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What is goniometry?
the measurment of angles in human joints
- gonia-greek meaning angle
- metron-greek meaning measure
What can goniometry be used to determine?
particular joint position and total amount of motion available at a joint
What term refers to movement of joint surfaces?
In arthrokinematics, movements are normally described in what three ways?
usually occur in combination with each other and result in movement of the shafts of bones
What is a translatory motion which is the sliding of one joint surface over another?
*a braked wheel skidding
What is a rotary motion where all points on the moving surface rotate at a constant distance around a fixed axis of motion?
*a toy top spinning
What is a rotary motion?
- *bottom of rocking chair on the floor
- *tire rolling on the road
What is the movement of the shafts of bones rather than the movement of a joint surface?
*this is what we really measure (angle created by the rotary motion of the shafts of the bones)
What is ROM?
arc of motion that occurs at a joint or series of joints
What is the starting position for measuring ROM?
anatomical position......ZERO degrees
What is the arc of motion attained by a subject during unassisted voluntary joint motion?
active ROM (AROM)
What information does AROM provide us with?
- willingness to move
- muscle strength
- joint ROM
What is the arc of movement attained by an examiner without assistance from a subject?
passive ROM (PROM)
passive is slightly greater than active bc each joint has a small amount of available motion that is not under voluntary control
What joint structure allow for the additional movement in PROM?
- joint capsules
Why do we have the extra PROM available?
to protect joint structures...it allows the joint to absorb extrinsic forces
What information for PROM provide us with?
- -amount of motion permitted by joint structure(PROM) -vs- subjects ability to produce motion at a joint (AROM)
- -integrity of articular surfaces
- -extensibility of joint capsule
- -extensibility of associated ligaments, muscles, fascia, and skin
What is active assistive ROM?
patients efforts are joined by the PTA to determine the AAROM
allows pt to assist to whatever level they can during testing
What is a decrease in PROM that is substantially less than normal values for that joint, given the subjects age and gender?
What is a capsular patter of restricted motion?
pathological condition involving the entire joint capsule that causes a particular pattern of restriction involving all or most of the passive motions of the joint
What is a non-capsular pattern of restricted motion?
limitation of PROM that isnt proportioned similarly to a capsular pattern
- *usually involves structures other than the entire joint capsule
- -internal joint derangement
- -adhesion of a part of a joint capsule
- -ligament shortening
- -muscle strains
- -muscle contractures
Why is positioning important?
its used to place the joint in a zero starting position to help stabilize the proximal joint segment
What is stabilization?
isolating motion to one joint..helps to ensure that a true motion is obtained, rather than a measurement of combined motions that occue at a series of joints
What is the feeling gained by an experienced examiner as a barrier to further motion at the end of PROM?
What is the structure and example of a normal soft end feel?
soft tissue approximation
knee flexion (contact between soft tissue of the posterior leg and posterior thigh)
What is the structure and example of a firm end feel?
- muscular stretch - hip flexion with knee straight (passive elastic tension of hamstring muscle)
- capsular stretch - extenstion of MCP joints of the fingers (tension in the anterior capsule)
- ligamentous stretch - forearm supination (tension in the palmar radioulnar ligament of the inferior radioulnar joint, interosseous membrane, oblique cord)
What is an abnormal soft end feel?
occurs sooner or later in ROM than is usual, or in a joint that normally has a firm or hard end feel. feels boggy
What is an abnormal firm end feel?
occurs sooner or later in ROM than is usual, or in a joint that normally has a soft or hard end feel
What is an abnormal hard end feel?
- occurs sooner or later in the ROM than is usual, or in a joint that normally has a soft or firm end feel.
- a bony grating or block is felt
What is an empty end feel?
no real end feel bc pain prevents reaching end of ROM. no resistance is felt except for patients protective muscle splinting or muscle spasm
What are 2 examples of an abnormal soft end feel?
- soft tissue edema
What are 2 examples of abnormal firm end feels?
- increased muscular tonus
- capsular, muscular, ligamentous, and fasical shortening
What are 5 examples of abnormal hard end feels?
- loose bodies in joint
- myositis ossificans
What are 5 examples of abnormal empty end feels?
- acute inflammation
- psychogenic disorder
What is an increase in PROM that exceeds normal values for that joint, given the subjects age and gender?
What causes hypermobility?
laxity (looseness) of soft tissue structures such as ligaments, capsules, and muscles that normally prevent excessive motion at joint
What is validity?
how well the measurement represents the true value of the variable of interest
What is reliability?
amount of consistency between successive measurements of the same variable, on the same subject, under the same conditions
What can a highly reliable goniometric measurement be used to determine?
- presence of jt ROM limitations
- pt progress toward rehabilitative goals
- assess the effectiveness of ther interventions
What are some sources of error when measuring jt ROM?
- mvmt of the joint axis (neck)
- variations in manual force applied by the examiner during PROM
- variations in a subjects effort during AROM
What is an intratester?
What is an intertester?
2 different testers
What is the reliability range of jt ROM for an intratester?
*must have >6degrees for improvement
What is the reliability range of jt ROM for an intertester?
*must have >7degrees for improvement
What is alignment?
alignment of the arms of the goniometer with the proximal and distal segments of the jt being evaluated
What is the greatest extensibility of a muscle-tendon unit?
-maximal distance between the proximal and distal attachments of a muscle to bone
What is the purpose of measuring muscle length (flexability)?
to assess for hypermobility or hypomobility and the structures involved
measured indirectly by determining the end of ROM of the joints crossed by the muscles
How are muscles categorized?
by the number of joints they cross from their proximal to their distal attachments
One joint muscles cross and influence motion in how many joints?
One-joint muscles usually have sufficient length to allow full PROM where?
at the end of the joint they cross
How is PROM affected if the one-joint muscle is shorter than normal?
PROM in the direction opposite to the muscles action is decreased and the end feel is firm owing to a muscular stretch
Two-joint muscles cross and influence the motion of how many joints? Multi joints?
The length of a two-joint and multi-joint muscle is usually not sufficient to allow what? What is the term for this?
full PROM to occur simultaneously at all joints crosses by these muscles
*This is known as passive insufficiency
How are two-joint and multi-joint muscle length determined?
indirectly by measuring PROM in the direction opposite to the muscles action at the 2nd joint (for two-joint) or the last joint to be moved (for multi-joint)