Goniometry For Clinical Practice
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SHOULDER SHOULDER EXTENSION
SHOULDER SHOULDER FLEXION
SHOULDER SHOULDER ABDUCTION
SHOULDER MEDIAL (INTERNAL) SHOULDER ROTATION
SHOULDER LATERAL (EXTERNAL) SHOULDER ROTATION
ELBOW
ELBOW
ELBOW FLEXION
ELBOW EXTENSION
1670 +/- 4.50
1840 +/- 7.00
Subject prone ,Shoulder no abduction, adduction or rotation (note: to measure glenohumeral motion, Capsular or ..\..\..\goniometry links\shoulder stabilize scapula) extension.JPG ligamentous Subject supine, Flatten lumbar spine (flex knees) Shoulder no abduction, adduction or rotation (note: to measure glenohumeral motion, Subject supine, ..\..\..\goniometry links\shoulder stabilize scapula) flexion.JPG Muscle Stretch Shoulder 0o flexion and extension, Shoulder laterally (externally) rotated,Shoulder abducted, Stabilize thorax (note: to measure glenohumeral motion, stabilize scapula) Muscle Stretch
center of humeral head near acromion process
aligned with midline of humerus parallel mid- (lateral axillary line epicondyle)
center of humeral head near acromion process
parallel to sternum
aligned with midline of humerus
1040 +/- 8.50
Subject supine,Shoulder 90o abduction,Forearm olecranon neutral,Elbow flexed process of aligned ..\..\..\goniometry links\SHOULDER LATERAL (EXTERNAL) ROTATION.JPG 90o,Stabilize arm Capsular ulna vertically
aligned with ulna (styloid process)
1410 +/- 4.90
Subject supine, Shoulder neutral (arm Soft tissue at side) , Forearm approximation supinated, Elbow (capsular for thin ..\..\..\goniometry links\ELBOW FLEXION.JPG flexed, Stabilize arm subjects)
69 +/- 4.6
0.30 +/- 2.00
Subject supine, Shoulder neutral (arm at side) , Forearm supinated, Elbow flexed, Stabilize arm Bone on Bone
aligned with humerus lateral (center of aligned with epicondyle acromion radius (styloid of humerus process) process) aligned with humerus lateral (center of aligned with epicondyle acromion radius (styloid of humerus process) process)
TU P IC IN G H EA D
N A TE
IA L P EC S
A LT ER
C O N
M R A IN G
aligned with midline of humerus parallel mid- (lateral axillary line epicondyle)
aligned with ulna (styloid process)
0
M ET H O D
ER
R A R Y M O V
TI O N A TA S
A X IS center of humeral head near acromion process
Subject supine,Shoulder 90o abduction,Forearm olecranon neutral,Elbow flexed process of aligned o ..\..\..\goniometry links\SHOULDER MEDIAL (INTERNAL) ROTATION.JPG Capsular 90 ,Stabilize arm ulna vertically
0
S ID
M
FE EL EN D A L N O R M
TE S
P IC TU
620 +/- 9.50
T
R E
P O S
R A L N O R M A
EM EN T M O V
JO IN T
N G
IT IO N
E
O F
A TI O N
M O TI O N
R E
GONIOMETRY FOR CLINICAL PRACTICE
FOREARM FOREARM SUPINATION
FOREARM FOREARM PRONATION
WRIST
WRIST
WRIST
WRIST
Subject sitting, Shoulder neutral (arm at side) , Elbow flexed to 900 ,Stabilize arm, ..\..\..\goniometry links\FOREARM SUPINATION.JPG Pronate forearm Capsular
medial to ulnar styloid
parallel to humerus
aligned with ventral aspect of radius
Subject sitting, Shoulder neutral (arm at side) , Elbow flexed to 900 ,Stabilize arm, ..\..\..\goniometry links\FOREARM Supinate forearm PRONATION.jpg Capsular
Lateral to ulnar styloid
parallel to humerus
aligned with dorsum aspect of radius
Subject seated, Forearm stabilized on table, Flex wrist ..\..\..\goniometry links\WRIST (fingers relaxed) FLEXION.JPG Capsular
lateral wrist aligned with (triquetrum aligned with fifth ) ulna metacarpal
740 +/- 6.60
Subject seated, Forearm stabilized on table, Extend wrist ..\..\..\goniometry links\WRIST (fingers relaxed) EXTENSION.JPG Capsular
lateral wrist aligned with (triquetrum aligned with fifth ) ulna metacarpal
210 +/- 4.00
Subject sitting with forearm resting on table, Stabilize forearm to prevent pronation or Ligamentous (ulnar ..\..\..\goniometry links\WRIST RADIAL DEVIATION.jpg supination collateral ligament) capitate
0
81 +/- 4.0
0
75 +/- 5.3
0
0
WRIST FLEXION 75 +/- 6.6
WRIST EXTENSION
WRIST RADIAL DEVIATION
WRIST ULNAR DEVIATION
MCP JOINT MCP JOINT FLEXION
MCP JOINT MCP JOINT EXTENSION
MCP JOINT MCP JOINT ABDUCTION
0
0
aligned with forearm aligned with (lateral metacarpal of epicondyle) middle finger
86o (index), 91o (long), 99o (ring), 105o (little)
Subject sitting with forearm resting on table, Stabilize aligned with forearm to prevent Ligamentous forearm pronation or (Radial collateral (lateral ..\..\..\goniometry links\WRIST ULNAR DEVIATION.jpg supination ligament) capitate epicondyle) Subject sitting with forearm resting on table, Wrist and interphalangeal joints relaxed, Forearm neutral, Stabilize metacarpal to prevent dorsal MCP aligned with ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT FLEXION.JPG motion Capsular joint metacarpal
22o (index), 18o (long), 23o (ring), 19o (little)
Subject sitting with forearm resting on table, Wrist and interphalangeal joints relaxed, Forearm neutral, Stabilize aligned with metacarpal to prevent dorsal MCP aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT EXTENSION.JPG Capsular motion joint metacarpal phalange
????????
