1. Chapter 1 Introduction to Goniometry
1.1. Comprehensive examination
1.1.1. Interview and review of records
1.1.1.1. Current symptoms
1.1.1.2. Functional activities
1.1.1.3. Activities
1.1.1.3.1. Occupational
1.1.1.3.2. Social
1.1.1.3.3. Recreational
1.1.2. Observation of the body
1.1.2.1. Bone contour
1.1.2.2. Soft tissue contour
1.1.2.3. Skin/nail condition
1.1.3. Gentle palpation
1.1.3.1. Skin temperature
1.1.3.2. Quality of soft tissue deformities
1.1.3.3. Pain symptoms
1.1.3.3.1. Match to anatomical structures
1.1.4. Anthropometric measurements
1.1.4.1. Leg length
1.1.4.2. Circumference
1.1.4.3. Body volume
1.1.5. Goniometry
1.1.5.1. Term is derived from:
1.1.5.1.1. "gonia" (angle)
1.1.5.1.2. "metron" (measure)
1.1.5.2. Can be used to determine:
1.1.5.2.1. Joint position
1.1.5.2.2. ROM
1.1.5.3. Used in conjunction with:
1.1.5.3.1. Resisted isometric muscle contractions
1.1.5.3.2. Joint integrity tests
1.1.5.3.3. Mobility tests
1.1.5.3.4. Special tests
1.1.5.3.5. Often included:
1.1.5.4. Goniometric data used in conjunction with other information can provide a basis for the following:
1.1.5.4.1. Determining the presence or absence of impairment
1.1.5.4.2. Establishing a diagnosis
1.1.5.4.3. Developing a prognosis, treatment goals, and plan of care
1.1.5.4.4. Evaluating progress or lack of progress toward rehabilitative goals
1.1.5.4.5. Modifying treatment
1.1.5.4.6. Motivating the subject
1.1.5.4.7. Researching the effectiveness of therapeutic techniques or regimens
1.1.5.4.8. Fabricating orthoses and adaptive equipment
1.1.5.5. Active joint motion
1.1.5.5.1. Enables the examiner to
1.1.5.5.2. If abnormal active motions are found...
1.1.5.6. Passive joint motion
1.1.5.6.1. Enables examiner to
1.2. Arthrokinematics
1.2.1. Movement of joint surfaces
1.2.2. Types of joint surface movement:
1.2.2.1. Slide (Glide)
1.2.2.2. Spin
1.2.2.3. Roll
1.2.3. Convex on concave
1.2.3.1. Roll and slide opposite
1.2.4. Concave on convex
1.2.4.1. Roll and slide same
1.2.5. Examined for:
1.2.5.1. ROM
1.2.5.1.1. Joint play, or accessory movements
1.2.5.1.2. Very small
1.2.5.1.3. Can't be measured with a goniometer or standard ruler
1.2.5.1.4. Instead, are objectively compared to:
1.2.5.2. End feel
1.2.5.2.1. Tissue resistance at the end of the motion
1.2.5.2.2. Types
1.2.5.3. Effect on patient's symptoms
1.3. Osteokinematics
1.3.1. Gross movement of bone shafts
1.3.2. Described in terms of angular motion
1.3.2.1. Measured with goniometry
1.3.2.2. Doesn't take into account translatory shifting of the axis during movement
1.3.2.3. Most clinicians find it to be sufficiently accurate
1.4. Cardinal planes and corresponding axes
1.4.1. Sagittal
1.4.1.1. Medial-lateral
1.4.2. Frontal
1.4.2.1. Anterior-posterior
1.4.3. Transverse
1.4.3.1. Vertical
1.5. ROM
1.5.1. Test prior to MMT
1.5.2. Starting positions
1.5.2.1. Anatomical position, except for rotations in the transverse plane
1.5.3. Notations systems
1.5.3.1. 0-180
1.5.3.1.1. Neutral zero method
1.5.3.1.2. Flexion/Extension
1.5.3.1.3. Rotation
1.5.3.2. 180-0
1.5.3.2.1. Flexion/Extension
1.5.3.3. 360
1.5.3.3.1. Anatomical is 180
