GONIOMETR

Y
DR. KHYATI CHAVDA
MPT(ORTHO.)
 GONIOMETER
The term goniometry is derived from two
Greek words,
gonia = angle
metron = measure
Goniometry refers to the measurement of
angles, in particular the measurement of joint
angles created at human joints by the bones of
the body.
GONIOMETER
GONIOMETER
GONIOMETER
o Universal goniometer

Includes

 body,
 movable arm and
 stationary arm.
 A body
The body of the goniometer is designed like a
protractor and may form a full or half circle.
 A measuring scale is located around the body. The
scale can extend either from 0 to 180 degrees and
180 to 0 degrees for the half circle models, or from
0 to 360 degrees and from 360 to 0 degrees on the
full circle models.[1]
The intervals on the scales can vary from 1 to 10
degrees
 A stationary arm.
The stationary arm is structurally a part of the body
and therefore cannot move independently of the
body
 A moving arm
 The moving arm is attached to the fulcrum in the
center of the body by a rivet or screw-like device
that allows the moving arm to move freely on the
body of the device. In some instruments , the
screw-like device can be tightened to fix the
moving arm in a certain position or loosened to
permit free movement.
 o Gravity dependant goniometer
(inclinometer)
 They use gravity’s effect on pointers and fluid levels to
measure joint position and motion.
 Pendulum goniometer consist of a 360 protractor with

a weighted pointer hanging from the center of the

protractor.
Fluid goniometer has a fluid filled circular chamber
containing an air bubble.
 o electrogoniometer

They are used in research to obtain dynamic joint

measurement.
 • Procedure of goniometry
The examiner must have a knowledge of the following
for each joint and motion.
1. Recommended testing position
2. Alternative positioning
3. Stabilization required(proximal region)
4. Joint structure and function
5. Normal end feel
6. Anatomical bony landmarks
7. Instrument alignment
8. Position the patient in the relaxed manner and the
joint to be measured should be free from any
obstructions like pillow, couch etc.
9. Total procedure should be explained to the
patient.
10. Therapist has to stand near to the patient and
facing the joint, which has to be measured.
11. Axis or fulcrum of the goniometer is placed over
the axis of the joint to be measured.
12. Stable arm is fixed with the proximal segment of
the joint.
13. Movable arm is fixed with the distal segment of
the joint.
14. Therapist has to move the distal segment of the
joint with the movable arm of the goniometer to
measure the joint range.
End feel
 Limitation of ROM in normal individuals
 Capsular limitations
 Ligament limitations
 Tension in soft tissues
 Soft tissue approximation
 Contact of joint surfaces
End feel
“The type of structures that limits a ROM has a
characteristic feeling that may be detected by the
examiner who is performing the passive ROM.
This feeling which is experienced by the examiner
as a barrier to further ROM at the end of a
passive ROM is called as END-FEEL.”
End feel
 Requires practice and sensitivity
 Must be carried out slowly and carefully
 Importance to perform accurate goniometry.
 Helps in determining the type of limiting structures
End feel
 end feel
End feel
End feel
 • principles
For each joint movement principles are
1. Position and stabilize correctly.
2. Move a body part through the appropriate range of
motion.
3. Determine the end range of motion.
4. Palpate the appropriate bony landmark.
5. Align the measuring instrument with landmark.
6. Read the measuring instrument.
7. Record the measurement correctly.
  positioning
 Place the joint in a starting position of 00 .
 Expose the body part
 Permit a complete range of motion.
 Provides stabilization for the proximal joint
segment.
SHOULDER JOINT
 SHOULDER JOINT

Movement Normal Position Of Fulcrum Movable Arm Stable Arm

Range Patient

Flexion 0-1800 Supine with lateral Lateral midline Mid axillary

knee flexed to aspect of of humerus, line of
flatten the lumbar greater lateral thorax
spine tubercle epicondyle of
 shoulder in 00 humerus as
of abduction, reference.
adduction and
rotation.
 forearm in
midprone
position.

•ROM -According to american academy of orthopaedic surgeons.

 SHOULDER JOINT

Movement Normal Position Of Fulcrum Movable Arm Stable Arm

Range Patient

Extension 0-600 prone with head Lateral Lateral midline Mid axillary
facing away from aspect of of humerus, line of
shoulder being greater lateral thorax
tested. tubercle epicondyle of
No pillow under humerus as
head reference.
Shoulder in 00
of abduction,
adduction and
rotation.
Elbow in slight
flexion forearm
in midprone
position.

