GONIOMETRY

INTRODUCTION
The term GONIOMETRY derived from two Greek
words, GONIA meaning ANGLE, & METRON,
meaning MEASURE.
Goniometry refers to measurement of angles created
by the bones of the body at the joints.
Measuring instrument used by the examiner is called
GONIOMETER.
Goniometry is used to measure & document the
amount of active & passive joint motion as well as
abnormal fixed joint motion.
Determine the presence or absence of impairment.
Establishing a diagnosis.
Develop a prognosis, treatment goals, & plan of care.
To evaluate progress
Modify treatment
Motivating the patient
To fabricate orthoses
For research purposes-ROM used as a variable.
JOINT MOTION
 ARTHROKINEMATICS
ARTHROKINEMATICS refers to movements of joint
surfaces.
When a joint moves, 3 types of motion can occur
between the two articulating surfaces.:
1. Rolling
2. Sliding
3. Spinning
In a pure rolling motion, Each subsequent point on
one surface contacts a new point on the other surface.
In sliding/gliding---the same point on one surface
contacts new points on the other surface.
In human body, slides, spins, & rolls usually occur in
combination with each other & result in angular
movement of the shafts of the bones.
Arthrokinematic motions are examined for amount of
motion, tissue resistance at the end of motion(end
feel), & effect on the patient’s symptoms.
The ranges of arthrokinematic motions are very small
& cannot be measured with a goniometer.
Arthrokinematic motions are subjectively compared
to the same motion on the contra lateral side of the
body.
These motions are also called accessory or joint play
motion.
 OSTEOKINEMATICS
Osteokinematics refers---gross movement of the
shafts of bones.
Goniometry measures the angles created by the rotary
motion of the shafts of the bones.
 PLANES & AXES
Osteokinematics motions takes place in one of the three
cardinal planes of the body (SAGGITAL,
FRONTAL,TRANSVERSE) around three corresponding
axes (medial-lateral, anterior-posterior, vertical).
Sagittal:- The median sagittal plane divides the body into
right & left halves. Movement occurs in medial-lateral
axis.
Frontal:- Divides body into front & back halves.
Movement occurs in anterior-posterior axis.
Transverse:- Divides body into upper & lower halves.
Movement occurs in vertical axis.
 RANGE OF MOTION
Range of motion (ROM) is the arc of motion that
occurs at a joint.
Starting position for measuring all ROM, except
rotation in the transverse plane, is anatomical
position.
3 notation system have been used to define ROM
1. 0 to 180 degree system
2. 180 to 0 degree system
3. 360 degree system
Normally, a ROM begins at 0 degrees & proceeds in an
arc towards 180 degrees.
This 0 to 180 degrees system of notation, also called
NEUTRAL ZERO METHOD.
The 180 to 0 degrees notation system defines
anatomical position as 180 degrees. ROM begins at 180
degrees & proceeds in an arc towards 0 degrees.
360 degree notation system
 ACTIVE RANGE OF MOTION
AROM is the arc of motion attained by a subject
during unassisted voluntary joint motion.
 PASSIVE RANGE OF MOTION
PROM is the arc of motion attained by an examiner
without assistance from the subject.
Normally passive ROM is slightly greater than active
ROM.
 END-FEEL
Amount of passive ROM is determined by the unique
structures of the joint being tested.
In some joints joint capsules limits the end of the
ROM or motion in particular direction.
In some joints the ligaments limit the end of a
particular motion.
Other normal limitations to motion include passive
tension in soft tissue (muscles, fascia, & skin, soft
tissue approximation & contact of joint surface)
The type of structure, that limits a ROM has a
characteristic feel which is experienced by an examiner
as a barrier to further motion at the end of a passive
ROM, is called the END FEEL.
 NORMAL END FEELS
END FEEL DESCRIPTION EXAMPLE
SOFT Soft tissue approximation Knee flexion
FIRM Muscular stretch Hip flexion with knee
straight
Capsular stretch Extension of MCP joint of
fingers
Ligamentous stretch Forearm supination
HARD Bone contacting bone Elbow extension
END
ABNORMAL END FEELS
DESCRIPTION EXAMPLE
FEEL
SOFT Occurs sooner or later in the ROM than Soft tissue edema
is usual or in a joint that normally has a Synovitis
firm or hard end-feel. Feels boggy
FIRM Occurs sooner or later in the ROM than Increased muscular tone
is usual or in a joint that normally has a Capsular ligament, fascia
soft or hard end-feel shortening
HARD Occurs sooner or later in the ROM than Chondromalacia
is usual or in a joint that normally has a Osteoarthritis
soft or firm end-feel. A bony grating or Loose bodies in joint
bony block is felt. Myositis ossificans
Fracture
EMPTY No real end-feel because pain prevents Fracture
reaching end of ROM. No resistance is Abscess
felt except for patient’s protective Bursitis
muscle splinting or muscle spasm. Acute joint inflammation
 HYPOMOBILITY
Hypomobility refers to decrease in passive ROM.
Limitation in ROM due to joint pathology, muscle
imbalance etc.
 CAPSULAR PATTERNS OF RESTRICTED
MOTION
Cyriax proposed that pathological conditions
involving the entire joint capsule cause a particular
pattern of restriction involving all or most of the
passive motion of the joint.
This pattern of restriction is called CAPSULAR
PATTERN
NONCAPSULAR PATTERNS OF RESTRICTED
MOTION
A limitation of passive motion that is not
proportioned similarly to a capsular pattern is called a
NONCAPSULAR PATTERN.
Usually caused by a condition involving structures
other than the entire joint capsule .
Internal joint derangement, ligament shortening,
muscle strains, & muscle contractures.
Noncapsular patterns usually involve only one or two
motions of a joint, in contrast to capsular pattern,
which involve all or most motions of a joint.
 HYPERMOBILITY
HYPERMOBILITY refers to an increase in passive
ROM that exceeds normal values, given the subject’s
age & gender.
Hypermobility is due to the laxity of soft tissue
structures such as ligaments, capsules,& muscles that
normally prevent excessive motion at a joint.
 TYPES OF GONIOMETER
UNIVERSAL GONIOMETER
Most commonly used to measure joint position &
motion in the clinical setting.
Universal goniometer may be constructed of plastic or
metal & are produced in many sizes & shapes.
Design includes: BODY, A STATIONARY ARM &
MOVING ARM.
BODY- Resembles a protactor---may form a half circle or
a full circle---half circle goniometer read from 0 to 180
degrees & from 180 to 0 degrees.
Scales on a full circle instrument may read either from 0
to 180 degrees & from 180 to 0 degrees, or from 0 to 360
degrees & from 360 to 0 degrees.
STATIONARY ARM:- Structural part of the body of the
goniometer & cannot be moved independently from the
body.
MOVING ARM:- Attached to the center of the body by a
rivet that permits the arm to move freely on the body.
GRAVITY-DEPENDENT GONIOMETERS
(INCLINOMETERS)
Gravity-dependent goniometers or inclinometers
uses gravity effect on pointers & fluids levels to
measure joint position & motion.
The pendulum goniometer consists of a 360 degree
protractor with a weighted pointer hanging from the
center of the protractor.
The fluid (bubble) goniometer has a fluid filled
circular chamber containing an air bubble.
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