1.5.3.3.2. Flexion/Abduction
1.5.3.3.3. Extension/Adduction
1.5.4. Active
1.5.4.1. Unassisted and voluntary
1.5.4.2. Provides information about:
1.5.4.2.1. Subject's willingness to move
1.5.4.2.2. Coordination
1.5.4.2.3. Muscle strength
1.5.4.3. If pain occurs...
1.5.4.3.1. It may be due to stretching of contractile tissues
1.5.4.3.2. It may be due to stretching or pinching of noncontractile tissues
1.5.4.3.3. Further testing should be included
1.5.5. Passive
1.5.5.1. Examiner provides force for movement
1.5.5.2. Provides information about:
1.5.5.2.1. Integrity of the joint surfaces
1.5.5.2.2. Extensibility of
1.5.5.3. Greater than active normally
1.5.5.3.1. Each joint has a small amount of available motion that is not under voluntary control
1.5.5.3.2. Stretch of tissues surrounding the joint
1.5.5.3.3. Reduced bulk of relaxed muscles
1.5.5.4. If pain occurs...
1.5.5.4.1. During:
1.5.5.4.2. At the end of ROM:
1.5.6. To differentiate between contractile and non contractile structures...
1.5.6.1. Contractile structures:
1.5.6.1.1. Isometric contraction mid-range
1.5.6.2. Non-contractile structures:
1.5.6.2.1. Joint play
1.5.6.2.2. Joint integrity tests
1.5.7. Factors affecting ROM
1.5.7.1. Intrinsic
1.5.7.1.1. Age
1.5.7.1.2. Gender
1.5.7.2. Meditated
1.5.7.2.1. BMI
1.5.7.2.2. Occupational activities
1.5.7.2.3. Recreational activities
1.5.7.3. Process
1.5.7.3.1. Active or passive?
1.5.7.3.2. Testing position
1.5.7.3.3. Instrument employed
1.5.7.3.4. Experience of examiner
1.5.7.3.5. Time of day
1.6. Hypomobility
1.6.1. Significant decrease in PROM
1.6.2. End-feel occurs early and may be different in quality
1.6.3. May be due to:
1.6.3.1. Abnormalities of joint surfaces
1.6.3.2. Passive shortening/inflammation of:
1.6.3.2.1. Joint capsules
1.6.3.2.2. Ligaments
1.6.3.2.3. Muscles
1.6.3.2.4. Fascia
1.6.3.2.5. Skin
1.6.3.3. Orthopedic conditions
1.6.3.3.1. Osteoarthritis
1.6.3.3.2. Rheumatoid arthritis
1.6.3.3.3. Adhesive capsulitis
1.6.3.3.4. Spinal disorders
1.6.3.4. Prolonged immobilization
1.6.3.5. Burn scars
1.6.3.6. Neurological conditions
1.6.3.6.1. Stroke
1.6.3.6.2. Head trauma
1.6.3.6.3. Cerebral palsy
1.6.3.6.4. Complex regional pain syndrome
1.6.3.7. Metabolic conditions
1.6.3.7.1. Diabetes
1.6.4. Capsular pattern
1.6.4.1. Pattern of restriction caused by pathological condition involving a whole joint capsule
1.6.4.2. Pattern not based on degrees, but rather proportion between different movements
1.6.4.3. Usually involve all motions
1.6.4.4. Two main categories
1.6.4.4.1. Conditions in which there is considerable joint effusion or synovial inflammation
1.6.4.4.2. Conditions in which there is relative capsular fibrosis
1.6.4.5. Examples (extremity joints)
1.6.4.5.1. Glenohumeral joint
1.6.4.5.2. Elbow complex
1.6.4.5.3. Forearm
1.6.4.5.4. Wrist
1.6.4.5.5. Hand
1.6.4.5.6. Hip
1.6.4.5.7. Knee
1.6.4.5.8. Ankle
1.6.4.5.9. Foot
1.6.5. Noncapsular pattern
1.6.5.1. Usually involves structures other than the capsule
1.6.5.2. Usually involve one or two motions
1.6.5.3. Causes:
1.6.5.3.1. Internal joint derangement
1.6.5.3.2. Adhesion of a part of a joint capsule