Subject sitting with forearm resting on table, Wrist neutral, Forearm neutral, aligned with Stabilize metacarpal dorsal MCP aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT ABDUCTION.JPG to prevent motion Capsular joint metacarpal phalange
0
35 +/- 3.8
0
aligned with metacarpal of middle finger
aligned with proximal phalange
MCP JOINT MCP JOINT ADDUCTION
IP JOINT
IP JOINT FLEXION
IP JOINT
IP JOINT EXTENSION
THUMB THUMB CMC CMC JOINT JOINT FLEXION
THUMB CMC THUMB JOINT CMC JOINT EXTENSION
THUMB CMC THUMB JOINT CMC JOINT ABDUCTION
THUMB CMC THUMB JOINT CMC JOINT ADDUCTION
????????
Subject sitting with forearm resting on table, Wrist neutral, Forearm neutral, aligned with Stabilize metacarpal dorsal MCP aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT ADDUCTION.JPG to prevent motion Capsular joint metacarpal phalange
Proximal IP Finger Joints bone on bone (if tissues overlying Subject sitting with palmar aspect of forearm resting on bones is thin) soft o PIP fingers - 102 table, Wrist, tissue o (index), 105 (long), metacarpal, and non- approximation (if o o 108 (ring), 106 (little) tested interphalangeal tissues overlying ( active motion), DIP joints relaxed, palmar aspect of fingers - 72o (index), 71o Forearm neutral, bones is thick), dorsal (long), 63o (ring), 65o Stabilize proximal Distal IP Finger proximal (little) ( active motion), bone to prevent Joints and Thumb IP interphalan o ..\..\..\goniometry links\INTERPHALANGEAL JOINT FLEXION.JPG IP thumb - 73 motion Joint capsular geal joint Subject sitting with forearm resting on table, Wrist, metacarpal, and nonPIP fingers - 7o (index tested interphalangeal and long), 6o (ring), 9o joints relaxed, (little) ( active motion), Forearm neutral, dorsal o DIP fingers - 8 (all Stabilize proximal proximal finger DIPs). IP thumb bone to prevent interphalan o ..\..\..\goniometry links\INTERPHALANGEAL JOINT EXTENSION.JPG 5 motion capsular geal joint
aligned with aligned with proximal middle phalange phalange
aligned with aligned with proximal middle phalange phalange
??????????
Subject sitting with forearm supinated and resting on table, Wrist neutral, Stabilize aligned with carpals to prevent carpometac aligned with metacarpal of ..\..\..\goniometry CARPOMETACARPAL JOINT FLEXION.JPG wristlinks\THUMB motion capsular arpal joint radius thumb
??????????
Subject sitting with forearm supinated and resting on table, Wrist neutral, Stabilize aligned with carpals to prevent carpometac aligned with metacarpal of ..\..\..\goniometry CARPOMETACARPAL JOINT EXTENSION.JPG wristlinks\THUMB motion capsular arpal joint radius thumb
70o
Subject sitting with forearm resting on table, Wrist neutral, aligned with Forearm neutral, Muscle stretch metacarpal aligned with Stabilize carpals to (adductor pollicus, radial of index metacarpal of ..\..\..\goniometry links\THUMB CARPOMETACARPAL JOINT ABDUCTION.JPG prevent wrist motion skin, fascia) styloid finger thumb
00 ??????
Subject sitting with forearm resting on table, Wrist neutral, aligned with Forearm neutral, metacarpal aligned with Stabilize carpals to Soft tissue radial of index metacarpal of ..\..\..\goniometry links\THUMB CARPOMETACARPAL ADDUCTION.JPG prevent wrist motion approximation JOINT styloid finger thumb
THUMB CMC THUMB JOINT CMC JOINT OPPOSITION
HIP
HIP
HIP
HIP
HIP
HIP
HIP FLEXION
Subject sitting with forearm supinated and Use a ruler to measure resting on table, Wrist Capsular or soft Goniometer distance between tip of neutral, Stabilize fifth tissue cannot be thumb and base of fifth ..\..\..\goniometry CARPOMETACARPAL OPPOSITION.JPG Able to touch tip of thumb to base of metacarpal fifth links\THUMB finger approximation JOINT used finger
o
121.0 +/- 6.4
o
HIP EXTENSION 12.0 +/- 5.4
o
o
Subject supine, Allow knee to flex (to avoid limitation by tight hamstrings), Stabilize pelvis to prevent ..\..\..\goniometry links\HIP FLEXION.JPG rotation, Flex hip Capsular
aligned with aligned with greater midline of femur (lateral trochanter plevis epicondyle)
Subject prone, Stabilize pelvis to prevent rotation, Capsular or ..\..\..\goniometry links\HIP EXTENSION.JPG Extend hip ligamentous
aligned with aligned with greater midline of femur (lateral trochanter plevis epicondyle)
HIP ADDUCTION 27.0o +/- 3.60
Subject supine, Stabilize pelvis to prevent pelvic list, Capsular or ..\..\..\goniometry links\HIP ABDUCTION.JPG Abduct hip ligamentous Subject supine, Stabilize pelvis to prevent pelvic list, Abduct opposite hip (to allow room for tested limb to adduct), Capsular or ..\..\..\goniometry links\HIP ADDUCTION.JPG Adduct hip ligamentous
HIP MEDIAL (INTERNAL) ROTATION
Subject sitting on table, knee flexed, Stabilize distal thigh, medially (internally) center of ..\..\..\goniometry links\HIP MEDIAL (INTERNAL) ROTATION.JPG rotate hip Capsular patella
aligned vertically
aligned with leg (crest of tibia)
Subject sitting on table, knee flexed, Stabilize distal thigh, hip laterally center of ..\..\..\goniometry links\HIP LATERAL Capsular (EXTERNAL) ROTATION.JPG (externally) rotat patella
aligned vertically
aligned with leg (crest of tibia)
o
HIP ABDUCTION 41.0 +/- 6.0
HIP LATERAL (EXTERNAL) ROTATION
KNEE
KNEE FLEXION
KNEE
KNEE EXTENSION
o
44.0 +/- 4.3
o
44.0 +/- 4.8
0
o
o
141o +/- 5.3o
o
minus 2.0 +/- 3.0
o
anterior superior iliac spine (ASIS)
aligned with aligned with opposite femur (center ASIS of patella)
anterior superior iliac spine (ASIS)
aligned with aligned with opposite femur (center ASIS of patella)
Subject supine, Allow Soft tissue ..\..\..\goniometry links\KNEE FLEXION.JPG hip to flex Flex knee approximation
lateral aligned with aligned with epicondyle greater lateral of femur trochanter malleolus
Subject prone, Stabilize femur, ..\..\..\goniometry links\KNEE Extend Knee EXTENSION.JPG Capsular
lateral aligned with aligned with epicondyle greater lateral of femur trochanter malleolus
Knee flexion should be measured with the subject supine. This position allows assessment of the joint range of motion without interference from tightness in the rectus femoris muscle. If the examiner wishes to assess length of the rectus femoris, have the patient lie prone (see 2nd ..\..\..\goniometry links\KNEE FLEXION 2.JPG illustration).
