ROM Practical

Shoulder Flexion
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Terms in this set (27)
Shoulder Flexion
Normal range: 0-180 degrees

Axis: A point at which motion occurs through the lateral aspect of the glenohumeral joint . It lies apps 1 in below the acromion process.

Stationary arm: Parallel to the lateral midline of the trunk

Moveable arm: Parallel to the longitudinal axis of the humerus on the lateral side

Substitutions: Trunk extension/rotation, shoulder abduction

Muscles (notice this is shoulder flexion, not elbow):
*Deltoid (anterior fibers)
*Pectoralis major (upper fibers)
Biceps brachii
Coracobrachialis
Image: Shoulder Flexion
Shoulder Extension
Normal range: 0-60 degrees

Axis: Approximately 1 inch below the acromion process through the lateral aspect of the glenohumeral joint

Stationary arm: Parallel to the lateral midline of the trunk

Moveable arm: Parallel to the longitudinal axis of the humerus on the lateral side

Substitutions: Trunk flexion/rotation, excessive scapular elevation and downward rotation, shoulder abduction

Muscles (notice this is shoulder extension, not elbow):
*Deltoid (posterior fibers)
*Latissimus dorsi
Teres major
Pectoralis major (lower fibers)
Triceps brachii (long head)
Image: Shoulder Extension
Shoulder Abduction/Adduction
Normal range: 0-180 degrees

Axis: A point through the anterior or posterior aspect of the glenohumeral joint

Stationary arm: Along the trunk, parallel to the spine

Moveable arm: Parallel to the longitudinal axis of the humerus

Substitutions: Lateral flexion of the trunk, scapular elevation, shoulder flexion or extension

Muscles of abduction:
Deltoid (all fibers)
Supraspinatus

Muscles of adduction:
*Latissimus dorsi
*Teres major
Infraspinatus
Teres minor
Pectoralis major (all fibers)
Triceps brachii (long head)
Coracobrachialis
Image: Shoulder Abduction/Adduction
Shoulder horizontal Abduction
Normal range: from 90 degrees of shoulder abduction (0-45 degrees)

Axis: On top of the acromion process

Stationary arm: Across the shoulder, anterior or posterior to the neck and in line with the opposite acromion process

Moveable arm: Parallel to the longitudinal axis of the humerus on the superior aspect

Substitutions: Trunk rotation or flexion, scapular motion, shoulder flexion

Muscles:
*Deltoid (posterior fibers)
Image: Shoulder horizontal Abduction
Shoulder horizontal Adduction
Normal range: From 90 degrees of shoulder abduction through 90 degrees of shoulder flexion across the trunk to the limit of motion (0-140 degrees)

Axis: On top of the acromion process

Stationary arm: Across the shoulder, anterior or posterior to the neck and in line with the opposite acromion process

Moveable arm: Parallel to the longitudinal axis of the humerus on the superior aspect

Substitutions: Trunk rotation, scapular motion, shoulder flexion/extension

Muscles:
*Deltoid (anterior fibers)
Pectoralis major (upper fibers)
Image: Shoulder horizontal Adduction
Shoulder Internal (Medial) Rotation
Normal range: 0-70 degrees

Axis: Olecranon process of the ulna

Stationary arm: Perpendicular to the floor which will be parallel to the lateral trunk if the client is sitting with hips at 90 degrees

Moveable arm: Parallel to the longitudinal axis of the ulna

Substitutions: Scapular elevation and downward rotation, trunk flexion, elbow extension

*Remember: The goniometer reads 90 degrees at the start and this score must be adjusted from the final score when recording ROM

Muscles:
*Deltoid (anterior fibers)
*Latissimus dorsi
Teres major
Subscapularis
Pectoralis major (all fibers)
Shoulder External (Lateral) Rotation
Normal range: From the 90 degree abducted start position it is 0-90 degrees

Axis: Olecranon process of the ulna

Stationary arm: Perpendicular to the floor

Moveable arm: Parallel to the longitudinal axis of the ulna

Substitutions: Scapular depression and upward rotation, trunk extension, elbow extension

*Remember: The goniometer reads 90 degrees at the start and this score must be adjusted from the final score when recording ROM

