Joint mobility (ROM test)
(I) General matters of rangeofmotionROM examination
1. Purpose of ROM examination
(1) To detect the factors that hinder joint movement through the examination.
(2) To determine the degree of impairment.
(3) To suggest treatment methods.
(4) To be used as an evaluation tool for treatment and training.
2.Types of ROM
(1) Active activity: The degree of joint mobility that the subject can move by self-reliance.
(2) Passive activity: the degree of joint mobility that can be moved with external force.
(3) In addition to passive activity, there is also non-physiological additional joint mobility (accessory), which is mainly used for rehabilitation manipulative therapy.
3.Basic posture
All joints of the body are placed in 0° according to the anatomical posture of the Rauch. The forearm motion palm surface in the sagittal plane state is 0 ° axis, the concept of surface and anatomical consistency.
(B) ROM representation method
In the literature, ROM is expressed in different ways. One method uses the anatomical site as the “O” regardless of flexion or extension, and when the joint is restricted in extension, the measured angular number may become a negative number. The other method uses “O” for full extension in flexion and “180” for full extension in extension, which can avoid negative numbers, but complicates the calculation of total joint mobility.
(iii) Factors limiting ROM
1. Abnormalities in the bony anatomy of the joint.
2, soft tissue lesions around the joint, such as joint capsule adhesions, ligament injuries, tendon contractures, etc.
3. Weakness of the muscles that move the joint.
4.High antagonist muscle tone.
(D) Notes on ROM measurement
1.The joint to be measured must be fully exposed, especially for women, a single room and dressing room should be prepared for the examination. A third party must be present when examining the opposite sex.
2. The patient should be calm and patient, so that he/she can adopt a relaxed posture.
3.Fixation of the basic axis is very important. The position of fixation should be at the proximal or distal end of the joint, not at the joint.
4.The axis of the goniometer should be made in line with the axis of the joint and should not hinder the equal movement of the axis.
5, with the angle meter to be measured twice, that is, before and after the measurement of the activity, and left and right control.
6.For the joint with two joint muscles (multi-joint muscles), the influence of the muscles should be fully considered.
7.When there is joint pain, the range of pain should be found and recorded, and attention should be paid to checking slowly.
(V) ROM measurement method
1.Ordinary protractor method
Visual measurement of ROM is rougher, so generally use a protractor for inspection. The ordinary protractor is made of two straight edges connected with a semicircular protractor or a full-circular protractor, and the finger joints are measured with a small semicircular protractor. (See Figure 2-1-7.) When used, the center of the protractor is accurately aligned with the center of the axis of joint movement (with reference to certain bony landmarks), and the distal ends of the two rulers are placed or pointed at the bony landmarks on the limb at each end of the joint or parallel to the long axis of the limb. As the distal limb of the joint is moved, the joint mobility is read on the protractor dial. See Table 2-1-3 for details of each joint measurement.