•ROM -According to american academy of orthopaedic surgeons.

 SHOULDER JOINT
Movement Normal Position Of Fulcrum Movable Arm Stable Arm
Range Patient

Abduction 0-1800 •Supine with Close to •Anterior Parallel to

shoulder in 00 of anterior midline of the midline
flexion, extension aspect of humerus. of anterior
and full lateral acromion •Medial aspect of the
rotation. process epicondyle of sternum.
•Elbow extended humerus as
reference.

Adduction 1800-00 •Supine with Close to Anterior Parallel to

shoulder in 00 of anterior midline of the midline
flexion, extension aspect of humerus, of anterior
and full lateral acromio Medial aspect of
rotation. n process epicondyle of the
•Elbow extended humerus as sternum.
reference.

•ROM -According to american academy of orthopaedic surgeons.

 SHOULDER JOINT
Movement Normal Position Of Fulcrum Movable Arm Stable Arm
Range Patient
Medial 0-700 •Supine with arm over With ulna Parallel o
internal being tested in 900 olecranon using perpendicular
rotation of shoulder process. olecranon and to the floor .
abduction . ulnar styloid
•Forearm for reference.
perpendicular to
supporting surface
and is in 0 of
supination and
pronation so that
the palm faces the
feet full humerus
is supported and
elbow not to be
supported.
•pad is placed
under the humerus
it is in level with
acromion process.
 SHOULDER JOINT
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Lateral 0-900 •Supine with arm over With ulna Parallel or
external being tested in 900 olecranon using perpendicular
rotation of shoulder process. olecranon and to the floor .
abduction. ulnar styloid
•Forearm for reference.
perpendicular to
supporting surface
and is in 00 of
supination and
pronation so that
the palm faces the
feet
• full humerus is
supported and
elbow not to be
supported.
•pad is placed
under the humerus
it is in level with
ELBOW JOINT
 ELBOW JOINT
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Flexion 0-1400 •Supine with Over With lateral With the
shoulder in 00 of lateral midline of lateral
flexion ,extension epicondyle radius head midline of
and abduction so of humerus and radial the humerus
arm close to body. styloid using center
•pad placed under process for of acromion
humerus to allow reference. process for
full elbow reference.
extension.
•forearm in
supination so
palm faces celing.

ROM 0-140 - according to american medical association .

 ELBOW JOINT
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
extension 1400 - 00 •Supine with Over With lateral With the
shoulder in 00 of lateral midline of lateral
flexion, extension epicondyle radius head midline of
and abduction so of and radial the humerus
arm close to body. humerus. styloid using center
•Pad placed under process for of acromion
humerus to allow reference. process for
full elbow reference.
extension.
FOREARM
 FOREARM

Movement Normal Position Of Fulcrum Movable Arm Stable Arm

range Patient
Pronation 0-800 •Sitting with Lateral to Across the Parallel to
shoulder in 00 of ulnar dorsal aspect the anterior
flexion, extension, styloid of forearm just midline of
abduction, process proximal to the humerus.
adduction and styloid process
rotation. of radius and
•Elbow flexed to ulna.
900 forearm
initially in
midprone
position.

ROM – According to AAOS AND AMA .

 FOREARM
Movement Normal Position Of Fulcrum Movable Arm Stable Arm
range Patient
Supination 0-800 •Sitting with Medial to Across the Parallel to
shoulder in 00 of ulnar ventral aspect the anterior
flexion, extension, styloid of forearm just midline of
abduction, process. proximal to the humerus.
adduction and styloid process
rotation. of radius and
•Elbow flexed to ulna.
900 forearm
initially in
midprone
position.

ROM – According to AAOS AND AMA.

Wrist joint
 WRIST AND HAND
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Flexion 0-800 •Sitting with Over the With lateral With lateral
shoulder 900 lateral midline of midline of
abducted and aspect of fifth ulna.
elbow 900 flexed. wrist metacarpal. (using
•Palm should face (over the olecranon
the ground. triquetrum) and ulnar
•Hand is free to styloid
move. process for
•Avoid radial reference).
deviation and
ulnar also.

