End feel

exercise therapy

1. END FEEL K.SOUNDARARAJAN K. Soundararajan, SRIHER 1

2. General concept End feel Types Goniometry K. Soundararajan, SRIHER 2

3. GENERAL concept Passive ROM is determined by structure of joint Joint capsule limits the movements in particular direction Other limitation include muscle, skin , fascia, soft tissue approximation, contact of joint surface K. Soundararajan, SRIHER 3

4. End feel - meaning Type of structure that limits ROM has a characteristic feel , that may be detected by examiner who is performing the passive ROM This feeling , which is barrier to further motion at the end of a passive ROM , is called End feel K. Soundararajan, SRIHER 4

5. Definition One of the most important factors to investigate with passive range-of-motion testing is the end feel. The end feel is the quality of movement perceived by the practitioner at the very end of the available range of motion. The end feel can reveal a great deal about the nature of various pathologies. K. Soundararajan, SRIHER 5

6. Types of End feel Soft Firm Hard K. Soundararajan, SRIHER 6

7. NORMAL END FEEL End Feel Structure Example Soft Soft tissue approximation Knee flexion Firm Muscular stretch, Capsular stretch, Ligamentous stretch Hip flexion (knee straight) Extension of MCP Joint at finger Forearm supination Hard Bone contacting Bone Elbow extension K. Soundararajan, SRIHER 7

8. SHOULDER FLEXION Range of motion: 0-180 Patient’s position: supine lying Goniometer positioning: Movable arm = long axis of humerus Stable arm = parallel to the sternum Fulcrum = greater tubercle of humerus End feel = firm end feel K. Soundararajan, SRIHER 8

9. SHOULDER EXTENTION Range of motion: 0-40 Patient’s position: prone lying Goniometer position: Movable arm = long axis of humerus Stable arm = parallel to midline Fulcrum = greater tubercle of humerus End feel = firm end feel   K. Soundararajan, SRIHER 9

10. SHOULDER ABDUCTION & ADDUCTION Range of motion: 0-180 Patient’s position: supine Goniometer position: Moveable arm = long axis of humerus Stable arm = in line with trunk Fulcrum = acromion process End feel = firm end feel K. Soundararajan, SRIHER 10

11. LATERAL ROTATION Range of motion: 0-90 Patient’s position: supine lying, place a sheet below the hand and move the pillow to elbow to facilitate the scapula-humeral rhythm Goniometer position: Moveable arm = long axis of ulna Stable arm = in the line of trunk Fulcrum = olecranon process End feel = firm end feel K. Soundararajan, SRIHER 11

12. MEDIAL ROTATION Range of motion: 0-60 Patient’s position: supine lying, place a sheet below the hand and move the pillow to elbow to facilitate the scapula-humeral rhythm Goniometer position: Moveable arm = long axis of ulna Stable arm = in the line of trunk Fulcrum = olecranon process End feel = firm end feel K. Soundararajan, SRIHER 12

13. ELBOW FLEXION Range of motion: 0-150 Patient’s position: supine lying, place a sheet below the elbow to avoid compression of olecranon process. Goniometer position: Movable arm = long axis of radius Stable arm = long axis of humerus Fulcrum = lateral epicondyle of humerus End feel = firm end feel. K. Soundararajan, SRIHER 13

14. PRONATION Range of motion: 0-90 Patient’s position: sitting with forearm placed on a couch in midprone position, holding pen at folded hand. Place sheet below the hand Goniometer position: Movable arm = perpendicular to ground / Parallel to Pen Stable arm = at 90 degree / Perpendicular to ground Fulcrum = styloid process of ulna / 3 rd metacarpal bone End feel = firm end feel K. Soundararajan, SRIHER 14

15. SUPINATION Range of motion: 0-90 Patient’s position: sitting with forearm placed on a couch in midprone position, holding pen at folded hand. Place sheet below the hand Goniometer position: Movable arm = perpendicular to ground / Parallel to Pen Stable arm = at 90 degree / Perpendicular to ground Fulcrum = styloid process of ulna / 3 rd metacarpal bone End feel = firm end feel K. Soundararajan, SRIHER 15

16. WRIST FLEXION Range of motion: 0-80 Patient’s position: sitting with forearm placed on couch. Place a sheet below the hand Goniometer position: Movable arm = parallel to third M.C bone Stable arm = long arm of ulna Fulcrum = styloid process of ulna End feel = firm end feel   K. Soundararajan, SRIHER 16