Muscles:
*Deltoid (posterior fibers)
Infraspinatus
Teres minor
Elbow Flexion/Extension
Normal range: 0-150 degress

Axis: Lateral epicondyle of the humerus

Stationary arm: Parallel to the longitudinal axis of the arm on the lateral side

Moveable arm: Parallel to the longitudinal axis of the radius

Muscles of Flexion:
*Biceps brachii
Brachialis
Brachioradialis

Muscles of Extension:
*Triceps brachii (all heads)
Anconeus
Image: Elbow Flexion/Extension
Forearm supination
Normal range: 0-80 degrees

Axis: Longitudinal axis of the forearm displaces toward the ulnar side

Stationary arm: Perpendicular with the floor and parallel with the humerus

Moveable arm: Across the distal radius and ulna on the solar surface

Substitutions: Adduction and external rotation of the shoulder

*Place goniometer on the inside of the arm/wrist (soup side)

Muscles:
*Biceps brachii
*Supinator
Image: Forearm supination
Forearm pronation
Normal range: 0-80 degrees

Axis: Longitudinal axis of forearm displaced toward the ulnar side

Stationary arm: Perpendicular to the floor and parallel to the humerus

Moveable arm: Across the distal radius and ulna on the dorsal surface

Substitutions: Abduction and internal rotation of the shoulder

*Place goniometer on the outside of the arm (dorsal side)

