Goniometry.ppt uche

GONIOMETRY
By
CHUKWUEMEKA UCHE MARTHA
9/15/2015
1

OUTLINE
 What is goniometry ?
 Importance of goniometry
 Types of goniometer
 Universal Goniometer
 Range of Motion
 Planes and Axes of joint motion
 Important Notes
 Procedures for Goniometric measurement
 ROM measurement
 Current Trends
 References
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WHAT IS GONIOMETRY
 Goniometry is the measuring of angles created by
the bones of the body at the joints.1, 2, 3
 The term goniometry is derived from two Greek
words, gonia meaning angle and metron, meaning
measure. 1, 2, 3, 4, 5,
 System to measure the joint ranges in each plane
of the joint is termed goniometry. 4
 These measurements are done with instrument
such as goniometer, a tape measure,
inclinometers or by visual estimate. 1, 2, 3, 4, 5
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IMPORTANCE OF GONIOMETRY
 Goniometry is useful in determining
 the presence of dysfunction
 establishing a diagnosis
 developing goals
 evaluating progress,
 fabricating orthoses
 a measurement for research purposes 4, 5, 6
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TYPES OF GONIOMETERS
 Universal goniometer
 Gravity goniometer/
inclinometer
 Electro goniometer
sensor with angle meter
Single and twin axis
goniometer
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 Bubble goniometer
 Smartphone soft wares
 Digital goniometer
 Arthroidal protractor
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UNIVERSAL GONIOMETER
 A universal goniometer may be constructed of metal
or plastic and it has three parts
 A body
 Fulcrum
 Stationary arms
 Moving arms
The body of the goniometer is designed like a
protractor and may form a full or half circle; and on
it is a scale from 0 to 180 or 360 1, 2, 3
The fulcrum is a rivet or screw-like device at the
center of the body that allows the moving arm to
move freely on the body of the device.1, 2, 3, 4, 5 6,
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UNIVERSAL GONIOMETER
The fulcrum and body is placed over the joint being
measured 3, 4, 5, 6, 7, 8
The stationary arm will be aligned with the inactive
part of the joint measured while the moving arm is
placed on the part of the limb which is moved in
the joint’s motion1, 2, 3, 4, 5, 6, 7.
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RANGE OF MOTION
 Range of motion can be defined as the amount
of motion available at a joint. 5
 Each specific joint has a normal range of motion
that is expressed in degrees. 1
 Joint ranges are divided into
 Active range of motion AROM
 Passive range of motion PROM
 The structure involved with movement of the
bones as well as the bony arrangements are
factors in limiting motion. 1, 2, 3,4.
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RANGE OF MOTION
 Determinants of joint ROM
 Normal
 Age
 Gender
 Others such as ADL, right vs left, body physique,
active vs passive ROM
 Abnormal
 Tight soft tissues around the joint
 Muscle insufficiency
 Adhesion
 Foreign body
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RANGE OF MOTION
 The end-feel is the feeling which is experienced
by the examiner as a barrier to further motion at
the end of a PROM.
 These normal end-feels have been described as
soft, firm, and hard. The same terms are used to
describe abnormal end-feels with the addition of
"empty". 1, 2, 3
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RANGE OF MOTION
Contraindications to ROM testing:
 Dislocation or unhealed fracture in the region,
 immediately following surgery,
 On medication for pain or muscle relaxants (careful)
 Regions of osteoporosis or bone fragility,
 Patients with hemophilia,
 Immediately after an injury where disruption of tissue is
present.
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PLANES AND AXES OF JOINT MOTION
 Motion at a joint occurs as a result of movement of
one joint surface in relation to another. 1
 Arthrokinematics is the term used to refer to the
movement of joint surfaces. The movements at
the joint surfaces are described as slides (glides),
spins, and rolls. These three usually occur in
combination with each other and result in
movement of the shafts of the bones. 1, 2, 3, 4, 5, 9,
 Osteokinematics refers to the movement of the
shafts of the bones. These are usually described
in terms of rotary movement about an axis of
motion. 1, 2, 3
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PLANES AND AXES OF JOINT MOTION
 Goniometry measures the angles created by the
rotary motion of the shafts of the bones.1, 2, 3, 4
 Osteokinematic motions are classically described
as taking place in one of the three cardinal planes
of the body (sagittal, frontal, and transverse)
around three corresponding axes (medial-lateral,
anterior-posterior, and vertical).