ANKLE
ANKLE DORSIFLEXION 13o +/- 4.4o
Subject prone, Flex knee, Stabilize subtalar in neutral, Dorsiflex ankle by pushing through 5th ..\..\..\goniometry links\ANKLE metatarsal head DORSIFLEXION.JPG Capsular
ANKLE
ANKLE PLANTARFLEXIO N 56o + or - 6.1o
Subject supine, Extend knee, Stabilize leg, ..\..\..\goniometry links\ANKLE Plantarflex ankle PLANTARFLEXION.JPG Capsular
CALCANEA CALCANEAL L JOINT INVERSION
CALCANEA CALCANEAL L JOINT EVERSION
MID TARSAL
MIDTARSAL INVERSION
o
37.0 + or - 4.5
o
21.0 +/- 5.0
o
o
Subject prone, Stabilize tibia in sagittal plane (rotate hip or pelvis to align ..\..\..\goniometry links\CALCANEAL tibia), Invert calcaneusINVERSION.JPG Capsular
Subject prone, Stabilize tibia in sagittal plane (rotate hip or pelvis to align ..\..\..\goniometry links\CALCANEAL tibia), Evert calcaneusEVERSION.JPG Capsular
??????????
Subject supine, Stabilize calcaneus and talus, Invert ..\..\..\goniometry links\MIDTARSAL INVERSION.JPG forefoot Capsular
??????????
Subject supine, Stabilize calcaneus and talus, evert ..\..\..\goniometry links\MIDTARSAL EVERSION.JPG forefoot Capsular
lateral malleolus
aligned with aligned with fifth fibular head metatarsal
lateral aligned with malleolus fibular head automatical ly positioned by alignment of aligned with goniometer midline of arms leg automatical ly positioned by alignment of aligned with goniometer midline of arms leg automatical ly positioned by alignment of aligned with goniometer midline of arms leg automatical ly positioned by alignment of aligned with goniometer midline of arms leg
Pronation of the sub-talar joint can compensate for a loss of ankle joint dorsiflexion range of motion. To avoid measurement error (by accidentally including sub-talar pronation), the sub-talar joint must be stabilized in its neutral position. To assess the range of JOINT motion, flex the knee (first illustration). To assess tightness of the gastrocnemius muscle, extend the knee (second illustration).
Assessing Gastrocnemius Tightness (muscle stretch ..\..\..\goniometry links\Assessing Gastrocnemi end-feel)
aligned with fifth metatarsal
aligned with midline of calcaneus
aligned with midline of calcaneus
aligned with plantar aspect of metatarsal heads
Subject supine, METATARS Stabilize 1st medial to o o 1st - 50 , 2nd - 40 , OMTP JOINT metatarsal in center of PHALANGE DORSIFLEXION 3rd - 30o , 4th - 20o , 5th plantarflexion, metararsal aligned ..\..\..\goniometry links\METATARSOPHALANGEAL JOINT head DORSIFLEXION.JPG AL JOINT (Extension) - 10o Dorsiflex MTP Capsular metatarsal
aligned with plantar aspect of metatarsal heads Range of first metatarsophalangeal (MTP) joint dorsiflexion is functionally important for gait. The available range of 1st MTP joint dorsiflexion depends on the position of the 1st ray. A plantarflexed 1st ray allows greater range of 1st MTP dorsiflexion. I recommend stabilizing the 1st ray in plantarflexion to measure maximum range Assessing MTP of 1st MTP dorsiflexion. The first photo Dorsiflexion by demonstrates a good method for measuring 1st Placing or 5th MTP joint dorsiflexion by placing the Goniometer on goniometer alongside the bones. This technique Dorsum of aligned with cannot be used for the 2nd, 3rd, or 4th MTP Bones (requires proximal joints. The second photo shows a technique for modified ..\..\..\goniometry links\Assessing phalange measuring these joints. goniometer) MTP Dorsifl
METATARS Subject supine, medial to 1st - 30o , 2nd - 30o , OMTP JOINT Stabilize 1st center of PHALANGE PLANTARFLEXIO 3rd - 20o , 4th - 10o , 5th metatarsal, Planterflex metararsal aligned o ..\..\..\goniometry JOINT head PLANTARFLEXION.JPG AL JOINT N (Flexion) - 10 MTP links\METATARSOPHALANGEAL Capsular metatarsal
Assessing MTP Plantarflexion The first photo demonstrates a good method for by Placing measuring 1st or 5th MTP joint plantarflexion by Goniometer on placing the goniometer alongside the bones. This Dorsum of technique cannot be used for the 2nd, 3rd, or 4th Bones (requires MTP joints. The second photo shows a technique modified ..\..\..\goniometry links\Assessing for measuring these joints. goniometer) MTP Plantar
MID TARSAL
MIDTARSAL EVERSION
aligned with proximal phalange
METATARS OPHALANGE MTP JOINT AL JOINT ABDUCTION
METATARS OPHALANGE MPT JOINT AL JOINT ADDUCTION
??????????
dorsum of Foot flat on table, center of aligned with Stabilize metatarsal, metararsal aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT ABDUCTION.JPG Abduct MTP Capsular head metatarsa phalange
??????????
dorsum of Foot flat on table, center of aligned with Stabilize metatarsal, metararsal aligned with proximal ..\..\..\goniometry links\METATARSOPHALANGEAL JOINT head ADDUCTION.JPG Adduct MTP Capsular metatarsa phalange
75.5o + or - 8.5o (20 CERVICAL SPINE 29 yrs.), 70.5o + or FORWARD 17.5o (30 - 49 yrs.), BENDING 64.5o + or - 7o (>50 (flexion) yrs.)
