Goniometer by K Divakar

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1. Goniometry
K DIVAKAR
BPT-2
nd
year,Batch:2019
Vapmscollege of physiotherapy

2. Introduction
ThetermgoniometryisderivedfromtwoGreekwords,gonia,meaningangle,
andmetron,meaningmeasure.
Therefore,goniometryreferstothemeasurementofangles,inparticularthe
measurementofanglescreatedathumanjointsbythebonesofthebody.
Theexaminerobtainsthesemeasurementsbyplacingthepartsofthemeasuring
instrument,calledagoniometer,alongthebonesimmediatelyproximalanddistal
tothejointbeingevaluated.
Goniometrymaybeusedtodeterminebothaparticularjointpositionandthetotal
amountofmotionavailableatajoint.
Goniometryisanimportantpartofacomprehensiveexaminationofjointsand
surroundingsofttissue.

3. Acomprehensiveexaminationtypicallybeginsbyinterviewingthesubjectand
reviewingrecordstoobtainanaccuratedescriptionofcurrentsymptoms;
functionalabilities;occupational,social,andrecreationalactivities;andmedical
history.
Observationofthebodytoassessboneandsofttissuecontour,aswellasskinand
nailcondition,usuallyfollowstheinterview.
Gentlepalpationisusedtodetermineskintemperatureandthequalityofsofttissue
deformitiesandtolocatepainsymptomsinrelationtoanatomicalstructures.
Anthropometricmeasurementssuchasleglength,circumference,andbody
volumemaybeindicated.
Thepurposeofgoniometryistomeasurethearcofmotionofajoint
Thegoniometeristhemostcommonlyusedinstrumenttomeasurethejointrangeof
motion.
TheseareManyshapesandsizes.

4. AllgoniometersHaveabodyandtwoarms.
ThebodyisfullorsemicircleswithaCentrepointcalledtheaxisorfulcrum.
Onearmiscalledstationaryarmandtheotherismovablearm.

5. Types of goniometer
1.Universal goniometer
2.Finger goniometer
3.Gravity dependent goniometer or fluid goniometer
4.Pendulum goniometer
5.Electro goniometer

6. Universalgoniometer:
Thisisaverycommonestvariety.ithasstationaryarm,movablearm,and
body
Fingergoniometer:
Afingergoniometermeasuresrangeofmotionoffingerjoints(M.C.P,I.P)and
othersmalljoints
Gravitydependentgoniometerorfluidgoniometer:
IthasgravityeffectingpointerandthefluidfilledChamberwiththeair
bubbles.
ItismostlyusedformeasuringthepelvictiltorDrop.

7. Pendulum goniometer:
It is designed by fox and vanbreemenin 1934
It consists of 360 degrees protractor with the weighted pointer.
Electrogoniometer:
It has two arms. One is attached with the proximal segment and another is
attached with the distal segment of the measuring joint.
The potentiometer is connected with these two arms.
Changes in the joint position show the angulations In the potentiometer.

8. Principles of goniometry
The examiner must have knowledge of the following principles for each joint
and motion:
Joint structure and function
Normal end-feels
Testing positions
Stabilization required
Anatomical bony landmarks
Instrument alignment
Instruct the patient to avoid any sort of trick movement while taking
measurment.

9. The examiner must also have the skill to perform the following for each joint
and motion:
Position and stabilize correctly
Move a body part through the appropriate range of motion (ROM)
Determine the end of the ROM and end-feel
Palpate the appropriate bony landmarks
Align the measuring instrument with landmarks
Read the measuring instrument
Record measurements correctly

10. Procedure
Goniometricmeasurementrequiresproperalignmentofthestationaryand
moveablearmsandthegoniometer'saxis.
Usebonylandmarkstoproperlyplacetheseelements.Placethestationary
armalongthelongitudinalaxisofthestabilizedjointsegmentandthe
moveablearmparalleltothelongitudinalaxisofthemovingjointsegment.
Whenusinga180°-scalegoniometer,youmayneedtoreversethestationary
andmovingarmsbeforethemoveablearmwillregisteronthescale.
Alignthegoniometer'saxiswiththejoint'saxisofmotion.
Ifthegoniometerarmsareaccuratelyplaced,thefulcrumwillbepositioned
correctly.