ROM – According to AAOS.

 WRIST AND HAND

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-700 •Sitting with At the level With (volar) With dorsal
shoulder 900 of capitate. dorsal volar
abducted and midline of 3rd midline of
elbow 900 flexed. metacarpal. forearm.
•Palm should face
the ground.
•Hand is free to
move.
•Avoid radial
deviation and
ulnar also.

ROM – According to AAOS.

 WRIST AND HAND

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Radial 0-200 •Sitting with Over the dorsal dorsal
deviation shoulder 900 middle of midline of 3rd midline of
abducted and the dorsal metacarpal. forearm.
elbow 900 flexed. aspect of
•Palm should face wrist
the ground. (capitate).
•Hand is free to
move.
•Rest forearm and
hand on
supporting
surface.

ROM – According to AMA and AAOS.

 WRIST AND HAND

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Ulnar 0-300 •Sitting with Over the dorsal dorsal
deviation shoulder 900 middle of midline of 3rd midline of
abducted and the dorsal metacarpal. forearm.
elbow 900 flexed. aspect of
•Palm should face wrist
the ground. (capitate).
•Hand is free to
move.

ROM – According to AMA and AAOS.

HAND
 METACARPO PHALANGEAL JOINTS (2-5)

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-900 •Sitting with the Over dorsal Over the dorsal
forearm in aspect of dorsal midline of
midprone the MCP jt. midline of metacarpal.
position. the proximal
•Wrist in 00 of phalanx.
flexion, extension
and radial and
lateral rotation.
•Forearm and
hand rest on
supporting surface
MCP jt in neutral
position.

ROM – According to AMA and AAOS.

 METACARPO PHALANGEAL JOINTS (2-5)

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-450 •Sitting with the Over dorsal Over the dorsal
forearm in aspect of dorsal midline of
midprone the MCP jt. midline of metacarpal.
position. the proximal
•Wrist 00 of phalanx
flexion, extension
and radial and
lateral rotation.
•Forearm and
hand rest on
supporting surface
MCP jt in neutral
position.

ROM – According to AAOS.

 METACARPO PHALANGEAL JOINTS (2-5)

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Abduction 0-450 •Sitting with the Over dorsal Over the dorsal
wrist in 00 of aspect of dorsal midline of
flexion, extension the MCP jt. midline of metacarpal.
and radial and the proximal
ulnar deviation. phalanx
•Forearm is fully
pronated so that
the palm faces
ground.
•MCP jt in 00 of
flexion and
extension.
•forearm and hand
rest on supporting
surface.

Adduction same as abduction

 PROXIMAL INTER PHALANGEAL
JOINTS (2-5)

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-1000 •Sitting with the Over dorsal Over the dorsal
forearm in aspect of dorsal midline of
midprone the PIP jt. midline of the proximal
position. the middle phalanx.
•The wrist and phalanx.
MCP jt position in
00 of all motion
forearm and hand
rest on supporting
surface.

extension same as abduction

 DISTAL INTER PHALANGEAL
JOINTS

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-900 •Sitting with the Over dorsal Over the dorsal
forearm in aspect of dorsal midline of
midprone the DIP jt. midline of the middle
position. the distal phalanx.
•The wrist and phalanx.
MCP jt position in
00 of all motion.
•PIP joint in 700 to
900 of flexion.
•Forearm and
hand rest on
supporting
surface.
 DISTAL INTER PHALANGEAL
JOINTS