Subject sitting with lumbar and thoracic spines supported, Stabilize lumbar and external thoracic spines, Flex Capsular or auditory ..\..\..\goniometry links\CERVICAL SPINE FORWARD BENDING (flexion).JPG vertical cervical spine ligamentous meatus
SPINE
75.5o + or - 8.5o (20 CERVICAL SPINE 29 yrs.), 70.5o + or BACKWARD 17.5o (30 - 49 yrs.), BENDING 64.5o + or - 7o (>50 (extension) yrs.)
Subject sitting with lumbar and thoracic spines supported, Stabilize lumbar and external thoracic spines, auditory ..\..\..\goniometry links\CERVICAL SPINE BACKWARD BENDING (extension).jpg Extend cervical spine Bony or Capsular meatus vertical
SPINE
Subject sitting with lumbar and thoracic spines supported, 50.5o + or - 5.5o (20 Stabilize lumbar and 29 yrs.), 46.5o + or thoracic spines, spinous CERVICAL SPINE 6.5o (30 - 49 yrs.), 40o Sidebend cervical Capsular or process of ..\..\..\goniometry SIDEBENDING.JPG SIDEBENDING + or - 8.5o (>50 yrs.) spinelinks\CERVICAL SPINE ligamentous C7
posterior spinous midline of processes of head at thoracic occipital spine protuberance
SPINE
Subject sitting with lumbar and thoracic 91.5o + or - 5.5o (20 spines supported, 29 yrs.), 81o + or - 6.5o Stabilize lumbar and CERVICAL SPINE (30 - 49 yrs.), 77.5o + thoracic spines, Rotate Capsular or ..\..\..\goniometry links\CERVICAL SPINE ROTATION.JPG ROTATION or - 7.5o (>50 yrs.) cervical spine ligamentous
aligned with acromion aligned with processes tip of nose
SPINE
THORACOLUMBAR SPINE FORWARD BENDING (flexion) 10 cm
SPINE
picture 2
center of superior aspect of head
aligned with nostrils
aligned with nostrils
Tape Measure Alignment Subject standing, Flex thoracic and lumbar Capsular or ..\..\..\goniometry links\THORACO-LUMBAR SPINE FORWARD BENDING (flexion).JPG spines ligamentous Spinous processes of C7 and S1
..\..\..\goniometry links\THORACO-LUMBAR SPINE FORWARD BENDING (flexion) 2.JPG
The position of the mouth influences the available range of cervical backward bending. With the mouth closed, thghtness of the infrahyoid and suprahyoid muscles can limit range of cervical backward bending. If you wish to assess the range of the cervical spine, the mouth should be relaxed and slightly open.
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the forward bending position. Note the difference.
SPINE
SPINE
SPINE
Subject standing, Capsular or Extend thoracic and ligamentous Tape Measure Alignment ..\..\..\goniometry links\THORACO-LUMBAR SPINEbony) BACKWARD BENDING (extenion).JPG lumbar spines (sometimes Spinous processes of C7 and S1
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the backward bending position. Note the difference
..\..\..\goniometry links\THORACO-LUMBAR SPINE BACKWARD BENDING (extenion) 2.JPG picture 2 Normal Range (unilateral) RIGHT: 20 29 yrs 37.6o + or 5.8o,,, 30 - 39 yrs 35.3o + or - 6.5o,,, 40 - 49 yrs 27.1o + or - 6.5o,,, 50 59 yrs 25.3o + or 6.2o,,, 60 - 69 yrs 20.2o + or - 4.8o,,, 70 - 79 yrs 18.0o + or - 4.7o,,, LEFT: 20 - 29 yrs 38.7o + or - 5.7o,,, 30 - 39 yrs 36.5o + or - 6.0o,,, 40 - 49 yrs 28.5o + or 5.2o,,, 50 - 59 yrs 26.8o + or - 6.4o,,, 60 Subject standing, THORACO- 69 yrs 20.3o + or Stabilize pelvis, LUMBAR SPINE 5.3o,,, 70 - 79 yrs Sidebend thoracic and Capsular or S1 spinous C7 spinous ..\..\..\goniometry links\THORACO-LUMBAR SPINE SIDEBENDING.JPG vertical SIDEBENDING 18.9o + or - 6.0o lumbar spines ligamentous process process
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise.
THORACOLUMBAR SPINE BACKWARD BENDING (extenion) ????????????
THORACOLUMBAR SPINE ROTATION 45o
Subject sitting, Stabilize pelvis, Do not allow sidebending, forward bending or center of backward bending, superior Rotate thoracic and Capsular or aspect of ..\..\..\goniometry links\THORACO-LUMBAR SPINE ROTATION.JPG lumbar spines ligamentous head
TM JOINT
TM JOINT OPENING
35 to 50 mm, or two and 1/2 flexed PIPs
Use a ruler to measure the distance between the upper and lower incisors,,,,, Alternate method - have the subject flex the proximal Subject sitting, interphalangeal joints (PIPs) of the Stabilize cervical Capsular or fingers and assess how many PIPs can ..\..\..\goniometry links\TEMPEROMANDIBULAR JOINT OPENING.JPG spine, Open Mouth ligamentous fit between the teeth
TM JOINT
TM JOINT PROTRUSION
3 to 5 mm
Subject sitting, Stabilize cervical spine, Protrude Capsular or Use a ruler to measure the distance ..\..\..\goniometry links\TEMPEROMANDIBULAR JOINT PROTRUSION.JPG mandible forward ligamentous between the upper and lower incisors
10 to 15mm
1 - Identify points on the upper and lower teeth that are aligned when the mouth is in resting position (upper and lower incisors in this illustration) 2 Subject sitting, Deviate the mandible laterally and use Stabilize cervical a ruler to measure the distance spine, Deviate Capsular or between the two points (upper and ..\..\..\goniometry links\TEMPEROMANDIBULAR JOINT LATERAL DEVIATION.JPG mandible laterally ligamentous lower incisors in this illustration)
SPINE
TM JOINT
TM JOINT LATERAL DEVIATION
aligned with anterior superior iliac spines
aligned with anterior superior iliac spines
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise.