11. Theaxisisplacedatthejoint,thestationaryarmisalongthelongitudinal
aspectofthestabilizedsegment,andthemoveablearmisplacedin
alignmentwiththemovingsegment.
Tocorrectlyalignthegoniometerarms,positionyourselfsoyourlineofvisionis
atthesamelevelasthegoniometer.
Repeatthemeasurment3timesandrecordtheaverageasthegoniometric
values,forthejointsROM.
Often,youwillalignthestationaryarmandthenunwittinglymoveitagain
whenadjustingthemoveablearm;evenhighlyexperiencedcliniciansmakea
habitofcheckingandrecheckingthegoniometricarmandaxispositions
beforereadingthemeasurement.

12. Beforemeasuringrangeofmotion,youshouldexplaintothepatientwhat
youwilldo.
Takemeasurementsatthestartandendpositionsofthejointmotion.
IfyouareonlyinterestedintheendoftheROM,itisassumedthatthestart
positionis0°andhasbeenverifiedbyvisualdetermination.
ROMexaminationisusuallyperformedontheuninvolvedextremitybefore
theinjuredextremity.
Performingtheexaminationinthissequenceprovidesyouwithanideaof
whattoexpectwhenyouexamineROMoftheinjuredsegment.

13. Example:
Theleftupperextremityofasubjectinthesupinepositionisshown.The
partsofthemeasuringinstrumenthavebeenplacedalongtheproximal
(humerus)anddistal(radius)segmentsandcenteredovertheaxisofthe
elbowjoint.Whenthedistalsegmenthasbeenmovedtoward

14. Factors affecting ROM
Softtissuetightness:muscle,ligaments,capsule,cartilage,synovial
membranespasm.
Adhesionformation:lackofmobilityofthejointreducetheflexibilityand
thenourishmentcirculationaroundthejointstructure.
Injuriesorinflammation:injuriesorinflammationaroundthejointeg.OA,
RA,TB
Musclebulk:increasemusclebulkmaycausethereductionof
PROM/AROM
Sex:femaleismoreflexible
Nervoussystem:paralysis,hypomobility

15. Indications
Joint injury
Edemapain
Skin tightness
Spasticity
Adaptive shortening
Poor muscle
Muscle weakness
Joint stiffness
Muscle tightness,contracturs.

16. Contraindications
Dislocation of a joint
Diagnosis of mucositis ossificans
Infection of joint
Unstable joint
Infection or inflammatory conditions
Recent surgical procedure
Open wounds
Unhealed scar

17. Precautions
The therapist must take extra care when performing active or passive ROM
assessment where motion to the part might aggravate the condition, such as
in: -
Patients under medications for pain or muscle relaxants.
Patients with hemophilia.
Presence of an infection or inflammatory process in a joint.
Region of marked osteoporosis.
Region of hematoma (notably at the elbow, hip or knee).
Hyper-mobile or subluxedjoint.
Painful conditions,
where the assessment technique might reinforce the severity of symptoms.

18. GONIOMETRY MEASUREMENTS OF
UPPER LIMB
SHOULDER CLIENT POSITION ENDFEEL NROM
Humeral flexion: supine/sitting firm 0-180degress
Humeral extension: prone/sitting firm 0-60 degrees
Humeral abduction: sitting/standing firm 0-180 degrees
Humeral adduction: Sitting/standing Soft 80-0degrees
Humeral external rotation: prone firm 0-90 degrees
Humeral internal rotation: Prone firm 0-70 degrees
Humeral horizontal abduction: Sitting firm 0-45degrees
Humeral horizontal adduction: Sitting firm/soft 0-135 degrees