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-100 •Sitting with the Over dorsal Over the dorsal
forearm in aspect of dorsal midline of
midprone the DIP jt. midline of the middle
position. the distal phalanx.
•The wrist and phalanx.
MCP jt position in
00 of all motion.
•PIP joint in 700 to
900 of flexion.
•Forearm and
hand rest on
supporting
surface.
 CARPO METACARPAL JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-150 •Sitting with the Over Over ventral With the
forearm full palmar midline of 1st ventral
supination aspect of 1st metacarpal. midline of
position. CMC jt. the radius
•The wrist in 00 of using ventral
all motion. surface of
•CMP jt of thumb radial head
in 00 of abduction and radial
and adduction , styloid for
•MCP jt in 00 of reference.
flexion and
extension.
•Forearm and
hand rest on
supporting
surface.
 CARPO METACARPAL JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-200 •Sitting with the Over Over ventral With the
forearm full palmar midline of 1st ventral
supination aspect of 1st metacarpal. midline of
position. CMC jt. the radius
•The wrist in 00 of using ventral
all motion. surface of
•CMP jt of thumb radial head
in 00 of abduction and radial
and adduction , styloid for
•MCP jt in 00 of reference.
flexion and
extension.
•Forearm and
hand rest on
supporting
surface.
 CARPO METACARPAL JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Abduction 0-700 •Sitting with the Over With lateral With lateral
forearm in LATERAL midline of 1st midline of
midprone ASPECT of metacarpal 2nd
position. radial using center metacarpal
•The styloid of 1st MCP jt using center
wrist,CMC,MCP, process. for reference. of 2nd MCP
IP and MCP jt jt for
position in 0 of all reference.
motion.
•Forearm and
hand rest on
supporting
surface.
 CARPO METACARPAL JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Adduction 0-700 •Sitting with the Over With lateral With lateral
forearm in LATERAL midline of 1st midline of
midprone ASPECT of metacarpal 2nd
position. radial using center metacarpal
•The styloid of 1st MCP jt using center
wrist,CMC,MCP, process. for reference. of 2nd MCP
IP and MCP jt jt for
position in 00 of reference.
all motion.
•Forearm and
hand rest on
supporting
surface.
 METACARPO PHALANGEAL JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-500 •Sitting with the Over dorsal With dorsal Over the
forearm in full ASPECT midline of dorsal
supination of MCP jt. proximal midline of
position. phalanx. metacarpal.
•The wrist and
MCP jt in 00 of all
motion.
•IP jt of thumb in
00 of felxion and
extension.
•Forearm and
hand rest on
supporting
surface.
 INTER PHALANGEAL
JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-800 •Sitting with the Over dorsal With dorsal With the
forearm in full surface of midline OF dorsal aspect
supination IP jt. DISTAL of proximal
position. phalanx. phalanx .
•The wrist and
CMC jt in 00 of all
motion.
•MCP jt of thumb
in 00 of flexion
and extension.
 INTER PHALANGEAL JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-800 •Sitting with the Over dorsal With dorsal With the
forearm in full surface of midline OF dorsal aspect
supination IP jt. DISTAL of proximal
position. phalanx. phalanx .
•The wrist and
CMC jt in 00 of all
motion.
•MCP jt of thumb
in 00 of flexion
and extension.
LOWERLIMB
HIP JOINT
 HIP JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-1200 Supine with hip in Over the With the With the
00 of abduction, lateral lateral miline lateral
adduction and aspect of of femur midline of
rotation . hip jt using using lateral the pelvis.
Initially knee is greater condyle for
extended but as trochanter reference.
the range of hip of femur for
flexion completed reference.
knee is allowed to
flex.
 HIP JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-300 Prone with the hip Over the With the With the
in 00 of abduction, lateral lateral miline lateral
adduction and aspect of of femur midline of
rotation. hip jt using using lateral the pelvis.
Knee is extended. greater condyle for
No pillow is trochanter reference.
placed under the of femur for
head. reference.
 HIP JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Internal 0-450 •Sitting with Over the Align with Align so that
rotation knees flexed to 90 anterior anterior it is
degrees over the aspect of midline of he perpendicula
edge of surface . patella. lower leg, r to the floor
•Place the hip in 0 using the or parallel to
degrees of crest of tibia supporting
abduction and and a point surface.
adduction and in midway
90 of flexion . between two
•Place a towel roll malleoli for
under the distal reference.
end of femur to
maintain the
femur in
horizontal plane.
 HIP JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
External 0-450 •Sitting with Over the Align with Align so that
rotation knees flexed to 90 anterior anterior it is
degrees over the aspect of midline of he perpendicula
edge of surface . patella. lower leg, r to the floor
•Place the hip in 0 using the or parallel to
degrees of crest of tibia supporting
abduction and and a point surface.
adduction and in midway
90 of flexion . between two
•Place a towel roll malleoli for
under the distal reference.
end of femur to
maintain the
femur in
horizontal plane.
 HIP JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Abduction 0-450 supine with the Over the Over the An
hip in 00 of anterior anterior imaginary
flexion, extension superior midline of horizontal
and rotation. iliac spine femur using line
Knee is extended. of the the midline extending
extremity of patella for from one
being reference. ASIS to
measured. another
ASIS.
 HIP JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Adduction 0-200 •supine with the Over the Over the An
(AMA)
hip in 00 of anterior anterior imaginary
flexion, extension superior midline of horizontal
and rotation. iliac spine femur using line
•Knee is of the the midline extending
extended. extremity of patella for from one
•Abduct the being reference. ASIS to
contralateral measured. another
extremity to ASIS.
provide sufficient
space to complete
the full rom in
adduction.
KNEE JOINT
 KNEE JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Flexion 0-1350 Supine with knee Over the With the With lateral
extension . lateral lateral midline of
Initially hip is in condyle of midline of femur using
00 of femur. the fibula , greater
extension ,abducti Using lateral trochanter
on but as knee malleoli and for
begins to flex, hip fibular head reference.
also flexes. for reference.
Alternative in
prone with hip in
00 of all motion .
The foot is over
the edge of
supporting
surface.
 KNEE JOINT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Extension 0-1350 •Supine with knee Over the With the With lateral
extension . lateral lateral midline of
•Initially hip is in condyle of midline of femur using
00 of extension, femur. the fibula , greater
abduction but as Using lateral trochanter
knee begins to malleoli and for
flex, hip also fibular head reference.
flexes. for reference.
•Alternative in
prone with hip in
00 of all motion .
•The foot is over
the edge of
supporting
surface.
ANKLE JOINT
 ANKLE TALOCRURAL JOINT