..\..\..\goniometry links\TEMPEROMANDIBULA
SHOULDER SHOULDER FLEXION
SHOULDER SHOULDER ABDUCTION
SHOULDER MEDIAL (INTERNAL) SHOULDER ROTATION
SHOULDER LATERAL (EXTERNAL) SHOULDER ROTATION
ELBOW
ELBOW
ELBOW FLEXION
ELBOW EXTENSION
1670 +/- 4.50
1840 +/- 7.00
Subject prone ,Shoulder no abduction, adduction or rotation (note: to measure glenohumeral motion, Capsular or ..\..\..\goniometry links\shoulder stabilize scapula) extension.JPG ligamentous Subject supine, Flatten lumbar spine (flex knees) Shoulder no abduction, adduction or rotation (note: to measure glenohumeral motion, Subject supine, ..\..\..\goniometry links\shoulder stabilize scapula) flexion.JPG Muscle Stretch Shoulder 0o flexion and extension, Shoulder laterally (externally) rotated,Shoulder abducted, Stabilize thorax (note: to measure glenohumeral motion, stabilize scapula) Muscle Stretch
center of humeral head near acromion process
aligned with midline of humerus parallel mid- (lateral axillary line epicondyle)
center of humeral head near acromion process
parallel to sternum
aligned with midline of humerus
1040 +/- 8.50
Subject supine,Shoulder 90o abduction,Forearm olecranon neutral,Elbow flexed process of aligned ..\..\..\goniometry links\SHOULDER LATERAL (EXTERNAL) ROTATION.JPG 90o,Stabilize arm Capsular ulna vertically
aligned with ulna (styloid process)
1410 +/- 4.90
Subject supine, Shoulder neutral (arm Soft tissue at side) , Forearm approximation supinated, Elbow (capsular for thin ..\..\..\goniometry links\ELBOW FLEXION.JPG flexed, Stabilize arm subjects)
69 +/- 4.6
0.30 +/- 2.00
Subject supine, Shoulder neutral (arm at side) , Forearm supinated, Elbow flexed, Stabilize arm Bone on Bone
aligned with humerus lateral (center of aligned with epicondyle acromion radius (styloid of humerus process) process) aligned with humerus lateral (center of aligned with epicondyle acromion radius (styloid of humerus process) process)
TU P IC IN G H EA D
N A TE
IA L P EC S
A LT ER
C O N
M R A IN G
aligned with midline of humerus parallel mid- (lateral axillary line epicondyle)
aligned with ulna (styloid process)
0
M ET H O D
ER
R A R Y M O V
TI O N A TA S
A X IS center of humeral head near acromion process
Subject supine,Shoulder 90o abduction,Forearm olecranon neutral,Elbow flexed process of aligned o ..\..\..\goniometry links\SHOULDER MEDIAL (INTERNAL) ROTATION.JPG Capsular 90 ,Stabilize arm ulna vertically
0
S ID
M
FE EL EN D A L N O R M
TE S
P IC TU
620 +/- 9.50
T
R E
P O S
R A L N O R M A
EM EN T M O V
JO IN T
N G
IT IO N
E
O F
A TI O N
M O TI O N
R E
GONIOMETRY FOR CLINICAL PRACTICE
FOREARM FOREARM SUPINATION
FOREARM FOREARM PRONATION
WRIST
WRIST
WRIST
WRIST
Subject sitting, Shoulder neutral (arm at side) , Elbow flexed to 900 ,Stabilize arm, ..\..\..\goniometry links\FOREARM SUPINATION.JPG Pronate forearm Capsular
medial to ulnar styloid
parallel to humerus
aligned with ventral aspect of radius
Subject sitting, Shoulder neutral (arm at side) , Elbow flexed to 900 ,Stabilize arm, ..\..\..\goniometry links\FOREARM Supinate forearm PRONATION.jpg Capsular
Lateral to ulnar styloid
parallel to humerus
aligned with dorsum aspect of radius
Subject seated, Forearm stabilized on table, Flex wrist ..\..\..\goniometry links\WRIST (fingers relaxed) FLEXION.JPG Capsular
lateral wrist aligned with (triquetrum aligned with fifth ) ulna metacarpal
740 +/- 6.60
Subject seated, Forearm stabilized on table, Extend wrist ..\..\..\goniometry links\WRIST (fingers relaxed) EXTENSION.JPG Capsular
lateral wrist aligned with (triquetrum aligned with fifth ) ulna metacarpal
210 +/- 4.00
Subject sitting with forearm resting on table, Stabilize forearm to prevent pronation or Ligamentous (ulnar ..\..\..\goniometry links\WRIST RADIAL DEVIATION.jpg supination collateral ligament) capitate
0
81 +/- 4.0
0
75 +/- 5.3
0
0
WRIST FLEXION 75 +/- 6.6
WRIST EXTENSION
WRIST RADIAL DEVIATION
WRIST ULNAR DEVIATION
MCP JOINT MCP JOINT FLEXION
MCP JOINT MCP JOINT EXTENSION
MCP JOINT MCP JOINT ABDUCTION
0
0
aligned with forearm aligned with (lateral metacarpal of epicondyle) middle finger
86o (index), 91o (long), 99o (ring), 105o (little)
Subject sitting with forearm resting on table, Stabilize aligned with forearm to prevent Ligamentous forearm pronation or (Radial collateral (lateral ..\..\..\goniometry links\WRIST ULNAR DEVIATION.jpg supination ligament) capitate epicondyle) Subject sitting with forearm resting on table, Wrist and interphalangeal joints relaxed, Forearm neutral, Stabilize metacarpal to prevent dorsal MCP aligned with ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT FLEXION.JPG motion Capsular joint metacarpal
22o (index), 18o (long), 23o (ring), 19o (little)
Subject sitting with forearm resting on table, Wrist and interphalangeal joints relaxed, Forearm neutral, Stabilize aligned with metacarpal to prevent dorsal MCP aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT EXTENSION.JPG Capsular motion joint metacarpal phalange
????????