 The three planes lie at right angles to one another
whereas the three axes are both at right angles to
the corresponding plane and to each other.1, 2, 3, 4
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PLANES AND AXES OF MOVEMENT
ANATOMICAL POSITION
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VALIDITY AND RELIABILITY OF GONIOMETER
 According to the American Academy of Orthopeadic
Surgeons, Kendall and McCreary, Hoppenfeld, and the
American Medical Association. 1, 2, 3, 4, 5, 6, 7
 Content validity – it is assumed that the angle created
by aligning the arms of the goniometer with bony
landmarks truly represents the angle. “The accurate
application of knowledge and skills, combined with
interpreting the results as measurement of range of
motion only, provide sufficient evidence to ensure
content validity.”
 Reliability – overall good to excellent reliability. Higher
reliability has been found for measurements of joint
position compared to range of motion.
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VALIDITY AND RELIABILITY OF GONIOMETER
 Reliability varies depending on the joint being measured.
Intratester reliability is found to be higher than intertester
reliability
 Advantages
• Good reliability and validity.
• Ease of use.
• Inexpensive.
•Can be used to establish presence or absence of dysfunction and also
monitor progress
 Limitations
• Reliability dependent on examiner experience.
• Reliability varies depending on what joint is measured.
• Requires consistency in positioning, stabilization, and alignment.
• Some disagreement between sources for normal values of range of
motion.
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IMPORTANT NOTES
 The starting position for measuring all ROM is the
anatomical position except for rotation in
transverse plane.
 Be aware of the position the body is supposed to
be in for movement and any stabilization issues.
 Stabilize the part of the body that is proximal
(stationary portion) to the joint you are testing.
 The patient do not move his body while the
moving the joint; this step isolates the joint
movement for a more accurate measurement.
 There are three notation of goniometric
measurement which are 0-180º, 180-0º and 0-
360º.
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IMPORTANT NOTES
 Zero degrees is the neutral starting position
 Consistently use the same stationary and movable
landmarks on the body when measuring, to
ensure consistency.
 The angle of movement from the stationary arm to
the moving arm is read off the body and reported
as the ROM.
 Look at the reading on the goniometer at eye level
before removing it from the patient’s body.
 Be sure to record the ROM of the joint
 Compare reading with contralateral side
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PROCEDURE FOR GONIOMETRIC MEASUREMENT
 The patient is positioned in the recommended testing
position.
 While stabilizing the proximal joint component, the
clinician gently moves the distal joint component through
the available range of motion until the end feel is
determined.
 An estimate is made of the available range of motion and
the distal joint component is returned to the starting
position.
 The clinician palpates the relevant bony landmarks and
aligns the goniometer.
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PROCEDURE FOR GONIOMETRIC MEASUREMENT
 A record is made of the starting measurement.
 The goniometer is then removed and the patient
moves the joint through the available range of
motion.
 Once the joint has been moved through the
available range of motion, the goniometer is
replaced and realigned, and a measurement is read
and recorded.
 Repeat measurement three times and record the
average as the goniometric value for the joint’s
ROM
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ROM MEASUREMENT
 Shoulder ROM
Flexion:
 Motion: 0-180º
 Position: Subject supine with
knees flexed or sitting. elbow
extended with the palm facing the
body
 Goniometer: Axis at the
acromion process, laterally through
the head of the humerus.
 Stationary arm is placed along the
mid-axillary line of the trunk
 Moving arm place along the lateral
mid-line of the humerus in line with
the lateral epicondyle.
Extension:
 Motion: 0-45º~60º from
neutral position
 Position: Subject prone or sitting ,
elbow in slight flexion with the
palm facing the body.
 Goniometer: Axis at the acromion
process, laterally through the head of
the humerus
 Stationary Arm aligned with mid-
axillary line of the trunk
 Moving arm along the lateral mid-line
of humerus in line with lateral
epicondyle.