The ankle joint (or talocrural joint) is a synovial joint located in the lower limb. It is formed by
the bones of the leg and the foot – the tibia, fibula and talus. Functionally, it is a hinge type joint,
permitting dorsiflexion and plantarflexion of the foot
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Dorsiflexio 0-200 Sitting or supine , Over the With the With lateral
n with the knee lateral lateral aspect midline of
flexed at least aspect of of 5th MT or fibula, using
900. lateral palpate and head of
The foot is in 00 malleolus align lateral fibula for
of inversion and to inferior reference.
eversion. aspect of
calcaneus.
 ANKLE TALOCRURAL JOINT

Movement Norma Position Of Fulcrum Movable Stable Arm

l Patient Arm
range
Plantarflexio 0-500 Sitting or Over the With the With lateral
n supine , with lateral lateral aspect midline of
the knee flexed aspect of of 5th MT or fibula, using
to 900 . lateral palpate and head of
The foot is in 00 malleolus align lateral fibula for
of inversion and to inferior reference.
eversion. aspect of
calcaneus.
 ANKLE TARSAL JOINTS

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Inversion 0-350 Sitting with Over the With anterior With
knee flexed to anterior midline of 2nd anterior
900 and leg over aspect of metatarsal. midline of
the edge of the ankle lower leg,
supporting midway using tibial
surface . between tuberosity
Hip in 00 of mallioli for
abduction reference.
rotation and
adduction.
 ANKLE TARSAL JOINTS

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Eversion 0-120 Sitting with Over the With anterior With
knee flexed to anterior midline of 2nd anterior
900 and leg over aspect of metatarsal. midline of
the edge of the ankle lower leg,
supporting midway using tibial
surface . between tuberosity
Hip in 00 of mallioli for
abduction reference.
rotation and
adduction.
 SUBTALAR JOINT HIND
FOOT
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Inversion 0-50 Prone with hip Posterior Posterior Posterior
in 00 of all aspect of midline of midline of
motion knee in the ankle calcaneous. lower leg.
00 of flexion midway
and extension. between
Foot is placed malleoli.
over edge of
supporting
surface.
 SUBTALAR JOINT HIND FOOT