Subject sitting with forearm resting on table, Wrist neutral, Forearm neutral, aligned with Stabilize metacarpal dorsal MCP aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT ABDUCTION.JPG to prevent motion Capsular joint metacarpal phalange
0
35 +/- 3.8
0
aligned with metacarpal of middle finger
aligned with proximal phalange
MCP JOINT MCP JOINT ADDUCTION
IP JOINT
IP JOINT FLEXION
IP JOINT
IP JOINT EXTENSION
THUMB THUMB CMC CMC JOINT JOINT FLEXION
THUMB CMC THUMB JOINT CMC JOINT EXTENSION
THUMB CMC THUMB JOINT CMC JOINT ABDUCTION
THUMB CMC THUMB JOINT CMC JOINT ADDUCTION
????????
Subject sitting with forearm resting on table, Wrist neutral, Forearm neutral, aligned with Stabilize metacarpal dorsal MCP aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT ADDUCTION.JPG to prevent motion Capsular joint metacarpal phalange
Proximal IP Finger Joints bone on bone (if tissues overlying Subject sitting with palmar aspect of forearm resting on bones is thin) soft o PIP fingers - 102 table, Wrist, tissue o (index), 105 (long), metacarpal, and non- approximation (if o o 108 (ring), 106 (little) tested interphalangeal tissues overlying ( active motion), DIP joints relaxed, palmar aspect of fingers - 72o (index), 71o Forearm neutral, bones is thick), dorsal (long), 63o (ring), 65o Stabilize proximal Distal IP Finger proximal (little) ( active motion), bone to prevent Joints and Thumb IP interphalan o ..\..\..\goniometry links\INTERPHALANGEAL JOINT FLEXION.JPG IP thumb - 73 motion Joint capsular geal joint Subject sitting with forearm resting on table, Wrist, metacarpal, and nonPIP fingers - 7o (index tested interphalangeal and long), 6o (ring), 9o joints relaxed, (little) ( active motion), Forearm neutral, dorsal o DIP fingers - 8 (all Stabilize proximal proximal finger DIPs). IP thumb bone to prevent interphalan o ..\..\..\goniometry links\INTERPHALANGEAL JOINT EXTENSION.JPG 5 motion capsular geal joint
aligned with aligned with proximal middle phalange phalange
aligned with aligned with proximal middle phalange phalange
??????????
Subject sitting with forearm supinated and resting on table, Wrist neutral, Stabilize aligned with carpals to prevent carpometac aligned with metacarpal of ..\..\..\goniometry CARPOMETACARPAL JOINT FLEXION.JPG wristlinks\THUMB motion capsular arpal joint radius thumb
??????????
Subject sitting with forearm supinated and resting on table, Wrist neutral, Stabilize aligned with carpals to prevent carpometac aligned with metacarpal of ..\..\..\goniometry CARPOMETACARPAL JOINT EXTENSION.JPG wristlinks\THUMB motion capsular arpal joint radius thumb
70o
Subject sitting with forearm resting on table, Wrist neutral, aligned with Forearm neutral, Muscle stretch metacarpal aligned with Stabilize carpals to (adductor pollicus, radial of index metacarpal of ..\..\..\goniometry links\THUMB CARPOMETACARPAL JOINT ABDUCTION.JPG prevent wrist motion skin, fascia) styloid finger thumb
00 ??????
Subject sitting with forearm resting on table, Wrist neutral, aligned with Forearm neutral, metacarpal aligned with Stabilize carpals to Soft tissue radial of index metacarpal of ..\..\..\goniometry links\THUMB CARPOMETACARPAL ADDUCTION.JPG prevent wrist motion approximation JOINT styloid finger thumb
THUMB CMC THUMB JOINT CMC JOINT OPPOSITION
HIP
HIP
HIP
HIP
HIP
HIP
HIP FLEXION
Subject sitting with forearm supinated and Use a ruler to measure resting on table, Wrist Capsular or soft Goniometer distance between tip of neutral, Stabilize fifth tissue cannot be thumb and base of fifth ..\..\..\goniometry CARPOMETACARPAL OPPOSITION.JPG Able to touch tip of thumb to base of metacarpal fifth links\THUMB finger approximation JOINT used finger
o
121.0 +/- 6.4
o
HIP EXTENSION 12.0 +/- 5.4
o
o
Subject supine, Allow knee to flex (to avoid limitation by tight hamstrings), Stabilize pelvis to prevent ..\..\..\goniometry links\HIP FLEXION.JPG rotation, Flex hip Capsular
aligned with aligned with greater midline of femur (lateral trochanter plevis epicondyle)
Subject prone, Stabilize pelvis to prevent rotation, Capsular or ..\..\..\goniometry links\HIP EXTENSION.JPG Extend hip ligamentous
aligned with aligned with greater midline of femur (lateral trochanter plevis epicondyle)
HIP ADDUCTION 27.0o +/- 3.60
Subject supine, Stabilize pelvis to prevent pelvic list, Capsular or ..\..\..\goniometry links\HIP ABDUCTION.JPG Abduct hip ligamentous Subject supine, Stabilize pelvis to prevent pelvic list, Abduct opposite hip (to allow room for tested limb to adduct), Capsular or ..\..\..\goniometry links\HIP ADDUCTION.JPG Adduct hip ligamentous
HIP MEDIAL (INTERNAL) ROTATION
Subject sitting on table, knee flexed, Stabilize distal thigh, medially (internally) center of ..\..\..\goniometry links\HIP MEDIAL (INTERNAL) ROTATION.JPG rotate hip Capsular patella
aligned vertically
aligned with leg (crest of tibia)
Subject sitting on table, knee flexed, Stabilize distal thigh, hip laterally center of ..\..\..\goniometry links\HIP LATERAL Capsular (EXTERNAL) ROTATION.JPG (externally) rotat patella
aligned vertically
aligned with leg (crest of tibia)
o
HIP ABDUCTION 41.0 +/- 6.0
HIP LATERAL (EXTERNAL) ROTATION
KNEE
KNEE FLEXION
KNEE
KNEE EXTENSION
o
44.0 +/- 4.3
o
44.0 +/- 4.8
0
o
o
141o +/- 5.3o
o
minus 2.0 +/- 3.0
o
anterior superior iliac spine (ASIS)
aligned with aligned with opposite femur (center ASIS of patella)
anterior superior iliac spine (ASIS)
aligned with aligned with opposite femur (center ASIS of patella)
Subject supine, Allow Soft tissue ..\..\..\goniometry links\KNEE FLEXION.JPG hip to flex Flex knee approximation
lateral aligned with aligned with epicondyle greater lateral of femur trochanter malleolus
Subject prone, Stabilize femur, ..\..\..\goniometry links\KNEE Extend Knee EXTENSION.JPG Capsular
lateral aligned with aligned with epicondyle greater lateral of femur trochanter malleolus
Knee flexion should be measured with the subject supine. This position allows assessment of the joint range of motion without interference from tightness in the rectus femoris muscle. If the examiner wishes to assess length of the rectus femoris, have the patient lie prone (see 2nd ..\..\..\goniometry links\KNEE FLEXION 2.JPG illustration).