Muscles:
*Pronator teres
*Pronator quadratus
Image: Forearm pronation
Wrist Flexion (Volar Flexion)Normal range: 0-80 degrees Axis: On the dorsal aspect of the wrist joint in line with the base of the third metacarpal in the proximal capitate region Stationary arm: Along the midline of the dorsal surface of the forearm Moveable arm: Parallel to the longitudinal axis of the third metacarpal Muscles: *Flexor carpi radialis (FCR) *Flexor carpi ulnaris (FCU) Palmaris longus (weak) Flexor digitorum superficialis (FDS)Wrist Extension (Dorsiflexion)Normal range: 0-70 degrees Axis: On the dorsal aspect of the wrist joint in line with the base of the third metacarpal in the proximal capitate region Stationary arm: Along the midline of the solar surface of the forearm Moveable arm: Parallel to the longitudinal axis of the third metacarpal Muscles: *Extensor carpi radialis longus & brevis *Extensor carpi ulnaris (FCU)Wrist Ulnar Deviation (Adduction)Normal range: 0-30 degrees Axis: On the dorsal aspect of the wrist joint in line with the base of the third metacarpal over the capitate where the motion is observed Stationary arm: Along the midline of the forearm on the dorsal surface Moveable arm: Along the midline of the third metacarpal Substitutions: Wrist extension, wrist flexion *towards the ulna Muscles: *Extensor carpi ulnaris (ECU) *Flexor carpi ulnaris (FCU)Wrist Radial Deviation (Abduction)Normal range: 0-20 degrees Axis: On the dorsal aspect of the wrist joint in line with the base of the third metacarpal over the capitate Stationary arm: Along the midline of the forearm on the dorsal surface Moveable arm: Along the midline of the third metacarpal Substitutions: Wrist extension *towards the radius Muscles: *Extensor carpi radialis longus & brevis *Extensor carpi ulnaris (ECU) Extensor pollicis brevis & longus Flexor carpi radialis (FCR) Abductor pollicis longus (APL)Thumb Carpometacarpal FlexionNormal range: 0-15 degrees Axis: On the radial side of the wrist at the junction of the base of the first metacarpal and the trapezium Stationary Arm: Parallel to the longitudinal axis of the radius Moveable arm: Parallel to the longitudinal axis of the first metacarpal Muscles: *Flexor pollicis longus & brevisThumb Carpometacarpal ExtensionNormal range: 0-20 degrees Axis: On the volar side of the wrist at the junction of the base of the first metacarpal and the trapezium Stationary arm: Parallel to the longitudinal axis of the radius Moveable arm: Parallel to the longitudinal axis of the first metacarpal Muscles: *Extensor pollicis longus & brevis Abductor pollicis longus (APL)Thumb Metacarpophalangeal Flexion-ExtensionNormal range: 0-50 degrees Axis: On the dorsal aspect of the MP joint Stationary arm: On the dorsal surface along the midline of the first metacarpal Moveable arm: On the dorsal surface along the midline of the proximal phalanx of the thumb Muscles of Flexion: *Flexor pollicis longus & brevis Muscles of Extension: *Extensor pollicis longus & brevisThumb Interphalangeal Flexion-ExtensionNormal range: 0-80 degrees Axis: On the dorsal aspect of the interphalangeal (IP) joint Stationary arm: On the dorsal surface along the proximal phalanx Movable arm: On the dorsal surface along the distal phalanx Muscles of flexion: *Flexor pollicis longus (FPL) Muscles of extension: *Extensor pollicis longus (EPL)Thumb Palmar AbductionNormal range: 0-70 degrees Axis: Over the trapezium on the dorsal aspect of the hand Stationary arm: On the dorsal surface parallel to the second metacarpal Moveable arm: Parallel to the first metacarpal Muscles: *Abductor pollicis brevisThumb Radial AbductionNormal range: 0-80 degrees Axis: Over the trapezium on the dorsal aspect of the hand Stationary arm: On the dorsal surface parallel to the second metacarpal Moveable arm: Parallel to the first metacarpal Muscles: *Abductor pollicis longusOppositionRecord the distance from the tip of the thumb pad to the tip end of the little finger or base of little finger Muscles: Opponens pollicisFinger Metacarpophalangeal Flexion-ExtensionNormal range: 0-90 degrees Axis: On the dorsal aspect of the MP joint of the finger being measured Stationary arm: On the dorsal surface along the midline of the metacarpal of the finger being measured Moveable arm: On the dorsal surface along the midline of the proximal phalanx of the finger being measured Muscles of flexion: *Flexor digitorum superficialis and profundus (FDS and FDP) Muscles of extension: *Extensor digitorum (ED) and Extensor digiti minimi (*for #5 only) and Extensor indicis (*for #2 only)Finger Proximal Interphalangeal Flexion-ExtensionNormal range: 0-100 degrees Axis: On the dorsal aspect of the proximal interphalangeal (PIP) joint of the finger being measured Stationary arm: On the dorsal surface along the midline of the proximal phalanx of the finger being measured Moveable arm: On the dorsal surface along the midline of the middle phalanx of the finger being measured Muscles of flexion: *Flexor digitorum superficialis (FDS) *Flexor digitorum profundus (FDP) Muscles of extension: *Extensor digitorum LumbricalsFinger Distal Interphalangeal Flexion-ExtensionNormal range: 0-90 degrees Axis: On the dorsal aspect of the distal interphalangeal (DIP) joint of the finger being measured Stationary arm: On the dorsal surface along on the midline of the middle phalanx of the finger being measured Moveable arm: On the dorsal surface along the midline of the distal phalanx of the finger being measured Muscles of flexion: *Flexor digitorum superficialis (FDS) *Flexor digitorum profundus (FDP) Muscles of extension: *Extensor digitorum LumbricalsFinger AbductionMovement of the index, ring and little fingers away from the midline of the hand in the frontal plane. Axis: On the dorsal aspect of the MP joint of the finger being measured Stationary arm: Along the dorsal surface of the metacarpal of the finger being measured Moveable arm: Along the dorsal surface o1f the proximal phalanx of the finger being measured Muscles: Dorsal interosseiFinger AdductionMovement of the index, ring and little fingers toward the midline of the hand in a frontal plane. Axis: On the dorsal aspect of the MP joint of the finger being measured Stationary arm: Along the dorsal surface of the metacarpal of the finger being measured. The middle finger is not measured. Moveable arm: Along the dorsal surface of the proximal phalanx of the finger being measured Muscles: Palmar interosseiMetacarpophalangeal Deviation Correction MeasurementWhen there is ulnar deviation deformity of the MP joints, often seen in rheumatoid arthritis, this additional measurement is taken. The active range is compared with the passive range to determine whether muscle weakness is present. PROM is compared with the norm of 0 degrees deviation to determine whether a fixed deformity exists. Axis: Over the MP joint of the finger being measured Stationary arm: Placed along the dorsal midline of metacarpal Moveable arm: Placed along the dorsal midline of the proximal phalanx