Movement Normal Position Of Fulcrum Movable Stable Arm

range Patient Arm
Eversion 0-50 Prone with hip Posterior Posterior Posterior
in 00 of all aspect of midline of midline of
motion knee in the ankle calcaneous. lower leg.
00 of flexion midway
and extension. between
Foot is placed malleoli.
over edge of
supporting
surface.
 TRANSVERSE TARSAL
JOINT
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Inversion 0-350 Same as tarsal Over the With the With
joint . anterior anterior anterior
aspect of midline of 2nd midline of
ankle slightly meta tarsal lower leg,
distal to a OR using tibial
point With plantar tuberosity
midway aspect of 1st for
between to 5th reference.
malleoli . metacarpal
OR head.
At the lateral
aspect of 5th
metatarsal
head
 TRANSVERSE TARSAL
JOINT
Movement Normalr Position Of Fulcrum Movable Stable Arm
ange Patient Arm
Eversion 0-200 Same as tarsal Over the With the Lateral to
joint . anterior plantar aspect anterior
aspect of of 1st to 5th midline of
ankle slightly metatarsal lower leg.
distal to a heads.
point midway
between
malleoli .
OR
At the lateral
aspect of 5th
metatarsal
head
FOOT
 META TARSO
PHALANGEAL JOINTS
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Flexion 0-300-450 •Supine or Over the Dorsal Dorsal
sitting position. anterior midline of midline of
•Ankle and aspect over proximal metatarsal.
foot in 0 the dorsal phalanx.
degrees of aspect of
dorsiflexion,pl MTP jt.
antar
flexion ,eversio Alternative Alternative Alternative
n and position: position: position:
inversion. Over the Medial Medial
•Position MTP medial aspect midline of midline of
joint in 0 of first MTP proximal the first
degree of jt. phalanx of metatarsal.
abduction and first toe.
adduction .
• IP joints in 0
degree of
flexion and
 META TARSO
PHALANGEAL JOINTS
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Extension 0-500-700 •Supine or Over the Dorsal Dorsal
sitting position. anterior midline of midline of
•Ankle and aspect over proximal metatarsal.
foot in 0 the dorsal phalanx.
degrees of aspect of
dorsiflexion,pl MTP jt.
antar
flexion ,eversio Alternative Alternative Alternative
n and position: position: position:
inversion. Over the Medial Medial
•Position MTP medial aspect midline of midline of
joint in 0 of first MTP proximal the first
degree of jt. phalanx of metatarsal.
abduction and first toe.
adduction .
• IP joints in 0
degree of
flexion and
 META TARSO
PHALANGEAL JOINTS
Movement Normal Position Of Fulcrum Movable Stable Arm
range Patient Arm
Abduction 0-500-700 •Supine or Over the Dorsal Dorsal
sitting position. anterior midline of midline of
• foot in o aspect over proximal metatarsal.
degrees of the dorsal phalanx.
eversion and aspect of
inversion. MTP jt.
•Position MTP
joint and IP
joints in 0
degree of
flexion and
extension.
Flexion:
Interphalangeal Joint Of The First Toe
and
Proximal Interphalangeal Joints Of The Four
Lesser Toes.

 Testing position: place the subject supine or sitting ,with

the ankle and foot in 0 degree of dorsiflexion,plantar
flexion,inversion and eversion.
 Position the MTP joint in 0 degree of
flexion,extension,abduction and adduction.
 ROM: is between 30 degrees and 90 degrees for the first
toe.
 Flexion:
Interphalangeal Joint Of The First Toe
and
Proximal Interphalangeal Joints Of The Four
Lesser Toes.

Fulcrum Movable arm Stable arm

Over the
Over the
Dorsal aspect of dorsal midline
dorsal midline
interphalangeal of the phalanx
of the
joint being distal to the
proximal
tested. joint being
phalanx
tested.
 EXTENSION :
Interphalangeal Joint Of The First Toe
And
Proximal Interphalangeal Joints Of The Lesser Four
Toes.

 Motion occurs in the saggital plane around a medial

–lateral axis.
 Usually it is not measured because it is return from
flexion to 0 starting position.
 Flexion:
Distal Interphalangeal Joints Of The Lesser Four
Toes.