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Abduction:
 Motion:0-180º
 Position: Supine, prone or
sitting with the limb in
anatomic position
 Goniometer: Axis at anterior
portion of acromion process.
 Stationary arm at lateral aspect of
anterior surface of chest parallel to
midline of sternum.
 Moving arm on anterior aspect of
arm parallel to midline of humerus
and in line with medial epicondyle.
OR
Goniometer: Axis at the posterior
portion of the acromion process;
Stationary arm aligned parallel to spinous
process of the vertebral colomn
Moving arm aligned with the midline of
the humerus in line with lateral
epicondyle
Adduction:
Motion: 0-30º
Aligment of goniometer is
same for abduction.
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External rotation:
 Motion: 0-90º
 Position: Supine. Shoulder is
abducted to 90º. Elbow flexed
with forearm in neutral and
perpendicular to table top such
that the palm is facing the feet.
Elbow not supported. Humerus
is fully supported on the table.
Stabilize the distal humerus,
thorax, and scapula.
 Goniometer: Axis at olecranon
process of the ulna.
 Stationary arm placed parallel to the
table top or perpendicular to the
floor.
 Moving arm along the ulnar shaft
aligned with the styloid process of
the ulna.
Internal rotation:
 Motion: 0-65~90º
 Positioning and goniometer
alignment is same as in
external rotation
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 Radio-ulnar ROM
Supination:
 Motion: 0- 80º~ 90º
 Position: Subject sitting or
supine, with the elbow flexed
to 90º. Shoulder in zero
degrees of its’ ROM. Position
starts midway between
Supination and Pronation.
 Goniometer: Axis is medial to
the ulnar styloid process.
 Stationary arm is aligned parallel
to the anterior midline of the
humerus.
 Moving arm across the ventral
aspect of the wrist on a line
between and proximal to the
styloid process of the radius and
the ulna.
Pronation:
 Motion: 0- 80º~ 90º
 Position: same for supination
 Goniometer: Axis is lateral
to the ulnar styloid process.
 Stationary arm is aligned parallel to the
anterior midline of the humerus.
 Moving arm across the dorsum of the
wrist on a line between and proximal to
the styloid process of the radius and
the ulna.
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 Wrist ROM
Flexion:
 Motion: 0-60º~80º
 Position: Subject sitting,
shoulder in 90º of abduction;
elbow flexed to 90º. The forearm
placed in between supination
and pronation such that the
palm of the hand parallels the
floor.
 Goniometer: Axis is distal to the
ulnar styloid process or over the
lateral aspect of the wrist over the
triquetrum
 Stationary arm parallel to and over
the lateral midline of the ulna, in line
with the olecranon.
 Moving arm along the lateral
midline of the 5th MC.
Extension:
 Position and goniometer: same
for flexion
Ulnar deviation:
Radial deviation:
 Motion: 0-20º
 Position: same for wrist flexion
 Goniometer: Axis is at the middle of
the dorsal aspect of the wrist over the
capitate.
 Stationary arm midline on the dorsal
surface of the forearm in line with the
lateral epicondyle of the humerus.
 Moving arm along midline of the dorsal
surface of the 3rd MC.
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 Hip ROM
Flexion:
 Motion: 0-100º~125º
 Position: Supine or side lying
on the opposite limb to be
measured; limb in anatomical
position with knee flexed at the
end of the motion.
 Goniometer: Place the axis at
the lateral aspect of the hip joint
over the greater trochanter.
 stationary arm is parallel to the long
axis of the trunk in line with the
greater trochanter or the lateral
midline of the pelvis
 moving arm is placed along the
lateral midline of the femur in line
with lateral epicondyle of the femur
Extension:
 Position: Prone or Side lying on
the opposite limb to measured; the
limb in anatomical position
 Goniometer alignment is the
same for hip flexion.
*Stabilise the pelvis when
measuring hip flexion and
extension.
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Abduction:
 Motion: 0 - 40º~50º
 Position: Supine with the limb
in anatomical position (0º of all
limb joints ROM)
 Goniometer: axis at the anterior
superior iliac spine(ASIS) of the
measured limb.
 Stationary arm is at an imaginary
horizontal line extending from one
ASIS to the other.
