Naveen K PT 12/03/2020

GONIOMETRY
12/03/2020
12/03/2020 NAVEEN
NAVEENK KPTPT
OUTLINE
What is goniometry ?
 Importance of goniometry
 Types of goniometer
 Universal Goniometer
 Range of Motion
 Planes and Axes of joint motion
 Important Notes
 Procedures for Goniometric measurement
 ROM measurement
 Current Trends 2
 References
12/03/2020 NAVEEN K PT
WHAT IS GONIOMETRY
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 Goniometry is the measuring of angles created by
the bones of the body at the joints.1, 2, 3
 The term goniometry is derived from two
Greek
words, gonia meaning angle and metron, meaning
measure. 1, 2, 3, 4, 5,
 System to measure the joint ranges in each plane
of the joint is termed goniometry. 4
 These measurements are done 1,with
inclinometers or by visual estimate. 2, 3, 4, 5 3
instrument such as goniometer,
a tape measure,
IMPORTANCE OF GONIOMETRY
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 Goniometry is useful in determining
 the presence of dysfunction
 establishing a diagnosis
 developing goals
 evaluating progress,
 fabricating orthoses
 a measurement for research purposes 4, 5, 6
TYPES OF GONIOMETERS
 Electro goniometer
 Universal goniometer sensor with angle meter
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 Gravity goniometer/
inclinometer Single and twin axis
goniometer
 Bubble goniometer  Digital goniometer
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 Arthroidal protractor
 Smartphone soft wares
UNIVERSAL GONIOMETER
A universal goniometer may be constructed of metal
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or plastic and it has three parts
 A body
 Fulcrum
 Stationary arms
 Moving arms
The body of the goniometer is designed like a

protractor and may form a full or half circle; and on
it is a scale from 0 to 180 or 360 1, 2, 3
The fulcrum is a rivet or screw-like device at the
center of the body that allows the moving arm to
7
move freely on the body of the device.1, 2, 3, 4, 5 6,
UNIVERSAL GONIOMETER
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The fulcrum and body is placed over the joint being
measured 3, 4, 5, 6, 7, 8
The stationary arm will be aligned with the inactive
part of the joint measured while the moving arm is
placed on the part of the limb which is moved in
the joint’s motion1, 2, 3, 4, 5, 6, 7.
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RANGE OF MOTION
 Range of motion can be defined as the amount
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of motion available at a joint. 5
 Each specific joint has a normal range of motion
that is expressed in degrees. 1
 Joint ranges are divided into
 Active range of motion AROM
 Passive range of motion PROM
 The structure involved with movement of the
bones as well as the bony arrangements are
factors in limiting motion. 1, 2, 3,4. 10
RANGE OF MOTION
 Determinants of joint ROM
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 Normal
 Age
 Gender
 Others such as ADL, right vs left, body physique,

active vs passive ROM
 Abnormal
 Tight soft tissues around the joint
 Muscle insufficiency
 Adhesion
 Foreign body
11
RANGE OF MOTION
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 The end-feel is the feeling which is experienced
by the examiner as a barrier to further motion at
the end of a PROM.
 These normal end-feels have been described as
soft, firm, and hard. The same terms are used to
describe abnormal end-feels with the addition of
"empty". 1, 2, 3
12
RANGE OF MOTION
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Contraindications to ROM testing:
 Dislocation or unhealed fracture in the region,
 immediately following surgery,
 On medication for pain or muscle relaxants (careful)
 Regions of osteoporosis or bone fragility,
 Patients with hemophilia,
 Immediately after an injury where disruption of tissue

is present.
13
PLANES AND AXES OF JOINT MOTION
 Motion at a joint occurs as a result of movement of
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one joint surface in relation to another. 1