 Motion occurs in the saggital plane around a medial –lateral

axis.
 ROM: 0 to 30 degrees.
 Testing position:supine or sitting,with the ankle and foot in 0
degrees of dorsiflexion ,plantar flexion,inversion and
eversion.
 Position MTP and PIP joints in 0 degrees of
flexion,extension,abduction and adduction.
 Fulcrum Movable Arm Stable Arm

dorsal aspect of
distal dorsal midline of dorsal midline of
interphalangeal distal phalanx. middle phalanx.
joint.
CERVICAL
 CERVICAL JOINT FLEXION

Movemen Normal Position Fulcrum Movable Stable

t range Of Patient Arm Arm
Cervical 0-400 Sitting Over the Align Perpendicul
flexion position external with the ar or
thoracic auditory base of parallel to
and lumbar meatus. nares. the ground.
spine well
supported
by the
back of
chair.
Head in 0
of lateral
flexion and
rotation.
 CERVICAL JOINT EXTENSION

Movemen Normal Position Fulcrum Movable Stable

t range Of Patient Arm Arm
Cervical 0-500 Sitting Over the Align Perpendicul
extension position external with the ar or
thoracic auditory base of parallel to
and lumbar meatus. nares. the ground.
spine well
supported
by the back
of chair.
Head in 0
of lateral
flexion and
rotation.
 CERVICAL JOINT LATERAL FLEXION

Movemen Normal Position Fulcrum Movable Stable

t range Of Patient Arm Arm
Cervical 0-220 Sitting Over the Align with Align with
lateral position spinous the dorsal the spinous
flexion thoracic process midline of process of
and lumbar of C7 the head, thoracic
spine well vertebrae using vertebrae
supported . occipital so that it is
by the back protuberanc perpendicul
of chair. e for ar with the
Head in 0 reference. ground.
of flexion,
extension
and
rotation.
 CERVICAL JOINT ROTATION

Movement Normal Position Fulcrum Movable Stable

range Of Patient Arm Arm
Cervical 0-500 Sitting Over the Align with Align
rotation position center of the tip of parallel to
thoracic cranial nose. an
and lumbar aspect of imaginary
spine well the head. line
supported between
by the two
back of acromion
chair. process.
Head in 0
of flexion,
extension
and lateral
rotation.
THORACOLUMBAR
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tca TAPE MEASURE- 4 inches or 10cm
aet
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THORACOLUMBAR FLEXION
Finger tip to floor method :Assess general body
flexibility because it combines spinal and hip flexion
making it impossible to isolate either motion.
Ask the subject to slowly bend forward as far as possible in an
attempt to touchthe floor with the fingers while keeping the knees
extended and feet together

No stabilization is provided by examiner

At the end, of motion measure the perpendicular distance between

the tip of subject ‘s middle finger and the floor either with tape
 Thoracolumbar extension
 Standing with feet shoulder width apart and with the cervical
thoracic, and lumbar spine in 0 of lateral flexion and rotation.
 Stabilize the pelvis to prevent posterior tilting.

•Mark the spinous process of C7 and S2 vertebrae .

•Align the tape measure between two spinous process and record the measurement
•Keep the tape measure aligned during the motion and record the measurement at the end range of motion.

•The difference between the measurement taken at the beginning of the motion and that taken at the end indicates
amount of lumbar and thoracic extension
THORACO LUMBAR LATERAL FLEXION

Place the subject standing with the feet shoulder width apart and cevical ,thoracic and
lumbar spine in 0 of flexion,extension.and rotation.

• Stabilize the pelvis to prevent lateral tilting .

Ask the subject to bend the trunk on one side while keeping the arms relaxed at the
sides of body. keep both the feet flat on floor with the knees extended

• The end of motion occcurs when the heel begins to

rise on the foot opposite to the side of motion and the
pelvis begins to tilt laterally.
THORACO LUMBAR LATERAL FLEXION

According to American Academy of

orthopaedic surgeons ROM is 35 degrees
1
eachtheside.
Mark 2 3 4
spinous Center fulcrum of
goniometer over the
Align proximal arm so Align distal arm with
that it is perpendicular posterior aspect of
process of C7 posterior aspect of spinous
process of S2. to the ground. spinous process of C7.
and S2
vertebrae.
 PROCEDURE
 Mark the spinous process of c 7 and s 2 vertebrae
using a skin marking pensil.