 Moving arm is with the anterior
midline of the femur, in line with the
midline of the patella.
Adduction:
 Position: Supine, with opposite
limb abducted
 Goniometer alignment is
same as for hip abduction
*Stabilise the pelvis
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External Rotation:
 Position: Supine, with knees
extended over the table OR
Prone with knee flexed OR
High sitting with 90º flexion of
hip and knee, 0º of hip
abduction and adduction
 Goniometer: axis over the
anterior mid patella
 Stationary arm is parallel to the
supporting surface or the floor
 Moving arm is placed along the
anterior surface of the tibia
midway between the malleoli.
Internal Rotation:
alignment is same as in hip
external rotation
*Stabilise the femur pelvis
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 Knee ROM
Flexion:
 Motion: 0-135º~150º
 Position: Supine, knees in
extension with hip flexed to
90o at end of the motion OR
prone lying with knee
extended foot over the edge
of the supporting surface.
 Goniometer: Axis is placed
over the lateral epicondyle of the
femur
 Stationary arm is parallel to the
lateral midline of the femur in line
with the greater trochanter
 Moving arm is placed lateral at
the midline of the fibula in line
with the lateral malleolus.
Extension:
 Motion: note any
hyperextension
alignment is same with knee
flexion.
 Extension is an opposite
motion to flexion
*The thigh should be stabilized
in flexion motion
measurement
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 Ankle ROM
Dorsiflexion:
 Motion:0-20º
 Position: Subject was sitting
with legs off the table or on
high sitting with lower leg at
right angle to the thigh and the
foot at right angle to the lower
leg as the zero starting
position.
 Goniometer: fulcrum was aligned
slightly inferior to the lateral
malleolus.
 Stationary arm is with the midline
of the lateral aspect of the lower
leg, in line with the head of fibula.
 Moving arm was parallel to the 5th
metatarsal.
Plantarflexion:
 Motion:0-40º~50º
alignment is same with
dorsiflexion
Inversion:
 Position: same with dorsiflexion
 Goniometer: axis is midway
between the two malleoli at the
anterior aspect of the ankle
 Stationary arm is with the anterior
midline of tibia in line with the tibial
tuberosity
 Moving arm is with the anterior
midline of the 2nd metatarsal.
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 Eversion:
 positioning and goniometer
alignment is same as for
inversion
 Subtalar ROM
Inversion:
 Motion:0-5º
 Position: prone lying with hip and
knee in 0º of all their joints’ ROM, foot
is off the supporting surface such that
the toes are point downwards
 Goniometer: axis is over the posterior
aspect of the ankle midway between the
two malleoli.
 Stationary arm is with posterior midline of
the leg
 Moving arm is with posterior midline of the
calcaneus.
Eversion:
 Motion:0-5º
 Positioning and goniometer alignment
is same as for inversion.
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 Cervical ROM
Flexion:
 Motion:0-45º
 Position: sitting with head
and neck in anatomical
position, lumbar and thoracic
region supported on back rest
 Goniometer: axis on the
external auditory meatus
 Stationary arm is perpendicular to
the floor in line with head
 Moving arm is with the base of the
nares
 Extension:
 Motion:0-45º
alignment is same as flexion
Lateral flexion:
 Motion:0-45º
 Position: same as flexion
 goniometer: axis is on the spinous
process of the 7th cervical vertebra
 Stationary arm is with the spinous
processes of the thoracic vertebrae
perpendicular to the floor
 Moving arm is with the posterior
midline of the head in line with occipital
protuberance
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Rotation:
 Position: same as for flexion
centre of the cranial aspect of the
head
 Stationary arm in line with an
imaginary line between the two
acromial processes
 Moving arm is with the tip of the
nose
 Lumbar ROM
Flexion:
 Motion: 4inches
 Position: standing and in
anatomical position
 Tape Measure: Placed proximately
at the C7 spinous process and distally at
S1; calculate the difference between
standing and flexion ending position.
Extension:
 Motion:2inches
 Position: same with flexion
 Tape Measure: Placed proximately
at the C7 spinous process and distally at
S1; calculate the difference between
standing and extension ending position.