1.6.5.3.3. Ligament shortening
1.6.5.3.4. Muscle strains
1.6.5.3.5. Muscle contractures
1.7. Hypermobility
1.7.1. Significant increase in PROM
1.7.2. Due to:
1.7.2.1. Laxity of soft tissue structures
1.7.2.1.1. Trauma
1.7.2.1.2. Hereditary disorders
1.7.2.1.3. Rheumatic diseases
1.7.2.1.4. Osteogenesis imperfecta
1.7.2.1.5. Down syndrome
1.7.2.2. Abnormalities of the joint surfaces
1.7.2.3. HMS (BJHS)
1.7.2.3.1. Hypermobility syndrome (benign joint hypermobility syndrome)
1.7.3. Click for Beighton Hypermobility Score:
1.8. Muscle length testing
1.8.1. Maximal muscle length
1.8.1.1. Greatest extensibility of a muscle-tendon unit
1.8.1.2. Maximal distance between the proximal and the distal attachments of a muscle to bone
1.8.1.3. Measured indirectly
1.8.1.3.1. By determining the maximal passive ROM of the joint crossed by the muscle
1.8.1.3.2. By number of joints crossed
1.8.2. S&S for muscle shortness
1.8.2.1. Decreased ROM opposite to muscle's action
1.8.2.2. Firm end-feel
1.8.2.3. Palpation of tension within the muscle-tendon unit
1.8.2.4. Patient complains of pain in the region of the tight muscle and tendon
2. Chapter 2 Procedures
2.1. Examiner must have knowledge of and be able to perform the following:
2.1.1. Joint structure and function
2.1.2. ROM
2.1.2.1. Determine end of ROM
2.1.2.2. Appropriate end-feels
2.1.3. Testing positions
2.1.3.1. Movements of other joints can alter measurement
2.1.3.2. Consistency is key
2.1.3.3. Positions of the body recommended for obtaining goniometric measurements
2.1.3.3.1. Shoulder
2.1.3.3.2. Elbow
2.1.3.3.3. Forearm
2.1.3.3.4. Wrist and hand
2.1.3.3.5. Hip
2.1.3.3.6. Knee
2.1.3.3.7. Ankle, foot, and toes
2.1.3.3.8. Cervical spine
2.1.3.3.9. Thoracolumbar spine
2.1.3.3.10. Temporomandibular joint
2.1.3.4. If testing position can not be attained
2.1.3.4.1. Examiner must be creative
2.1.3.4.2. Alternative position must fit the 3 criteria
2.1.3.4.3. Must be described precisely to ensure consistency
2.1.3.5. 3 criteria for testing positions
2.1.3.5.1. Place the joint in a starting position of 0 degrees
2.1.3.5.2. Permit a complete ROM
2.1.3.5.3. Provide stabilization for the proximal joint segment
2.1.4. Stabilization required
2.1.5. Anatomical bony landmarks
2.1.5.1. Palpation
2.1.6. Instrument use
2.1.6.1. Alignment
2.1.6.1.1. In most cases...
2.1.6.1.2. Because the axis of joints varies somewhat throughout ROM...
2.1.6.2. Reading of instrument
2.1.6.2.1. Stay eye level with the instrument
2.1.6.3. Measurement recording
2.1.6.3.1. Recorded in:
2.1.6.3.2. Should provide enough information to permit an accurate interpretation of the measurement:
2.1.6.3.3. Normal:
2.1.6.4. Visual estimation is not recommended in practice
2.1.6.4.1. Developing it as a skill is useful in the learning process
2.1.6.5. Examples
2.1.6.5.1. Paper tracings
2.1.6.5.2. Tape measures
2.1.6.5.3. Universal goniometers
2.1.6.5.4. Gravity-dependent goniometers
2.1.6.5.5. Electrogoniometers
2.1.6.5.6. Other
2.2. Procedure
2.2.1. Before:
2.2.1.1. Determine which joints and motions need to be tested
2.2.1.2. Organize the testing sequence by body position