ANKLE
ANKLE DORSIFLEXION 13o +/- 4.4o
Subject prone, Flex knee, Stabilize subtalar in neutral, Dorsiflex ankle by pushing through 5th ..\..\..\goniometry links\ANKLE metatarsal head DORSIFLEXION.JPG Capsular
ANKLE
ANKLE PLANTARFLEXIO N 56o + or - 6.1o
Subject supine, Extend knee, Stabilize leg, ..\..\..\goniometry links\ANKLE Plantarflex ankle PLANTARFLEXION.JPG Capsular
CALCANEA CALCANEAL L JOINT INVERSION
CALCANEA CALCANEAL L JOINT EVERSION
MID TARSAL
MIDTARSAL INVERSION
o
37.0 + or - 4.5
o
21.0 +/- 5.0
o
o
Subject prone, Stabilize tibia in sagittal plane (rotate hip or pelvis to align ..\..\..\goniometry links\CALCANEAL tibia), Invert calcaneusINVERSION.JPG Capsular
Subject prone, Stabilize tibia in sagittal plane (rotate hip or pelvis to align ..\..\..\goniometry links\CALCANEAL tibia), Evert calcaneusEVERSION.JPG Capsular
??????????
Subject supine, Stabilize calcaneus and talus, Invert ..\..\..\goniometry links\MIDTARSAL INVERSION.JPG forefoot Capsular
??????????
Subject supine, Stabilize calcaneus and talus, evert ..\..\..\goniometry links\MIDTARSAL EVERSION.JPG forefoot Capsular
lateral malleolus
aligned with aligned with fifth fibular head metatarsal
lateral aligned with malleolus fibular head automatical ly positioned by alignment of aligned with goniometer midline of arms leg automatical ly positioned by alignment of aligned with goniometer midline of arms leg automatical ly positioned by alignment of aligned with goniometer midline of arms leg automatical ly positioned by alignment of aligned with goniometer midline of arms leg
Pronation of the sub-talar joint can compensate for a loss of ankle joint dorsiflexion range of motion. To avoid measurement error (by accidentally including sub-talar pronation), the sub-talar joint must be stabilized in its neutral position. To assess the range of JOINT motion, flex the knee (first illustration). To assess tightness of the gastrocnemius muscle, extend the knee (second illustration).
Assessing Gastrocnemius Tightness (muscle stretch ..\..\..\goniometry links\Assessing Gastrocnemi end-feel)
aligned with fifth metatarsal
aligned with midline of calcaneus
aligned with midline of calcaneus
aligned with plantar aspect of metatarsal heads
Subject supine, METATARS Stabilize 1st medial to o o 1st - 50 , 2nd - 40 , OMTP JOINT metatarsal in center of PHALANGE DORSIFLEXION 3rd - 30o , 4th - 20o , 5th plantarflexion, metararsal aligned ..\..\..\goniometry links\METATARSOPHALANGEAL JOINT head DORSIFLEXION.JPG AL JOINT (Extension) - 10o Dorsiflex MTP Capsular metatarsal
aligned with plantar aspect of metatarsal heads Range of first metatarsophalangeal (MTP) joint dorsiflexion is functionally important for gait. The available range of 1st MTP joint dorsiflexion depends on the position of the 1st ray. A plantarflexed 1st ray allows greater range of 1st MTP dorsiflexion. I recommend stabilizing the 1st ray in plantarflexion to measure maximum range Assessing MTP of 1st MTP dorsiflexion. The first photo Dorsiflexion by demonstrates a good method for measuring 1st Placing or 5th MTP joint dorsiflexion by placing the Goniometer on goniometer alongside the bones. This technique Dorsum of aligned with cannot be used for the 2nd, 3rd, or 4th MTP Bones (requires proximal joints. The second photo shows a technique for modified ..\..\..\goniometry links\Assessing phalange measuring these joints. goniometer) MTP Dorsifl
METATARS Subject supine, medial to 1st - 30o , 2nd - 30o , OMTP JOINT Stabilize 1st center of PHALANGE PLANTARFLEXIO 3rd - 20o , 4th - 10o , 5th metatarsal, Planterflex metararsal aligned o ..\..\..\goniometry JOINT head PLANTARFLEXION.JPG AL JOINT N (Flexion) - 10 MTP links\METATARSOPHALANGEAL Capsular metatarsal
Assessing MTP Plantarflexion The first photo demonstrates a good method for by Placing measuring 1st or 5th MTP joint plantarflexion by Goniometer on placing the goniometer alongside the bones. This Dorsum of technique cannot be used for the 2nd, 3rd, or 4th Bones (requires MTP joints. The second photo shows a technique modified ..\..\..\goniometry links\Assessing for measuring these joints. goniometer) MTP Plantar
MID TARSAL
MIDTARSAL EVERSION
aligned with proximal phalange
METATARS OPHALANGE MTP JOINT AL JOINT ABDUCTION
METATARS OPHALANGE MPT JOINT AL JOINT ADDUCTION
??????????
dorsum of Foot flat on table, center of aligned with Stabilize metatarsal, metararsal aligned with proximal ..\..\..\goniometry links\METACARPOPHALANGEAL JOINT ABDUCTION.JPG Abduct MTP Capsular head metatarsa phalange
??????????
dorsum of Foot flat on table, center of aligned with Stabilize metatarsal, metararsal aligned with proximal ..\..\..\goniometry links\METATARSOPHALANGEAL JOINT head ADDUCTION.JPG Adduct MTP Capsular metatarsa phalange
75.5o + or - 8.5o (20 CERVICAL SPINE 29 yrs.), 70.5o + or FORWARD 17.5o (30 - 49 yrs.), BENDING 64.5o + or - 7o (>50 (flexion) yrs.)