Arthrokinematics is the term used to refer to the
movement of joint surfaces. The movements at
the joint surfaces are described as slides (glides),
spins, and rolls. These three usually occur in
combination with each other and result in
movement of the shafts of the bones. 1, 2, 3, 4, 5, 9,
 Osteokinematics refers to the movement of the
shafts of the bones. These are usually described
in terms of rotary movement about an axis of 14
motion. 1, 2, 3
PLANES AND AXES OF JOINT MOTION
 Goniometry measures the angles created by the
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rotary motion of the shafts of the bones.1, 2, 3, 4
 Osteokinematic motions are classically described
as taking place in one of the three cardinal planes
of the body (sagittal, frontal, and transverse)
around three corresponding axes (medial-lateral,
anterior-posterior, and vertical).
 The three planes lie at right angles to one another
whereas the three axes are both at right angles to
the corresponding plane and to each other.1, 2, 3, 4
15
PLANES AND AXES OF MOVEMENT
ANATOMICAL POSITION
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VALIDITY AND RELIABILITY OF GONIOMETER
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 According to the American Academy of Orthopeadic
Surgeons, Kendall and McCreary, Hoppenfeld, and the
American Medical Association. 1, 2, 3, 4, 5, 6, 7
 Content validity – it is assumed that the angle created
by aligning the arms of the goniometer with bony
landmarks truly represents the angle. “The accurate
application of knowledge and skills, combined with
interpreting the results as measurement of range of
motion only, provide sufficient evidence to ensure
content validity.”
 Reliability – overall good to excellent reliability. Higher
reliability has been found for measurements of join1t7
position compared to range of motion.
VALIDITY AND RELIABILITY OF GONIOMETER
 Reliability varies depending on the joint being measured.
Intratester reliability is found to be higher than intertester
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reliability
 Advantages
• Good reliability and validity.

