Range of Motion of Upper Limb.pptx

Range of motion of upper limb

1. Range of Motion of Upper Limb Dr. Mohammad Taqi Ehsani PGY1 of Orthopedics, FMIC

2. Introduction to the Upper Limb The upper limb is attached to the  pectoral girdle  (shoulder girdle), which comprises the scapula and clavicle articulating at the  acromioclavicular joint . The only bony point of contact between the chest (axial skeleton) and the upper limb is by way of the  sternoclavicular joint . All other attachments to the upper limb and pectoral girdle are muscular. upper limb is segmented into the  arm , between the shoulder and the elbow the  forearm , from the elbow to the wrist the  hand , which joins the forearm at the wrist (carpus). The upper limb is highly mobile and capable of a wide range of controlled movements supported by the long bones

3. Goniometer A goniometer is an instrument that measures the available range of motion at a joint. The art and science of measuring the joint range in each plane of the joint are called goniometry

4. Types of Goniometer Universal Goniometer Comes in two forms: short arm and long arm. The short arm goniometer is used for smaller joints like the wrist, elbow, or ankle, The long arm goniometers are more accurate for joints with long levers like the knee and hip joints.

5. Types of Goniometer 2. Gravity Goniometer/Inclinometer One arm has a weighted pointer that remains vertical under the influence of gravity

6. Types of Goniometer 3. Software/Smartphone-based Goniometer: A smartphone as a digital goniometer has several benefits like availability, ease of measurement, application-based tracking of measurements, and one-hand use. These applications use the accelerometers in phones to calculate the joint angles.

7. Types of Goniometer 4. Arthrodial Goniometer: Ideal for measuring cervical rotation, anteroposterior flexion, and lateral flexion of the cervical spine.

8. Types of Goniometer 5. Twin Axis Electro goniometer: The inter-rater and intra-rater reliability of the electro goniometer is higher than the universal goniometer but challenging to apply in patients' clinical evaluation, hence used more often for research purposes

9. Range of Motion of Shoulder The range of motion of the shoulder girdle involves six motions: Abduction Adduction Extension Flexion Internal rotation External rotation

10. Range of Motion of Shoulder Active Range of Motion: The Apley “Scratch” test is the quickest active way to evaluate a patient’s range of motion A: Abduction and external rotation (touch the superior medial angle of the opposite scapula) B. Internal rotation and adduction (touch the inferior angle of the opposite scapula) C. Internal rotation and adduction (touch the opposite acromion)

11. Range of Motion of Shoulder Passive Range of Motion Tests If a patient is unable to perform fully any of the motions of the shoulder girdle, passive testing should be conducted Causes: muscle weakness, soft tissue contracture (in the joint capsule or ligaments, or as a result of muscle contracture), or bony blockage (bony fusion or excrescences) If the joints moves through a full range of motion under passive testing, but has restricted active motion, muscle weakness is the cause of restriction If restriction is consistent under passive test conditions, muscle weakness can usually be eliminated as the direct cause, and bony (intra-articular) or soft tissue (extra-articular) blockage is most likely When testing ROM of Shoulder girdle (especially in abduction), motion should be broken down into three categories: (1) pure glenohumeral motion, (2) scapulothoracic motion, and (3) a combination of both

12. Range of Motion of Shoulder Abduction – 180 ° Abduction of the arm occurs in the glenohumeral joint and scapulothoracic articulation in a two to one ratio (2:1); for every 3° of abduction, 2° occur in the glenohumeral joint, and 1° occurs at the scapulothoracic articulation. The scapula should not move until the arm is abducted to approximately 20° (indicating free glenohumeral motion). At that point, the humerus and scapula move together in a 2:1 ratio to complete abduction If the glenohumeral joint does not move in its normal ratio with the scapulothoracic articulation but seems to be fixed in adduction, the patient may have frozen shoulder syndrome. If this is the case, he may be able to shrug his shoulder to nearly 90° of abduction using pure scapulothoracic motion

13. Range of Motion of Shoulder

14. Adduction – 45 ° begin moving it across the front of his body in adduction. Normal adduction allows the arm to swing about 45° across the front of the body. Test the other shoulder and compare results. Adduction may be limited by bursitis or by tears in the rotator cuff (especially in the supraspinatus). Range of Motion of Shoulder