2.2.1.3. Gather the necessary equipment
2.2.1.3.1. Goniometers
2.2.1.3.2. Towel rolls
2.2.1.3.3. Recording forms
2.2.1.4. Prepare an explanation of the procedure for the subject
2.2.2. Explanation:
2.2.2.1. Introduce self and explain purpose
2.2.2.2. Explain and demonstrate goniometer
2.2.2.3. Explain and demonstrate anatomical landmarks
2.2.2.4. Explain and demonstrate examiner's and subject's roles
2.2.2.5. Confirm subject's understanding
2.2.2.6. Establish rapport
2.2.2.6.1. Use lay terms
2.2.2.6.2. Enlist the subject's participation in the evaluation process
2.2.2.7. Example found on pg. 35 of "Measurement..."
2.2.3. Testing:
2.2.3.1. Place the subject in the testing position
2.2.3.2. Stabilize the proximal joint segment
2.2.3.3. Move the distal joint segment to the zero starting position
2.2.3.3.1. If the joint cannot be moved into the zero starting position...
2.2.3.3.2. Slowly move the distal joint segment to the end of the passive ROM and determine the end-feel
2.2.3.4. Make a visual estimate of the ROM
2.2.3.5. Return the distal joint segment to the starting position
2.2.3.6. Palpate the bony anatomical landmarks
2.2.3.7. Align the goniometer
2.2.3.8. Read and record the starting position and remove the goniometer
2.2.3.9. Stabilize the proximal joint segment
2.2.3.10. Move the distal segment through the full ROM
2.2.3.11. Replace and realign the goniometer
2.2.3.11.1. Palpate the anatomical landmarks again if necessary
2.2.3.12. Read and record the ROM
3. Chapter 3 Validity and Reliability
3.1. Validity
3.1.1. Degree to which an instrument measures what it is purported to measure
3.1.1.1. The extent to which it fulfills its purpose
3.1.2. 4 Types:
3.1.2.1. Face
3.1.2.1.1. Indicates the instrument generally appears to measure what it proposes to measure
3.1.2.2. Content
3.1.2.2.1. Determined by judging whether or not an instrument adequately measures and represents the domain of content (the substance) of the variable of interest
3.1.2.3. Criterion
3.1.2.3.1. Justifies the validity of the measuring instrument by comparing the measurements made with the instrument to a well-established gold standard of measurement (the criterion)
3.1.2.3.2. Can be assessed objectively with statistical methods
3.1.2.4. Construct
3.1.2.4.1. Ability of an instrument to:
3.1.2.4.2. There is a movement within rehabilitation medicine to develop and validate measurement tools to identify functional limitations and predict disability
3.2. Reliability
3.2.1. Refers to the amount of consistency between successive measurements of the same variable on the same subject under the same conditions
3.2.2. Varies somewhat, depending on the joint and motion
3.2.3. 2 types:
3.2.3.1. Intertester
3.2.3.2. Intratester
3.2.3.2.1. More reliability
3.2.4. Sources of error in measuring ROM:
3.2.4.1. Movement of the joint axis
3.2.4.2. Variations in manual force applied by the examiner during PROM
3.2.4.3. Variations in a subject's effort during active ROM
3.2.4.4. Difficulties with palpation
3.2.5. See pg. 41 and 42 of "Measurement..." for examples of studies done on reliability