Fulcrum Movable arm Stable arm

Posterior Posterior
aspect of aspect of Perpendicular
spinous process spinous process to the ground
of s2. of c7
FINGER TIP TO FLOOR METHOD FOR
THORACOLUMBAR LATERAL FLEXION
 It is affected by the subjects body proportions ,therefore it is used to
compare repeated measurements for a single subject and not for
comparing one subject with another subject.
 Procedure:
 Feet with shoulder width apart and arms hanging freely at the sides
of body.
 Ask the subject to bend to the sides as far as possible while keeping
both feet flat on ground with knees extended.
 At the end of ROM , make a mark on the leg level with the tip of the
middle finger and use a tape measure or ruler to measure the
distance between the mark on the leg and floor.
 THORACOLUMBAR ROTATION

 Motion occurs in transverse plane around a vertical

axis.
 Testing position: place the subject sitting ,with the feet
on the floor to help stabilize the pelvis.
 A seat without backsupport is preferred so that the
rotation of spine can occur freely.
 The cervical,thoracic and lumbar spine are in 0 degrees
of flexion, extension and lateral flexion.
 According to AMA, normal ROM for thoracolumbar
rotation using universal goniometer is 45 degrees.
 THORACOLUMBAR ROTATION

Fulcrum Movable arm Stable arm

Parallel to an
An imaginary
Over the center imaginary line
line between
of the cranial between two
the two
aspect of the prominent
acromial
subjects head tubercles on
processes
the iliac crest.
 LUMBAR FLEXION
 Testing position: place the subject standing ,
with the cervical,thoracic and lumbar spine in 0
degrees of lateral flexion and rotation.
 Stabilization: stabilize the pelvis to prevent

anterior tilting.
 Testing motion: ask the subject to bend forward

as far as possible while keeping the knees

straight.
 Modified modified schobers test
 MMST uses two marks :
 One over the sacral spine on a line connecting the two PSIS and
the other mark over the spine 15cm superior to the first mark.
 Procedure:
 Use a ruler to locate and place first mark at a midline point on a
sacrum that is level with the PSIS.
 Make second mark.
 Align the tape measure between the superior and inferior
marks,Ask the subject to bend forward as far as possible while
keeping the knees straight.naintain the tape measure against the
subjects back during the motion.
 At the end ROM note the distance between two marks.the ROM
is the difference between 15cm and lengh measured at the end of
motion.
 MODIFIED SCHOBER TEST
 PROCEDURE:
 Place the first mark at lumbosacral junction with a skin
marking pencil,place second mark 10cms above 1st
mark,place a third mark 5cm below first mark at the
lumbosacral junction.
 Align the tape measure between most superior and most
inferior marks.Ask the subject to bend forward as far as
possible while keeping the knees straight.
 Maintain the tape measure against the subjects back
during movement ,note the distance between the most
superior and most inferior marks at the end ROM.
 Lumbar extension
 Testing position: place the subject standing with
the cervical,thoracic and lumbar spine in 0
degrees of lateral flexion and rotation.
 Stabilization:stabilize the pelvis to prevent

posterior tilting.
 Testing motion:ask the subject to extend the

spine as far as possible .

Modified modified schobers test
 Procedure
 Hold a ruler between two PSIS and place a first mark on a
midline point of sacrum that is on a level with PSIS ,this
will be over the spinous process of S2.a second mark
should be made on the lumbar spine that is above 15cm
above 1st mark.
 Align the tape measure between the first and second
marks on the spine and ask the subject to bend backward
as far as possible.
 At the end range of motion , note the distance between
the superior and inferior marks.
 Modified schober test
 Procedure:
 Place first mark over lumbosacral junction.place a second
mark 10cm above first mark.place a third mark 5cm
below the first mark.
 Align the tape measure between the most superior and
most inferior marks.
 Ask the subject to bend backwards as far as possible.
 Note the distance between the most superior and most
inferior marks at end ROM and subtract the final
measurement from initial 15 cm.the ROM is the
difference between 15cm and the length measured at the
LUMBAR LATERAL FLEXION
 SAME AS THORACOLUMBAR LATERAL
FLEXION.
 TMJ
Normal maximal active mouth opening

Depression of mandible
Motion occurs in saggital
plane around a medial lateral
axis.
Functionally, the mandible
is able to depress 35mm to
50mmso that subjects three
fingers or two knuckles cab
be placed between the upper
and lower central incisor
teeth.
Abnormal mouth opening with LATERAL
deviation
Overbite
 Protusion of mandible

Occurs in transverse
plane.

Normally the lower

central incisor teeth are
able to protude 6mm to
9mm beyond the upper
central incissor teeth.
Lateral excursion of mandible