GONIOMETRY

Introduction

Goniometry is the measuring of angles created by the bones of the body at the joints.
These joints are measured by a goniometer. The goniometer has a moving arm,
stationary arm, and the fulcrum. The fulcrum or body is placed over the joint being
measured and on it is a scale from 0 to 180.

Procedure

1.Puts the patient in appropriate position for examination

2. Positions himself appropriately for the examination
3. Demonstrates and Asks patient to move the required limb actively
4. Moves passively the joint to feel the limit (end-feel)
5. Identifies the landmark for the axis of the goniometer
6. Puts the axis/pivot of the goniometer on the joint axis
7. Aligns the fixed/immovable arm of the goniometer in line with
8. Aligns the movable arm of the goniometer in line with
9. Fixes the goniometer properly and asks the patient to move actively the limb at the joint
up to available ROM.
10. Moves the movable arm of the goniometer properly according to the movement of the
limb
11. Measures the active range of motion accurately
12. Performs and Measures Passive Range of motion examination for the above
mentioned joint appropriately
13. Observes the patient for any inconvenience during all the procedures
14. Reads off the range properly in Degrees
15. Records the findings

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GLENOHUMERAL JOINT ROM

Capsular Pattern: External Rotation, Abduction, Internal Rotation

SHOULDER FLEXION
Patient Position: Supine Lying / Crook Lying
Start Position: Arm at side, palm facing medially
Goniometer Axis/Fulcrum: Lateral aspect of center of humeral head (approximately 2.5
cm inferior to the lateral aspect of the acromion process)
Fixed Arm: Parallel to the lateral midline of the trunk
Movable Arm: Parallel to the longitudinal axis of the humerus, pointing
towards the lateral epicondyle of the humerus
Normal ROM: 0 – 180 degrees
Alternate Position: Sitting

SHOULDER EXTENSION
Patient Position : Prone lying
Start Position: Arm at side, palm facing medially
Goniometer Axis/Fulcrum: Lateral aspect of center of humeral head (approximately 2.5
cm inferior to the lateral aspect of the acromion process)
Fixed Arm: Parallel to the lateral midline of the trunk
Movable Arm: Parallel to the longitudinal axis of the humerus, pointing
towards the lateral epicondyle of the humerus
Normal ROM: 0 – 60 degrees
Alternate Position: Sitting

SHOULDER ABDUCTION
Patient Position : Supine Lying / Crook Lying
Start Position: Arm at side, Shoulder in external rotation
Goniometer Axis/Fulcrum: Mid point of anterior aspect of the shoulder joint
Fixed Arm: Parallel to the Sternum
Movable Arm: Parallel to the longitudinal axis of the humerus,
Normal ROM: 0 – 180 degrees
Alternate Position: Sitting/ Prone

SHOULDER EXTERNAL ROTATION

Patient Position : Supine Lying / Crook Lying
Start Position: Shoulder Abducted 90 degrees, elbow flexed 90 degrees,
Goniometer Axis/Fulcrum: On Olecranon process of the ulna
Fixed Arm: Perpendicular to the floor
Movable Arm: Parallel to the longitudinal axis of the Ulna, pointing
towards the Ulnar Styloid process
Normal ROM: 0 – 90 degrees

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SHOULDER INTERNAL ROTATION
Patient Position : Prone Lying
Start Position: Shoulder Abducted 90 degrees, elbow flexed 90 degrees,
forearm in midposition
Goniometer Axis/Fulcrum: On Olecranon process of the ulna
Fixed Arm: Perpendicular to the floor
Movable Arm: Parallel to the longitudinal axis of the Ulna, pointing
towards the Ulnar Styloid process
Normal ROM: 0 – 70 degrees

ELBOW/ FOREARM ROM

Capsular pattern: Elbow: Flexion, Extension

ELBOW FLEXION
Patient Position : Supine Lying / Crook Lying
Start Position: Arm is in anatomical position with a towel under the distal
end of the humerus with the elbow in extension.
Goniometer Axis/Fulcrum: Over the lateral epicondyle of the humerus
Fixed Arm: Parallel to the longitudinal axis of the humerus, pointing to
the top of the acromion process
Movable Arm: Parallel to the longitudinal axis of the Radius, pointing
towards the Radial Styloid process
Normal ROM: 0 – 140 degrees
Alternate Position: Sitting

ELBOW EXTENSION
Patient Position : Supine Lying / Crook Lying
Start Position: Arm is in anatomical position with a towel under the distal
end of the humerus with the elbow in Full Flexion.
Goniometer Axis/Fulcrum: Over the lateral epicondyle of the humerus
Fixed Arm: Parallel to the longitudinal axis of the humerus, poiting to
the top of the acromion process
Movable Arm: Parallel to the longitudinal axis of the Radius, pointing
towards the Radial Styloid process
Normal ROM: 140 –0 degrees
Alternate Position: Sitting

