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Principles of Goniometry

Overview
The term goniometry is derived from two Greek words, gonia meaning angle and metron, meaning measure. Thus, a goniometer is an instrument used to measure angles. Within the field of physical therapy, goniometry is used to measure the total amount of available motion at a specific joint. Goniometry can be used to measure both active and passive range of motion. Goniometers are produced in a variety of sizes and shapes and are usually constructed of either plastic or metal (see clip labeled Gonio_introduction). The two most common types of instruments used to measure joint angles are the bubble inclinometer and the traditional goniometer.
  • Bubble goniometer. The bubble goniometer, which has a 360° rotating dial and scale with fluid indicator can be used for flexion and extension; abduction and adduction; and rotation in the neck, shoulder, elbow, wrist, hip, knee, ankle, and the spine.
  • Traditional goniometer. The traditional goniometer, which can be used for flexion and extension; abduction and adduction; and rotation in the shoulder, elbow, wrist, hip, knee, and ankle, consists of three parts:
    1. A body. The body of the goniometer is designed like a protractor and may form a full or half circle. A measuring scale is located around the body. The scale can extend either from 0 to 180 degrees and 180 to 0 degrees for the half circle models, or from 0 to 360 degrees and from 360 to 0 degrees on the full circle models.[1] The intervals on the scales can vary from 1 to 10 degrees
    2. A stationary arm. The stationary arm is structurally a part of the body and therefore cannot move independently of the body
    3. A moving arm. The moving arm is attached to the fulcrum in the center of the body by a rivet or screw-like device that allows the moving arm to move freely on the body of the device.[1] In some instruments , the screw-like device can be tightened to fix the moving arm in a certain position or loosened to permit free movement.
The correct selection of which goniometer device to use depends on the joint angle to be measured. The length of arms varies among instruments and can range from 3-18 inches. Extendable goniometers allow varying ranges from 9 ½ inches to 26 inches (see clip labeled Gonio_introduction). The longer armed goniometers, or the bubble inclinometer are recommended when the landmarks are further apart, such as when measuring hip, knee, elbow, and shoulder movements. In the smaller joints such as the wrist and hand and foot and ankle, a traditional goniometer with a shorter arm is used.

Procedure[1]
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. NB: In the accompanying videos, it is assumed that the procedure up until this point has been completed.

The clinician palpates the relevant bony landmarks and aligns the goniometer. 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 the available range of motion, the goniometer is replaced and realigned, and a measurement is read and recorded.

Active ranges of motion of the larger joints

JOINTACTIONDEGREES OF MOTION
Shoulder Flexion
Extension
Abduction
Internal rotation
External rotation
0-180
0-40
0-180
0-80
0-90
ElbowFlexion0-150
Forearm Pronation
Supination
0-80
0-80
Wrist Flexion
Extension
Radial deviation
Ulnar deviation
0-60
0-60
0-20
0-30
Hip Flexion
Extension
Abduction
Adduction
Internal rotation
External rotation
0-100
0-30
0-40
0-20
0-40
0-50
KneeFlexion0-150
Ankle Plantarflexion
Dorsiflexion
0-40
0-20
Foot Inversion
Eversion
0-30
0-20

Active range of motion norms for the hand and fingers

MotionDegrees
Finger flexionMCP:85-90; PIP: 100-115; DIP: 80-90
Finger extensionMCP:30-45; PIP: 0; DIP: 20
Finger abduction20-30
Finger adduction0
Thumb flexionCMC: 45-50; MCP: 50-55; IP: 85-90
Thumb extensionMCP: 0; IP: 0-5
Thumb adduction30
Thumb abduction60-70

Normal ranges of motion, and end feels, for the toes[2, 3]

MotionNormal Range (Degrees)End Feel
Toe flexionGreat toe: MTP, 45º; IP, 90º
Lateral four toes: MTP, 40º; PIP, 35º; DIP, 60º
Tissue stretch
Toe extensionGreat toe: MTP, 70º; IP, 0º
Lateral four toes: MTP, 40º; PIP, 0º; DIP, 30º
Tissue stretch

  1. Norkin, C.C. and D.J. White, Techniques and procedures, in Measurement of joint motion: A guide to goniometry, C.C. Norkin and D.J. White, Editors. 1988, FA Davis: Philadelphia. p. 9-24.
  2. Rasmussen, O., Stability of the ankle joint. Acta Orthop. Scandinavica, 1985. Suppl. 211: p. 56-78.
  3. Seto, J.L. and C.E. Brewster, Treatment approaches following foot and ankle injury. Clin Sports Med, 1985. 13: p. 295







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