Subject sitting with lumbar and thoracic spines supported, Stabilize lumbar and external thoracic spines, Flex Capsular or auditory ..\..\..\goniometry links\CERVICAL SPINE FORWARD BENDING (flexion).JPG vertical cervical spine ligamentous meatus
SPINE
75.5o + or - 8.5o (20 CERVICAL SPINE 29 yrs.), 70.5o + or BACKWARD 17.5o (30 - 49 yrs.), BENDING 64.5o + or - 7o (>50 (extension) yrs.)
Subject sitting with lumbar and thoracic spines supported, Stabilize lumbar and external thoracic spines, auditory ..\..\..\goniometry links\CERVICAL SPINE BACKWARD BENDING (extension).jpg Extend cervical spine Bony or Capsular meatus vertical
SPINE
Subject sitting with lumbar and thoracic spines supported, 50.5o + or - 5.5o (20 Stabilize lumbar and 29 yrs.), 46.5o + or thoracic spines, spinous CERVICAL SPINE 6.5o (30 - 49 yrs.), 40o Sidebend cervical Capsular or process of ..\..\..\goniometry SIDEBENDING.JPG SIDEBENDING + or - 8.5o (>50 yrs.) spinelinks\CERVICAL SPINE ligamentous C7
posterior spinous midline of processes of head at thoracic occipital spine protuberance
SPINE
Subject sitting with lumbar and thoracic 91.5o + or - 5.5o (20 spines supported, 29 yrs.), 81o + or - 6.5o Stabilize lumbar and CERVICAL SPINE (30 - 49 yrs.), 77.5o + thoracic spines, Rotate Capsular or ..\..\..\goniometry links\CERVICAL SPINE ROTATION.JPG ROTATION or - 7.5o (>50 yrs.) cervical spine ligamentous
aligned with acromion aligned with processes tip of nose
SPINE
THORACOLUMBAR SPINE FORWARD BENDING (flexion) 10 cm
SPINE
picture 2
center of superior aspect of head
aligned with nostrils
aligned with nostrils
Tape Measure Alignment Subject standing, Flex thoracic and lumbar Capsular or ..\..\..\goniometry links\THORACO-LUMBAR SPINE FORWARD BENDING (flexion).JPG spines ligamentous Spinous processes of C7 and S1
..\..\..\goniometry links\THORACO-LUMBAR SPINE FORWARD BENDING (flexion) 2.JPG
The position of the mouth influences the available range of cervical backward bending. With the mouth closed, thghtness of the infrahyoid and suprahyoid muscles can limit range of cervical backward bending. If you wish to assess the range of the cervical spine, the mouth should be relaxed and slightly open.
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the forward bending position. Note the difference.
SPINE
SPINE
SPINE
Subject standing, Capsular or Extend thoracic and ligamentous Tape Measure Alignment ..\..\..\goniometry links\THORACO-LUMBAR SPINEbony) BACKWARD BENDING (extenion).JPG lumbar spines (sometimes Spinous processes of C7 and S1
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the backward bending position. Note the difference
..\..\..\goniometry links\THORACO-LUMBAR SPINE BACKWARD BENDING (extenion) 2.JPG picture 2 Normal Range (unilateral) RIGHT: 20 29 yrs 37.6o + or 5.8o,,, 30 - 39 yrs 35.3o + or - 6.5o,,, 40 - 49 yrs 27.1o + or - 6.5o,,, 50 59 yrs 25.3o + or 6.2o,,, 60 - 69 yrs 20.2o + or - 4.8o,,, 70 - 79 yrs 18.0o + or - 4.7o,,, LEFT: 20 - 29 yrs 38.7o + or - 5.7o,,, 30 - 39 yrs 36.5o + or - 6.0o,,, 40 - 49 yrs 28.5o + or 5.2o,,, 50 - 59 yrs 26.8o + or - 6.4o,,, 60 Subject standing, THORACO- 69 yrs 20.3o + or Stabilize pelvis, LUMBAR SPINE 5.3o,,, 70 - 79 yrs Sidebend thoracic and Capsular or S1 spinous C7 spinous ..\..\..\goniometry links\THORACO-LUMBAR SPINE SIDEBENDING.JPG vertical SIDEBENDING 18.9o + or - 6.0o lumbar spines ligamentous process process
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise.
THORACOLUMBAR SPINE BACKWARD BENDING (extenion) ????????????
THORACOLUMBAR SPINE ROTATION 45o
Subject sitting, Stabilize pelvis, Do not allow sidebending, forward bending or center of backward bending, superior Rotate thoracic and Capsular or aspect of ..\..\..\goniometry links\THORACO-LUMBAR SPINE ROTATION.JPG lumbar spines ligamentous head
TM JOINT
TM JOINT OPENING
35 to 50 mm, or two and 1/2 flexed PIPs
Use a ruler to measure the distance between the upper and lower incisors,,,,, Alternate method - have the subject flex the proximal Subject sitting, interphalangeal joints (PIPs) of the Stabilize cervical Capsular or fingers and assess how many PIPs can ..\..\..\goniometry links\TEMPEROMANDIBULAR JOINT OPENING.JPG spine, Open Mouth ligamentous fit between the teeth
TM JOINT
TM JOINT PROTRUSION
3 to 5 mm
Subject sitting, Stabilize cervical spine, Protrude Capsular or Use a ruler to measure the distance ..\..\..\goniometry links\TEMPEROMANDIBULAR JOINT PROTRUSION.JPG mandible forward ligamentous between the upper and lower incisors
10 to 15mm
1 - Identify points on the upper and lower teeth that are aligned when the mouth is in resting position (upper and lower incisors in this illustration) 2 Subject sitting, Deviate the mandible laterally and use Stabilize cervical a ruler to measure the distance spine, Deviate Capsular or between the two points (upper and ..\..\..\goniometry links\TEMPEROMANDIBULAR JOINT LATERAL DEVIATION.JPG mandible laterally ligamentous lower incisors in this illustration)
SPINE
TM JOINT
TM JOINT LATERAL DEVIATION
aligned with anterior superior iliac spines
aligned with anterior superior iliac spines
There are several methods for measuring the range of motion of the lumbar and thoracic spines. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). The method illustrated here is a good compromise.
..\..\..\goniometry links\TEMPEROMANDIBULA
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