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FOREARM PRONATION
Patient Position : Sitting
Start Position: Shoulder is adducted and elbow flexed to 90 degrees with
the forearm in midposition. A pencil is held in tightly
closed fist, the tip of the pencil protruding from the radial
aspect of the hand.
Goniometer Axis/Fulcrum: Over the head of the 3rd Metacarpal
Fixed Arm: Perpendicular to the floor
Movable Arm: Parallel to the pencil
End Position: The forearm is rotated internally so the palm of the hand
faces downwards towards the floor.
Normal ROM: 0 – 80/90 degrees

FOREARM SUPINATION
Patient Position : Sitting
Start Position: Shoulder is adducted and elbow flexed to 90 degrees with
the forearm in midposition. A pencil is held in tightly
closed fist, the tip of the pencil protruding from the radial
aspect of the hand.
Goniometer Axis/Fulcrum: Over the head of the 3rd Metacarpal
Fixed Arm: Perpendicular to the floor
Movable Arm: Parallel to the pencil
End Position: The forearm is rotated externally so the palm of the hand
faces upwards towards the ceiling.
Normal ROM: 0 – 80/90 degrees

WRIST JOINT ROM

Capsular pattern: flexion and extension equally restricted

WRIST FLEXION
Patient Position : Sitting
Start Position: Foream resting on table in pronation, wrist is in neutral, the
hand is over the edge of the table
Goniometer Axis/Fulcrum: At the Ulnar Styloid Process
Fixed Arm: Parallel to the longitudinal axis of the Ulna
Movable Arm: Parallel to the longitudinal axis of the 5th metacarpal
Normal ROM: 0 – 80 degrees

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WRIST EXTENSION
Patient Position : Sitting
Start Position: Forearm resting on table in pronation, wrist is in neutral,
the hand is over the edge of the table
Goniometer Axis/Fulcrum: At the Ulnar Styloid Process
Fixed Arm: Parallel to the longitudinal axis of the Ulna
Movable Arm: Parallel to the longitudinal axis of the 5th metacarpal
Normal ROM: 0 – 70 degrees

WRIST RADIAL DEVIATION

Patient Position : Sitting
Start Position: Forearm is pronated and the palmar surface of the hand
rests on the table.
Goniometer Axis/Fulcrum: Dorsal aspect of the wrist, over the capitate bone.
Fixed Arm: Along the midline of the forearm.
Movable Arm: Parallel to the longitudinal axis of shaft of 3rd metacarpal
Normal ROM: 0 – 20/30 degrees

WRIST ULNAR DEVIATION

Patient Position : Sitting
Start Position: Forearm is pronated and the palmar surface of the hand
rests on the table.
Goniometer Axis/Fulcrum: Dorsal aspect of the wrist, over the capitate bone.
Fixed Arm: Along the midline of the forearm.
Movable Arm: Parallel to the longitudinal axis of shaft of 3rd metacarpal
Normal ROM: 0 –30/40 degrees

HIP JOINT ROM

Capsular pattern: Flexion, Abduction, Internal Rotation

HIP FLEXION
Patient Position: Supine Lying
Start Position: Hip and Knee in neutral position.
Goniometer Axis/Fulcrum: Over the Greater Trochanter of the femur
Fixed Arm: Parallel to the midaxillary line of the trunk.
Movable Arm: Parallel to the longitudinal axis of the femur, pointing
towards the lateral epicondyle of the femur.
End Position: Hip is flexed while flexing the knee.
Normal ROM: 0- 120 degrees

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HIP EXTENSION
Patient Position: Prone Lying
Start Position: Hip and Knee in neutral position. Pelvis stabilized by
strapping.
Goniometer Axis/Fulcrum: Over the Greater Trochanter of the femur
Fixed Arm: Parallel to the midaxillary line of the trunk.
Movable Arm: Parallel to the longitudinal axis of the femur, pointing
towards the lateral epicondyle of the femur.
End Position: Hip is extended while keeping the knee extended
Normal ROM: 0 - 30 degrees

HIP ABDUCTION
Patient Position : Supine Lying
Start Position: Hip and Knee in neutral position.
Goniometer Axis/Fulcrum: Over the ASIS on the side of the hip being measured
Fixed Arm: Along the line between the two ASIS’s
Movable Arm: Parallel to the longitudinal axis of the femur (anteriorly),
pointing towards the mid patella
Normal ROM: 0 - 45 degrees