17. WRIST EXTENTION Range of motion: 0-70 Patient’s position: sitting with forearm placed on couch. Place a sheet below the hand Goniometer position: Movable arm = parallel to third M.C bone Stable arm = long arm of ulna Fulcrum = styloid process of ulna End feel = firm end feel   K. Soundararajan, SRIHER 17

18. ULNAR DEVIATION Range of movement: 0-20 Patient’s position: sitting with forearm placed on the couch and pronated. place a sheet below the hand. Goniometer position: Movable arm =along third metacarpal bone Stable arm = along the middle of forearm Fulcrum = middle of wrist joint End feel = firm end feel.   K. Soundararajan, SRIHER 18

19. RADIAL DEVIATION Range of movement: 0-20 Patient’s position: sitting with forearm placed on the couch and pronated place a sheet below the hand. Goniometer position: Movable arm =along third metacarpal bone Stable arm = along the middle of forearm Fulcrum = middle of wrist joint End feel = firm end feel.   K. Soundararajan, SRIHER 19

20. HIP FLEXION Range of motion: 0-120 Patient’s position: side lying with knee flexion Goniometer position: Moveable arm = long axis of femur Stable arm = in line with the trunk Fulcrum = greater trochanter of femur End feel = firm end feel K. Soundararajan, SRIHER 20

21. HIP EXTENTION Range of motion: 0-30 Patient’s position: prone lying Goniometer position: Movable arm =long axis of femur Stable arm =in the line with trunk Fulcrum = greater trochanter of femur End feel = firm end feel   K. Soundararajan, SRIHER 21

22. HIP ABDUCTION Range of motion: 0-45 Patient’s position: supine lying Goniometer position: Movable arm = in the line with femur bone Stable arm = imaginary line between two ASIS Fulcrum = ASIS End feel = firm end feel K. Soundararajan, SRIHER 22

23. HIP ADDUCTION Range of motion: 0-45 Patient’s position: supine lying Goniometer position: Movable arm = in the line with femur bone Stable arm = imaginary line between two ASIS Fulcrum = ASIS End feel = firm end feel K. Soundararajan, SRIHER 23

24. MEDIAL ROTATION Range of motion: 0-45 Patient’s position: high sitting with sheet below the knee to prevent popliteal fossa compression. Goniometer position: Moveable arm = long axis of tibia Stable arm = perpendicular to ground Fulcrum = apex of patella End feel = firm end feel K. Soundararajan, SRIHER 24

25. LATERAL ROTATION Range of motion: 0-45 Patient’s position: high sitting with sheet below the knee to prevent popliteal fossa compression. Goniometer position: Moveable arm = long axis of tibia Stable arm = perpendicular to ground Fulcrum = apex of patella End feel = firm end feel K. Soundararajan, SRIHER 25

26. KNEE FLEXION & EXTENTION Range of motion: 0-150 Patient’s position: prone lying, patients should lie in end of couch to start from neutral position. Place a sheet below ankle Goniometer position: Movable arm = long axis of fibula Stable arm = in line with femur Fulcrum = lateral condoyle of femur End feel = soft feel K. Soundararajan, SRIHER 26

27. DORSIFLEXION Range of motion: 0-20 Patient’s position: high sitting, foot should be in neutral for gastronemius relaxation Goniometer position: Movable arm = fifth metacarpal bone Stable arm = long axis of fibula Fulcrum = lateral to lateral malleoli End feel = firm end feel   K. Soundararajan, SRIHER 27

28. PLANTAR FLEXION Range of motion: 0-30 Patient’s position: high sitting, foot should be in neutral for gastronemius relaxation Goniometer position: Movable arm = fifth metacarpal bone Stable arm = long axis of fibula Fulcrum = lateral to lateral malleoli End feel = firm end feel   K. Soundararajan, SRIHER 28

29. INVERSION   Range of motion: 0-20 Patient’s position: supine lying Procedure: place a paper below the heel and place a cardboard in line with the foot and draw a straight-line. Ask the patient to perform inversion and then draw a line. Measure with goniometer . End feel: firm end feel. K. Soundararajan, SRIHER 29

30. EVERSION   Range of motion: 0-10 Patient’s position: supine lying Procedure: place a paper below the heel and place a cardboard in line with the foot and draw a straight line. Ask the patient to perform inversion and then draw a line. Measure with goniometer . End feel: firm end feel. K. Soundararajan, SRIHER 30

31. Reference Measurement of Joint Motion A Guide to Goniometry ; Cynthia C.Norkin, D.Joyce White; Japee ; 3 rd edition. K. Soundararajan, SRIHER 31

32. K. Soundararajan, SRIHER 32

33. Doctors are lucky , The sun sees their success & the earth covers their mistake - Bushnell K. Soundararajan, SRIHER 33