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Lateral flexion:
spinous process of 1st sacral
vertebra
 Stationary arm is
perpendicular to the floor
 Moving arm is in line with the
spinous process of the of the
7th cervical vertebra
 Tape Measure: Placed
proximally at the finger tips
and distally at the lateral
malleolus; calculate the
difference between sides when
standing and with side
bending.
Rotation:
 Goniometer: axis at the centre of
the cranial aspect of the head
 Stationary arm is parallel with the
imaginary line between the two
prominent tubercles on the iliac crest.
 Moving arm is with an imaginary line
between the two acromial processes
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CURRENT TRENDS
 The use of inclinometer software to measure ROM in a
joint. In a study by Brian et al, (2013), it was inferred that
Smart phones have good correlation with the “gold
standard” goniometer for measuring shoulder range of
motion. Additionally, there is good correlation amongst
different levels of providers with measurements obtained
using the smart phone
 Drgoniometer 12
 The use of sensor and goniometer probe setup to measure
joint ROM. It usually convenient for large joints
 It is designed as a sensor pad connected to a
potentiometer or a probe connected to a sensor angle
meter 7, 8
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Example of goniometric measurement
using DrGoniometer as it appears on the
smartphone screen
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CONCLUSION
 Goniometric measurement is an important skill all
physiotherapist must have as it employed in almost all
area of physiotherapy practice.
 There are different instrument for measurement of joint’s
range of motion but the universal goniometre remains the
gold standard due to it’s excellent validity and reliability in
most articles. It also has advantages such as ease of use,
inexpensive, easily available and accuracy.
 Though some other instrument are as reliable and valid as
the universal goniometer but the cost of purchase,
availability and ease of use may not be met.
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REFERNCES
1. Norkin, C.C. & White, D.C. (1988) Techniques and procedures, in Measurement of joint motion:
A guide to goniometry. In Norkin & White, Eds. FA Davis: Philadelphia. p. 9-24.
2. Norkin, & White.(1995) Measurement of Joint Motion: A Guide to Goniometry. 2nd ed.
Philadelphia, PA: F.A. Davis Company.
3. Norkin, & White.(2003) Measurement of Joint Motion: A Guide to Goniometry. 3rd ed.
Philadelphia, PA: F.A. Davis Company;.
4. The British Orthopaedic Association (1983) Joint motion: method of measuring and recording. In
Heck, C.V., Hendryson, I.E., Rowe, C.R. (eds). Edinburg: Churchill Livingstone.
5. Gadjosik, & Bohannon(1987) Clinical measurement of range of motion: review of goniometry
emphasizing reliability and validity. Physical Therapy; 67: 1867-1872.
6. Gogia, Braatz, Rose, & Norton.(1987) Reliability and validity of goniometric measurements at the
knee. Physical Therapy; 67: 192-195.
7. Nadeau, Kovacs, Gravel, Piotte, Moffet, Gagnon, & Hebert.(2007) Active movement
measurements of the shoulder girdle in healthy subjects with goniometer and tape measure
techniques: A study on reliability and validity. Physiotherapy Theory and Practice.; 23: 179-187.
8. Brian, C.W., Chris, M.K., Justin, W.G., Matthew, L.L., Joseph, M.H., & Stephen F.B.(2013)
Shoulder Range of Motion: Validation of an Innovative Measurement Method Using a
Smartphone The Orthopaedic Journal of Sports Medicine, 1(4)(suppl 1)
9. MacDermid, et al.(1999) Range of motion measurement. Journal of Hand Therapy; 12:187-192.
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REFERNCES
10. Rasmussen, O.(1985) Stability of the ankle joint. Acta Orthop. Scandinavica; Suppl.
211: p. 56-78.
11. Seto, J.L. & Brewster,C.E.(1985) Treatment approaches following foot and ankle injury.
Clinical Sports Medicine; 13: p. 295
12. Ferriero,G., Sartorio, F., Foti,C., Primavera,D., Brigatti, E.& Vercelli, S. (2012)
Reliability of a New Application for Smartphones (DrGoniometer) for Elbow Angle
Measurement. The American Academy of Physical Medicine and Rehabilitation; Vol.
3:1153-1154
9/15/2015
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Goniometry.ppt uche

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