HIP ADDUCTION
Patient Position : Supine Lying
Start Position: The hip on the nontested side is abducted to provide full
ROM in adduction to the tested side.
Goniometer Axis/Fulcrum: Over the ASIS on the side of the hip being measured
Fixed Arm: Along the line between the two ASIS’s
Movable Arm: Parallel to the longitudinal axis of the femur (anteriorly),
pointing towards the mid patella
Normal ROM: 0 - 30 degrees

HIP INTERNAL and EXTERNAL ROTATION

Patient Position: Sitting/ High Sitting
Start Position: The hip and knee in 90 degrees of flexion. A towel is
placed under the distal towel.
Goniometer Axis/Fulcrum: Over the midpoint of the patella
Fixed Arm: Perpendicular to the floor
Movable Arm: Parallel to the anterior midline of the tibia
Normal ROM: Internal Rotation: 0 - 45 degrees
External Rotation: 0- 45 degrees

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KNEE JOINT ROM
Capsular pattern: Flexion, Extension

KNEE FLEXION and EXTENSION

Patient Position : Prone Lying
Start Position: Hip and knee in neutral position with knee extended
position. The ankle joints are at the edge of the table.
Goniometer Axis/Fulcrum: Over the lateral epicondyle of the femur.
Fixed Arm: Parallel to the longitudinal axis of the femur, pointing
towards the greater trochanter.
Movable Arm: Parallel to the longitudinal axis of the fibula, pointing
towards the lateral malleolus.
Normal ROM: Flexion: 0 - 130 degrees
Extension: 130- 0 degrees

ANKLE JOINT ROM

Capsular pattern: Plantar flexion, Dorsiflexion

DORSIFLEXION and PLANTAR FLEXION

Patient Position : Sitting / High Sitting
Start Position: Hip and knee in 90 degrees flexed with the leg hanging at
the edge of the table.
Goniometer Axis/Fulcrum: 1.5 cms below the lateral malleolus.
Fixed Arm: Parallel to the longitudinal axis of the fibula, pointing
towards the head of the fibula.
Movable Arm: Parallel to the longitudinal axis of the 5th metatarsal bone.
Normal ROM: DorsiFlexion: 0 - 20 degrees
PlantarFlexion: 0 - 45 degrees

FOOT INVERSION and EVERSION

Patient Position : Supine Lying
Start Position: Ankle in neutral position, a piece of paper is kept under the
heel. A flat surfaced object (glass or book) is placed against
the sole of the foot. A line is drawn parallel to the book.
End Position: The foot is placed in inversion to the limit. The book is
positioned against the full sole of the foot and a line is
drawn parallel to the book. The process is repeated for
eversion to the limit of the motion.

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Goniometer Axis/Fulcrum: The Goniometer is placed on the line graphics to obtain a
measure of the arc of movement.
Normal ROM: Inversion: 0 - 35 degrees
Eversion: 0 - 20 degrees

NECK MOVEMENTS

Tape Measure: A linear measure is obtained through the use of a tape measure for
cervical spine movements.
Start Position: the patient is sitting in a chair with a back support. The head and neck are
in the anatomical position. The start position is same for all neck movements.

NECK FLEXION AND EXTENSION

The Patient flexes and extends the neck to the limit of motion.
A Tape measure is used to measure the distance between the tip of the chin and the
suprasternal notch.

NECK LATERAL FLEXION

The patient flexes the neck to the side (without rotation) to the limit of the motion.
A tape measure is used to measure the distance between the mastoid process of the skull
and the acromion process.

NECK ROTATION
The Patient rotates the head (without flexing or extending) to the limit of motion.
A tape measure is used to measure the distance between the tip of the chin and the
acromion process.

TRUNK MOVEMENTS

TRUNK FLEXION – THORACOLUMBAR SPINE

Start Position: The patient is standing in anatomical position.
End Position: The patient flexes the trunk forward to the limit of motion.
Measurement: A tape measure is used to measure the distance between the
spinous process of C7 and S2. A measure is taken in the
start position and at the limit of motion. The difference
between the two measures is the thoracolumbar spinal
ROM (approx. 10 cm).

TRUNK FLEXION – LUMBAR SPINE

Start Position: The patient is standing in anatomical position.
End Position: The patient flexes the trunk forward to the limit of motion.
Measurement: A tape measure is used to measure a distance and mark a
point 10 cm above the spinous process of S2. A measure is
taken in the start position and at the limit of motion. The

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 difference between the two measures is the lumbar spinal
ROM.

TRUNK LATERAL FLEXION

Start Position: The patient is standing in anatomical position.
End Position: The patient laterally flexes the trunk to the limit of motion.
Measurement: A tape measure is used to measure the distance between the
tip of the third digit and the floor.