19. ELBOW CLIENT POSITION ENDFEEL NROM
Elbow flexion supine soft 0-135degrees
Elbow extension supine firm 135-0degrees
FOREARM
Supination Sitting firm 0-90 degrees
Pronation Sitting hard 0-90 degrees

20. WRIST JOINT CLIENT POSITION ENDFEEL NROM
Wrist flexion sitting firm 0-80degrees
Wrist extension sitting firm 0-70degrees
Wrist radial deviation sitting hard 0-20degrees
Wrist ulnardeviation sitting firm 0-30 degrees

21. DIGIT AND THUMB: CLIENT POSITION ENDFEEL NROM
Metacarpal flexion sitting hard 0-90degrees
Metacarpal extension Sitting firm 90-0degrees
Metacarpal hypertension sitting firm 0-30degrees

22. DIGIT: CLIENT POSITION ENDFEEL NROM
PIP flexion sitting hard 0-100degrees
PIP extension sitting firm 90-0degrees
DIP flexion sitting firm 0-90degrees
DIP extension sitting firm 90-0degrees
THUMB:
IP flexion sitting firm 0-90degrees
IP extension sitting firm 90-0degrees
MCP abduction sitting soft As compared to the unaffected extremity

23. THUMB: CLIENT POSITION ENDFEEL NROM
CMC flexion sitting soft 0-20degrees
CMC extension sitting firm 0-45degrees
CMC Abduction sitting firm 0-70degrees
CMC Adduction sitting soft -
HAND
Opposition of 1
st
and 5
th
sitting soft zero centimeters
digits

24. GONIOMETRIC MEASUREMENTS OF
LOWER LIMB
HIP CLIENT POSITION ENDFEEL NROM
Hip flexion supine soft 0-120 degrees
Hip extension prone firm 0-30 degrees
Hip abduction Supine firm 0-45 degrees
Hip addiction Supine firm 30-0 degrees
hip external rotation sitting firm 0-45 degrees
Hip internal rotation sitting firm 0-45 degrees

25. KNEE CLIENT POSITION ENDFEEL NROM
Knee flexion supine soft 0-135 degrees
Knee extension supine firm 135-0 degrees

26. ANKLE CLIENT POSITION ENDFEEL NROM
Ankle dorsiflexion Sitting Firm 0-20 degrees
Ankle plantar flexion Sitting Firm 0-50 degrees
Ankle inversion(forefoot) Sitting Firm 0-35 degrees
Ankle eversion(forefoot) Sitting Hard 0-15 degrees
Ankle inversion(hindfoot) Prone Firm 0-5 degrees
Ankle eversion(hindfoot) Prone Firm/Hard 0-5 degrees

27. FOOT:(MTP) CLIENT POSITION ENDFEEL NROM
Metatarsophalangealflexion supine Firm Great toe 0-45˚ 2-5 (0-40˚)
Metatarsophalangealextension supine Firm Great toe 45˚-0˚ 2-5(40-0˚)
Metatarsophalangealabduction supine Firm compare to opposite side
Metatarsophalangealaddiction supine Firm compare to opposite side

28. FOOT: PIP CLIENT POSITION ENDFEEL NROM
PIP flexion supine soft/firm great toe 0˚-90˚,toes 2-5 (0-35˚)
PIP extension supine firm great toe 90˚-0,toes 2-5(35˚-0˚)
FOOT :DIP
DIP flexion supine firm 0-60 degrees
DIP extension supine firm compare to opposite side

29. GONIOMETRIC MEASUREMENTS OF THE TRUNK
TRUNK CLIENT POSITION NROM
Spinal flexion standing 0-80 degrees/4inches
Spinal extension standing 0-25 degrees
Spinal lateral flexion standing 0-35 degrees
Spinal rotation sitting/standing 0-45 degrees

30. Goniometry measurements of Neck
NECK CLIENT POSITION NROM
Cervical flexion sitting 0-45 degrees
Cervical extension sitting 0-45 degrees
Cervical lateral flexion sitting 0-45 degrees
Cervical rotation sitting 0-60 degrees