• Ease of use.
• Inexpensive.
•Can be used to establish presence or absence of dysfunction and also
monitor progress
 Limitations
• Reliability dependent on examiner experience.
• Reliability varies depending on what joint is measured.
• Requires consistency in positioning, stabilization, and alignment. 18
• Some disagreement between sources for normal values of range
of
motion.
IMPORTANT NOTES
 The starting position for measuring all ROM is the
anatomical position except for rotation in
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transverse plane.
 Be aware of the position the body is supposed to
be in for movement and any stabilization issues.
 Stabilize the part of the body that is proximal
(stationary portion) to the joint you are testing.
 The patient do not move his while
body moving the joint; this step the the
isolates
movement for a more accurate measurement. joint
 There are three notation of
19
measurement
goniometric which are 0-180º, 180-0º and
0- 360º.
IMPORTANT NOTES
 Zero degrees is the neutral starting position
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 Consistently use the same stationary and movable
landmarks on the body when measuring, to
ensure consistency.
 The angle of movement from the stationary arm to
the moving arm is read off the body and reported
as the ROM.
 Look at the reading on the goniometer at eye level
before removing it from the patient’s body.
 Be sure to record the ROM of the joint
 Compare reading with contralateral side 20
PROCEDURE FOR GONIOMETRIC MEASUREMENT
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 The patient is positioned in the recommended
testing
position.
 While stabilizing the proximal joint component, the
clinician gently moves the distal joint component through
the available range of motion until the end feel is
determined.
 An estimate is made of the available range of motion
and the distal joint component is returned to the starting
position.
 The clinician palpates the relevant bony landmarks and
21
aligns the goniometer.
PROCEDURE FOR GONIOMETRIC MEASUREMENT
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 A record is made of the starting measurement.
 The goniometer is then removed and the patient
moves the joint through the available range of
motion.
 Once the joint has been moved through
available range of motion, the goniometer the
replaced and realigned, and a measurement is read
is
and recorded.
 Repeat measurement three times and record the
average as the goniometric value for the joint’s
ROM
22
ROM MEASUREMENT
 Shoulder ROM Extension:
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Flexion:  Motion: 0-45º~60º from
 Motion: 0-180º neutral position
 Position: Subject supine with  Position: Subject prone or sitting ,
knees flexed or sitting. elbow elbow in slight flexion with the
extended with the palm facing the palm facing the body.
body  Goniometer: Axis at the acromion
 Goniometer: Axis at the process, laterally through the head of
acromion process, laterally through the humerus
the head of the humerus.  Stationary Arm aligned with mid-
 Stationary arm is placed along the axillary line of the trunk
mid-axillary line of the trunk  Moving arm along the lateral mid-line
 Moving arm place along the lateral of humerus in line with lateral
23
mid-line of the humerus in line with epicondyle.
the lateral epicondyle.
Abduction: OR
 Motion:0-180º Goniometer: Axis
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 Position: Supine, prone at
or sitting with the limb in
anatomic position the
 Goniometer: Axis at anterior the humerusposterior
in line lateral
portion of acromion process. with
portion of the acromion process;
 Stationary arm at lateral aspect of epicondyle
Stationary arm aligned parallel to spinous
anterior surface of chest parallel to Adduction:
process of the vertebral colomn
midline of sternum.
 Moving arm on anterior aspect of Motion:
Moving arm0-30º
aligned with the midline of
arm parallel to midline of humerus Aligment of goniometer is
and in line with medial epicondyle.
same for abduction.
24
External rotation: Internal rotation:
 Motion: 0-90º  Motion: 0-65~90º
 Position: Supine. Shoulder is  Positioning and goniometer
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abducted to 90º. Elbow flexed alignment is same as in
with forearm in neutral and external rotation
perpendicular to table top such
that the palm is facing the feet.
Elbow not supported. Humerus
is fully supported on the table.
Stabilize the distal humerus,
thorax, and scapula.
 Goniometer: Axis at olecranon
process of the ulna.
 Stationary arm placed parallel to the
table top or perpendicular to the
floor.
 Moving arm along the ulnar shaft 25
aligned with the styloid process of
the ulna.
 Radio-ulnar ROM
Supination: Pronation:
 Motion: 0- 80º~ 90º  Motion: 0- 80º~ 90º
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 Position: Subject sitting or  Position: same for supination
supine, with the elbow
 Goniometer: Axis is lateral
to 90º. Shoulder in
flexed
degrees of its’ ROM. Position
zero to the ulnar styloid process.
starts midway between  Stationary arm is aligned parallel to the
Supination and Pronation. anterior midline of the humerus.
 Moving arm across the dorsum of the
 Goniometer: Axis is medial to wrist on a line between and proximal to
the ulnar styloid process. the styloid process of the radius and
 Stationary arm is aligned parallel the ulna.
to the anterior midline of
the
humerus.
 Moving
aspect of armthe wrist
acrossonthea
ventral
line between and proximal to 27
styloid
theprocess of the radius and
the ulna.
 Wrist ROM Extension:
Flexion:  Motion: 0-60º~70º
 Motion: 0-60º~80º  Position and goniometer: same
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 Position: Subject sitting, for flexion
shoulder in 90º of abduction; Ulnar deviation:
elbow flexed to 90º. The forearm
Motion: 0-30º~35º
placed in between
and pronation such that the
supination Radial deviation:
palm of the hand parallels the  Motion: 0-
floor.
20º
 Goniometer: Axis is distal to the
 Position: same for
ulnar styloid process or over the  Goniometer: Axis is at the middle of
