment for the ACL and PCL

smooth and shallow for articulation with the condyles of the femur

• Medial and lateral condyles of the tibia-

Intercondylar Notch

- located on the posterior/inferior aspect of the distal femur separating the medial and lateral condyles

Proximal joint surface of the hip is the ?

acetabulum

Distal joint surface of the hip is the _______ ________

femoral head

Axis of motion of the hip joint is the is the ______ _______

femoral head

the hip joint is enclosed anteriorly by __________ and the _________ ligaments

iliofemoral (Y Ligament) & pubofemoral

the hip is Enclosed posteriorly by __________ ligaments

ischiofemoral

capsular pattern of the hip follows what motions?

Restricted:
*Medial/Internal rotation
Limited:
*Flexion
*Abduction

what are the 3 degrees of freedom at the hip?

flexion/extension
add/abduction
int/external rotation

Can occur anywhere in the labrum but __________ / _______ most common tear

anterior/superior

a labral tear can be Accompanied by clicking, slipping
Often due to repetitive twisting, cutting, and pivoting movements in addition to repetitive ______ at the hip

flexion

a labral tear can be associated with Pain with Flexion/Adduction and with axial loading
Often associated with _____ __________

hip impingement

avascular necrosis

Painful weightbearing
Restricted motion typically due to pain
Due to impaired blood supply from the lateral circumflex branches off the femoral artery
Often results in need for THR

Slipped Capital Femoral Epiphysis(SCFE)

Lower Extremity held in lateral/external rotation
Limb is shorter
Pain
Sometimes in knee
Decreased medial/internal rotation and flexion

antiversion/retroversion

Torsional Rotations of the femoral neck or the acetabulum

Extreme amounts of IR vs. ER

Extreme amounts of ER vs. IR