Joint Protractor
Figure 2-1-7 Joint Protractor
Table 2-1-3 Joint range of motion check
Joint motion measurement posture goniometer placement mark 0 point normal value center proximal distal shoulder flexion, extension anatomical position, back against the column standing shoulder peak axillary (plumb line) humerus epicondyle two feet phase re-flexion 180 °
Extension 50° abduction ditto ditto ditto ditto ditto 180° internal and external rotation supine, shoulder abduction elbow flexion 90° hawk’s beak plumb line ulnar styloid ditto each 90° elbow flexion, extension anatomical position humerus epicondyle crest ulnar styloid two feet into a straight line flexion 150° extension 0° wrist flexion, extension anatomical position radial styloid forearm longitudinal axis second metacarpal head two feet into a straight line flexion 90° ulnar, radial flexion anatomical position wrist joint midpoint ditto third metacarpal Bone as above radial flexion 25°
ulnar flexion 65° hip flexion supine, contralateral hip hyperextension femoral greater trochanter horizontal line femoral epicondyle two feet into a straight line 125° extension supine, contralateral hip flexion ditto ditto ditto ditto ditto 15° adduction, abduction supine, avoid thigh rotation anterior superior iliac spine contralateral anterior superior iliac spine patellar center two feet into a right angle each 45° internal and external rotation supine, two calf table edge
external inferior patellar lower lead line tibial anterior edge two feet phase weight each 45 ° knee flexion, extension supine femoral external ankle femoral greater trochanter external ankle two feet into a straight line flexion 150 °
Extend 0 ° ankle flexion, extension supine internal ankle femur internal ankle first metatarsal head two feet into a right angle flexion 150 ° extension 0 ° internal, external rotation prone ankle posterior two ankle calf posterior longitudinal axis heel midpoint two feet into a straight line internal rotation 35 ° midpoint external rotation 25 °
2.Square disk protractor measurement method
Fan Zhenhua in 1974 designed a square plate protractor, with a square, each side is 12 cm long, on a circular dial of wooden amidships, plus a pointer and handle composition (Figure 2-1-8). The pointer in the center of the square disk automatically points upward because the center of gravity is downward when the scale surface of the wooden disk is in the vertical position. The angle of the joint can be read by taking the appropriate position so that both limbs of the joint are in the same vertical plane, and making one limb in the horizontal or vertical position, and pressing one side of the square disk against the other limb so that the scale surface is in the same vertical plane with the limb. The specific operation of each joint measurement is shown in Table 2-4.
Square Disc Protractor
Figure 2-1-8 Square disk protractor
Table 2-1-4 Checking joint mobility with a square disk protractor
Joint motion measurement posture goniometer placement position goniometer dial orientation normal value shoulder flexion, extension standing, head, back, sacrum close to the column upper arm posterior middle 0 point to proximal flexion 180 ° extension 50 ° abduction same upper arm inner edge middle same 180 ° internal and external rotation supine, shoulder abduction, elbow flexion 90 ° forearm ulnar edge middle and lower section 0 point to distal internal rotation 80 °, external rotation 90 ° elbow flexion, extension sitting, upper arm Flat against the tabletop mid-dorsal forearm ulnar
Beneath the skin of the bone 0 point towards the ulna flexion 150 ° extension 0 ° forearm internal and external rotation standing, the upper arm lateral tightly against the column surface, elbow flexion 90 °, hand clutching the protractor handle protractor handle tightly against the palm 0 point towards the radial side internal rotation 55 °, external rotation 135 ° wrist flexion, extension forearm flat against the table, palm down the third metacarpal back 180 ° point towards the metacarpal flexion 80 °, extension
70° ulnar and radial flexion ditto, palm vertical, thumb palmar flexion second metacarpal radial margin ditto ulnar flexion 40°, radial flexion 20° hip flexion supine, contralateral hip over extension mid thigh 180° point opposite thigh 120° extension ditto, contralateral hip flexion ditto ditto 15° adduction abduction lateral, all the way to the ends of the ruler on the two anterior superior iliac spines, measure this size tilt, in adduction, abduction measurement results subtracted from the lateral thigh The middle part of the same as above, each 45° of internal and external rotation supine, legs apart and straightened with the medial edge of the palm of the foot pointing to the distal end of the 0 point of internal rotation 50°, external rotation 65° knee flexion and extension.
Sitting or supine in the anterior mid muscle and anterior mid calf each measured once, summed 180° point pointing to the knee
180° pointing to the knee 160° flexion, 5° extension
Flexion 160°, extension 5° ankle plantarflexion standing palm not off the ground, calf as far back as possible anterior mid tibial edge 0 pointing to proximal 40° dorsal extension as above, heel not off the ground, calf anterior tilt as above as above 25° internal and external rotation lying to the affected side, calf flat against the consultation table, external ankle on the edge of the table immediately above the transverse arch of the palm 0 pointing to medial internal rotation of the foot 45°, external rotation 20°.