lateral aspect of the wrist over the wrist flexion
the dorsal aspect of the wrist over the
triquetrum capitate.
 Stationary arm parallel to and over  Stationary arm midline on the
the lateral midline of the ulna, in line surface of the forearm in line with the
dorsal
with the olecranon. lateral epicondyle of the humerus. 28
 Moving arm along the  Moving arm along midline of the dorsal
lateral surface of the 3rd MC.
midline of the 5th MC.
HAND JOINTS ROM7
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29
 Hip ROM
Flexion:
Extension:
 Motion: 0-100º~125º
 Motion: 0-10º~30º
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 Position: Supine or side  Position: Prone or Side lying on
lyingthe opposite limb to be
on
the opposite limb to measured; the
measured; limb in
limb in anatomical position
position with knee flexed at the
anatomical
end of the motion.  Goniometer alignment is the
 Goniometer: Place the axis at same for hip flexion.
the lateral aspect of the hip *Stabilise the pelvis when
joint over the greater trochanter.
measuring hip flexion and
 stationary arm is parallel to the long
axis of the trunk in line with the extension.
greater trochanter or the
lateral midline of the pelvis
 moving arm is placed along the
lateral midline of the femur in line 30
with lateral epicondyle of the femur
Abduction: Adduction:
 Motion: 0 - 40º~50º  Motion: 0-20º~30º
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 Position: Supine with the limb  Position: Supine, with opposite
in anatomical position (0º of all limb abducted
limb joints ROM)  Goniometer alignment
 Goniometer: axis at the anterior is same as for hip
superior iliac spine(ASIS) of the abduction
*Stabilise the pelvis
measured limb.
 Stationary arm is at an imaginary
horizontal line extending from one
ASIS to the other.
 Moving arm is with the anterior
midline of the femur, in line with the
midline of the patella.
31
External Rotation: Internal Rotation:
 Motion: 0-40º~50º  Motion: 0-40º~45º
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 Position:  Positioning and goniometer
Supine, with
knees
extended over table alignment is same as in
the
OR Prone withknee flexed hip external rotation
HighOR
sitting with 90º flexion of
hip and knee, 0º of hip
*Stabilise the femur pelvis
abduction and adduction
 Goniometer: axis over the
anterior mid patella
 Stationary arm is parallel to the
supporting surface or the floor
 Moving arm is placed along the
anterior surface of the tibia
midway between the malleoli.
32
 Knee ROM
Extension:
Flexion:
 Motion: note any
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 Motion: 0-135º~150º
hyperextension
 Position: Supine, knees in
 Positioning and goniometer
extension with hip flexed
to 90o at end of the motion alignment is same with knee
prone
OR lying with flexion.
extended foot over the
knee  Extension is an
edge
motion to flexion
opposite
 of the supportingAxis
Goniometer: surface.
is placed
over the lateral epicondyle of the
*The thigh should be stabilized
femur in flexion motion
 Stationary arm is parallel to the measurement
lateral midline of the femur in line
with the greater trochanter
 Moving arm is placed lateral at 33
the midline of the fibula in line
with the lateral malleolus.
 Ankle ROM
Plantarflexion:
Dorsiflexion:
 Motion:0-40º~50º
 Motion:0-20º
 Positioning and
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 Position: Subject was sitting alignment goniometer
with legs off the table or on dorsiflexion is same with
high sitting with lower leg at
right angle to the thigh and the
Inversion:
foot at right angle to the lower  Motion:0-15º~20º
leg as the zero  Position: same with dorsiflexion
position.
starting
 Goniometer: axis is midway
 Goniometer: fulcrum was aligned
slightly inferior to the lateral between the two malleoli at the
malleolus. anterior aspect of the ankle
 Stationary arm is with the midline  Stationary arm is with the anterior
of the lateral aspect of the lower midline of tibia in line with the tibial
leg, in line with the head of fibula. tuberosity
 Moving arm was parallel to the 5th  Moving arm is with anterior
metatarsal. the midline of the 2nd 34
metatarsal.
 Subtalar ROM
 Eversion: Inversion:
 Motion:0-5º
 Motion:0-15º~20º
 Position: prone lying with hip and
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 positioning and goniometer
alignment is same as for knee in 0º of all their joints’ ROM, foot
inversion is off the supporting surface such that
the toes are point downwards
 Goniometer: axis is over the posterior
aspect of the ankle midway between the
two malleoli.
 Stationary arm is with posterior midline of
the leg
 Moving arm is with posterior midline of the
calcaneus.
Eversion:
 Motion:0-5º
 Positioning and goniometer alignm35ent
is same as for inversion.
 Cervical ROM Lateral flexion:
Flexion:  Motion:0-45º
 Motion:0-45º  Position: same as flexion
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 Position: with  goniometer: axis is on the spinous
and head
sitting neck in anatomical process of the 7th cervical vertebra
position, lumbar and thoracic  Stationary arm is with the
region supported on back rest spinous processes thoracic
of the vertebrae
 Goniometer: axis on the perpendicular to the floor
external auditory meatus  Moving arm is with the
 Stationary arm is perpendicular to midline of the head in line with occipital
posterior
the floor in line with head protuberance
 Moving arm is with the base of the
nares
 Extension:
 Motion:0-45º
36
 Positioning and goniometer
alignment is same as
flexion
 Lumbar ROM
Rotation: Flexion:
 Motion: 0-60º~80º  Motion: 4inches
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 Position: same as for flexion  Position: standing and in
 Goniometer: axis over the anatomical position
centre of the cranial aspect of the  Tape Measure: Placed
head proximately at the C7 spinous process
 Stationary in line with an and
S1; distally at the difference between
calculate
arm
imaginary line between the two standing and flexion ending position.
acromial processes
Extension:
 Moving arm is with the tip of the
nose  Motion:2inches
 Position: same with flexion
 Tape Measure: Placed proximately