15. Range of Motion of Shoulder FLEXION 180 ° EXTENSION 45° Normally the arm will extend to approximately 45°. Then move the arm forward through the anatomic position into flexion. Normal flexion is about 180°. Repeat the procedures of flexion and extension on the other side and compare results. A limited range of flexion and extension may indicate bicipital tendinitis or bursitis in the shoulder

16. Range of Motion of Shoulder INTERNAL ROTATION: 55 ° EXTERNAL ROTATION: 40°- 45° To test internal and external rotation, stand in front of the patient and hold his elbow to his waist to prevent the substitutions of abduction for internal rotation and adduction for external rotation. External rotation should range about 40° to 45°. Bursitis is one cause of limitation. move the arm into internal rotation. The arm will normally rotate about 55°.

17. Range of Motion of Elbow Basically, the range of motion in the elbow joint involves four movements: (1) elbow flexion, (2) elbow extension, (3) forearm supination (4) forearm pronation Flexion and extension originate primarily at the humeroulnar and humeroradial joints, while supination and pronation derive from the radioulnar articulations at the elbow and wrist

18. Range of Motion of Elbow FLEXION —135°+ Instruct the patient to bend his elbow and to try to touch the front of his shoulder with his hand. Flexion is limited by the muscle mass of the anterior arm, but the patient should normally be able to touch his shoulder EXTENSION—0°/ —5°. Extension of the elbow joint is motored by the triceps muscle. Extension limits are defined by the point at which the olecranon strikes the olecranon fossa. Ask the patient to straighten his elbow as far as he can. Most males can achieve the normal 0° extension; those who are unusually muscular may not be able to extend the elbow to 0° because of biceps muscle tension. Females are normally able to extend the arm to a minimum of 0° and many are able to hyperextend the elbow as much as 5° beyond the straight position

19. Range of Motion of Elbow SUPINATION—90° : The limits of supination are defined by the degree to which the radius can rotate around the ulna. PRONATION—90°: Pronation can be limited by pathology at the elbows, at the wrist radioulnar articulations, or within the forearms

20. Range of Motion of Wrist Those movements pertaining to wrist function are: 1) flexion 2) extension 3) radial deviation 4) ulnar deviation 5) supination (of the forearm) 6) pronation (of the forearm)

21. Range of Motion of Wrist WRIST FLEXION AND EXTENSION Instruct the patient to flex and extend his wrist. Normal flexion allows him to move his wrist to about 80° from the neutral or straight position (0°). The normal limit for extension is approximately 70°

22. Range of Motion of Wrist WRIST ULNAR AND RADIAL DEVIATION Ask the patient to move his wrist from side to side into ulnar and radial deviation. Ulnar deviation is the greater of the two, since the ulna does not extend distally as far as the radius and does not articulate directly with the carpus. Ulnar deviation has a range of approximately 30°, while the range of radial deviation is about 20° SUPINATION AND PRONATION. Discussed in previous slides

23. Range of Motion of Wrist Movements to be tested in the fingers are: 1) finger flexion and extension at the metacarpophalangeal joints 2) finger flexion and extension at the interphalangeal joints 3) finger abduction and adduction at the metacarpophalangeal joints 4) thumb flexion and extension at the metacarpophalangeal joint and the interphalangeal joint ( transpalmar abduction and radial abduction) 5) thumb abduction and adduction at the carpometacarpal joint (palmar abduction) 6) opposition

24. Range of Motion of Hand FINGER FLEXION AND EXTENSION:

25. Range of Motion of Hand FINGER ABDUCTION AND ADDUCTION Ask the patient to spread his fingers apart and back together again. Clinically, abduction and adduction are measured from the axial line of the hand which runs longitudinally down the middle finger. In abduction, the fingers should separate in equal amounts of approximately 20°; in adduction, they should come together and touch each other

26. Range of Motion of Hand THUMB FLEXION THUMB Extension (Radial Abduction) Palmar Abduction OPPOSITION: Normally, the patient should be able to touch the tip of his thumb to each of the other fingertips

27. Thanks for your attention