at the C7 spinous process and distally at
S1; calculate the difference between
standing and extension ending posit3io7n.
Lateral flexion: Rotation:
 Motion: 0-25º~35º  Motion:0-30º~45º
 Position: same as flexion  Position: same as flexion
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 Goniometer: axis over the  Goniometer: axis at the centre
spinous process of 1st sacral of
vertebra  the cranial aspect of the head
Stationary
 Stationary arm arm is parallel with
imaginary the line
is
between the two
perpendicular to the floor
prominent tubercles on the iliac crest.
 Moving arm is in line with the  Moving arm is with an imaginary line
spinous process of the of the between the two acromial processes
7th cervical vertebra
 Tape Measure: Placed
and distally
proximally at theatfinger
the tips
lateral
malleolus; the
calculate
difference between sides when 38
standing and with side
bending.
CURRENT TRENDS
 The use of inclinometer software to measure ROM in a
joint. In a study by Brian et al, (2013), it was inferred that
9/15/2015
Smart phones have good correlation with the “gold
standard” goniometer for measuring shoulder range of
motion. Additionally, there is good correlation amongst
different levels of providers with measurements obtained
using the smart phone
 Drgoniometer 12
 The use of sensor and goniometer probe setup to measure

joint ROM. It usually convenient for large joints
 It is designed as a sensor pad connected to a
potentiometer or a probe connected to a sensor angle
meter 7, 8
39
9/15/2015
40
12/03/2020
12/03/2020 NAVEEN
NAVEENK KPTPT
9/15/2015
Example of goniometric measurement
using DrGoniometer as it appears on 41
the smartphone screen
CONCLUSION
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 Goniometric measurement is an important skill all
physiotherapist must have as it employed in almost all
area of physiotherapy practice.
 There are different instrument for measurement of joint’s
range of motion but the universal goniometre remains the
gold standard due to it’s excellent validity and reliability in
most articles. It also has advantages such as ease of use,
inexpensive, easily available and accuracy.
 Though some other instrument are as reliable and valid as
the universal goniometer but the cost of purchase,
availability and ease of use may not be met.
42
REFERNCES
1. Norkin, C.C. & White, D.C. (1988) Techniques and procedures, in Measurement of joint motion:
A guide to goniometry. In Norkin & White, Eds. FA Davis: Philadelphia. p. 9-24.
2. Norkin, & White.(1995) Measurement of Joint Motion: A Guide to Goniometry. 2nd ed.
Philadelphia, PA: F.A. Davis Company.
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3. Norkin, & White.(2003) Measurement of Joint Motion: A Guide to Goniometry. 3rd ed.
Philadelphia, PA: F.A. Davis Company;.
4. The British Orthopaedic Association (1983) Joint motion: method of measuring and recording. In
Heck, C.V., Hendryson, I.E., Rowe, C.R. (eds). Edinburg: Churchill Livingstone.
5. Gadjosik, & Bohannon(1987) Clinical measurement of range of motion: review of goniometry
emphasizing reliability and validity. Physical Therapy; 67: 1867-1872.
6. Gogia, Braatz, Rose, & Norton.(1987) Reliability and validity of goniometric measurements at the
knee. Physical Therapy; 67: 192-195.
7. Nadeau, Kovacs, Gravel, Piotte, Moffet, Gagnon, & Hebert.(2007) Active movement
measurements of the shoulder girdle in healthy subjects with goniometer and tape measure
techniques: A study on reliability and validity. Physiotherapy Theory and Practice.; 23: 179-187.
8. Brian, C.W., Chris, M.K., Justin, W.G., Matthew, L.L., Joseph, M.H., & Stephen F.B.(2013)
Shoulder Range of Motion: Validation of an Innovative Measurement Method Using a
Smartphone The Orthopaedic Journal of Sports Medicine, 1(4)(suppl 1)
9. MacDermid, et al.(1999) Range of motion measurement. Journal of Hand Therapy; 12:187-192.
43
REFERNCES
9/15/2015
10. Rasmussen, O.(1985) Stability of the ankle joint. Acta Orthop. Scandinavica; Suppl.
211: p. 56-78.
11. Seto, J.L. & Brewster,C.E.(1985) Treatment approaches following foot and ankle injury.
Clinical Sports Medicine; 13: p. 295
12. Ferriero,G., Sartorio, F., Foti,C., Primavera,D., Brigatti, E.& Vercelli, S. (2012)
Reliability of a New Application for Smartphones (DrGoniometer) for Elbow Angle
Measurement. The American Academy of Physical Medicine and Rehabilitation; Vol.
3:1153-1154
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GONIOMETRY

 Smartphone soft wares

The body of the goniometer is designed like a

 Others such as ADL, right vs left, body physique,

 Tight soft tissues around the joint

 immediately following surgery,

 On medication for pain or muscle relaxants (careful)

 Regions of osteoporosis or bone fragility,

 Patients with hemophilia,

 Immediately after an injury where disruption of tissue

 Motion at a joint occurs as a result of movement of

• Good reliability and validity.

 Zero degrees is the neutral starting position

 Compare reading with contralateral side 20

 Shoulder ROM Extension:

 Position: Supine. Shoulder is  Positioning and goniometer

 Position: same with flexion

 Tape Measure: Placed proximately

 Position: same as flexion  Position: same as flexion

 The use of sensor and goniometer probe setup to measure

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