GONIOMETRY

ByCHUKWUEMEKA UCHE MARTHA

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OUTLINEWhat is goniometry ?Importance of goniometry Types of goniometerUniversal Goniometer Range of MotionPlanes and Axes of joint motionImportant NotesProcedures for Goniometric measurementROM measurementCurrent TrendsReferences

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WHAT IS GONIOMETRY Goniometry is the measuring of angles

created by the bones of the body at the joints.1, 2, 3

The term goniometry is derived from two Greek words, gonia meaning angle and metron, meaning measure. 1, 2, 3, 4, 5,

System to measure the joint ranges in each plane of the joint is termed goniometry. 4

These measurements are done with instrument such as goniometer, a tape measure, inclinometers or by visual estimate. 1, 2, 3, 4, 5

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IMPORTANCE OF GONIOMETRY Goniometry is useful in determining the presence of dysfunction establishing a diagnosis developing goals evaluating progress, fabricating orthoses a measurement for research purposes 4, 5, 6

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TYPES OF GONIOMETERS Universal goniometer

Gravity goniometer/ inclinometer

Electro goniometer sensor with angle

meter

Single and twin axis goniometer

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Bubble goniometer

Smartphone soft wares

Digital goniometer

Arthroidal protractor

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UNIVERSAL GONIOMETER A universal goniometer may be constructed of

metal or plastic and it has three partsA body Fulcrum Stationary armsMoving armsThe body of the goniometer is designed like a

protractor and may form a full or half circle; and on it is a scale from 0 to 180 or 360 1, 2, 3

The fulcrum is a rivet or screw-like device at the center of the body that allows the moving arm to move freely on the body of the device.1, 2, 3, 4, 5 6,

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UNIVERSAL GONIOMETERThe fulcrum and body is placed over the joint

being measured 3, 4, 5, 6, 7, 8

The stationary arm will be aligned with the inactive part of the joint measured while the moving arm is placed on the part of the limb which is moved in the joint’s motion1, 2, 3, 4, 5, 6, 7.

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RANGE OF MOTION Range of motion can be defined as the

amount of motion available at a joint. 5

Each specific joint has a normal range of motion that is expressed in degrees. 1

Joint ranges are divided intoActive range of motion AROMPassive range of motion PROM

The structure involved with movement of the bones as well as the bony arrangements are factors in limiting motion. 1, 2, 3,4.

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RANGE OF MOTION Determinants of joint ROM Normal Age Gender Others such as ADL, right vs left, body

physique, active vs passive ROM Abnormal Tight soft tissues around the joint Muscle insufficiency Adhesion Foreign body

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RANGE OF MOTION The end-feel is the feeling which is

experienced by the examiner as a barrier to further motion at the end of a PROM.

These normal end-feels have been described as soft, firm, and hard. The same terms are used to describe abnormal end-feels with the addition of "empty". 1, 2, 3

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RANGE OF MOTIONContraindications to ROM testing: Dislocation or unhealed fracture in the region, immediately following surgery, On medication for pain or muscle relaxants

(careful) Regions of osteoporosis or bone fragility, Patients with hemophilia, Immediately after an injury where disruption of

tissue is present.

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PLANES AND AXES OF JOINT MOTION Motion at a joint occurs as a result of

movement of one joint surface in relation to another. 1

Arthrokinematics is the term used to refer to the movement of joint surfaces. The movements at the joint surfaces are described as slides (glides), spins, and rolls. These three usually occur in combination with each other and result in movement of the shafts of the bones. 1, 2, 3, 4, 5, 9,

Osteokinematics refers to the movement of the shafts of the bones. These are usually described in terms of rotary movement about an axis of motion. 1, 2, 3

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PLANES AND AXES OF JOINT MOTION Goniometry measures the angles created by

the rotary motion of the shafts of the bones.1, 2, 3, 4

Osteokinematic motions are classically described as taking place in one of the three cardinal planes of the body (sagittal, frontal, and transverse) around three corresponding axes (medial-lateral, anterior-posterior, and vertical).

The three planes lie at right angles to one another whereas the three axes are both at right angles to the corresponding plane and to each other.1, 2, 3, 4

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PLANES AND AXES OF MOVEMENTANATOMICAL POSITION

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VALIDITY AND RELIABILITY OF GONIOMETER

According to the American Academy of Orthopeadic Surgeons, Kendall and McCreary, Hoppenfeld, and the American Medical Association. 1, 2, 3, 4, 5, 6, 7

Content validity – it is assumed that the angle created by aligning the arms of the goniometer with bony landmarks truly represents the angle. “The accurate application of knowledge and skills, combined with interpreting the results as measurement of range of motion only, provide sufficient evidence to ensure content validity.”

Reliability – overall good to excellent reliability. Higher reliability has been found for measurements of joint position compared to range of motion.

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VALIDITY AND RELIABILITY OF GONIOMETER

Reliability varies depending on the joint being measured. Intratester reliability is found to be higher than intertester reliability

Advantages • Good reliability and validity.• Ease of use.• Inexpensive.•Can be used to establish presence or absence of dysfunction

and also monitor progress Limitations • Reliability dependent on examiner experience.• Reliability varies depending on what joint is measured.• Requires consistency in positioning, stabilization, and

alignment.• Some disagreement between sources for normal values of

range of motion.

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IMPORTANT NOTES The starting position for measuring all ROM

is the anatomical position except for rotation in transverse plane.

Be aware of the position the body is supposed to be in for movement and any stabilization issues.

Stabilize the part of the body that is proximal (stationary portion) to the joint you are testing.

The patient do not move his body while the moving the joint; this step isolates the joint movement for a more accurate measurement.

There are three notation of goniometric measurement which are 0-180º, 180-0º and 0-360º.

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IMPORTANT NOTES Zero degrees is the neutral starting position Consistently use the same stationary and

movable landmarks on the body when measuring, to ensure consistency.

The angle of movement from the stationary arm to the moving arm is read off the body and reported as the ROM.

Look at the reading on the goniometer at eye level before removing it from the patient’s body.

Be sure to record the ROM of the joint Compare reading with contralateral side

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PROCEDURE FOR GONIOMETRIC MEASUREMENT 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.

The clinician palpates the relevant bony landmarks and aligns the goniometer.

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PROCEDURE FOR GONIOMETRIC MEASUREMENT 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.

Repeat measurement three times and record the average as the goniometric value for the joint’s ROM

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ROM MEASUREMENT

Shoulder ROMFlexion: Motion: 0-180º Position: Subject supine

with knees flexed or sitting. elbow extended with the palm facing the body

Goniometer: Axis at the acromion process, laterally through the head of the humerus.

Stationary arm is placed along the mid-axillary line of the trunk

Moving arm place along the lateral mid-line of the humerus in line with the lateral epicondyle.

Extension: Motion: 0-45º~60º from

neutral position Position: Subject prone or

sitting , elbow in slight flexion with the palm facing the body.

Goniometer: Axis at the acromion process, laterally through the head of the humerus

Stationary Arm aligned with mid-axillary line of the trunk

Moving arm along the lateral mid-line of humerus in line with lateral epicondyle.

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Abduction: Motion:0-180º Position: Supine, prone

or sitting with the limb in anatomic position

Goniometer: Axis at anterior portion of acromion process.

Stationary arm at lateral aspect of anterior surface of chest parallel to midline of sternum.

Moving arm on anterior aspect of arm parallel to midline of humerus and in line with medial epicondyle.

ORGoniometer: Axis at the

posterior portion of the acromion process;

Stationary arm aligned parallel to spinous process of the vertebral colomn

Moving arm aligned with the midline of the humerus in line with lateral epicondyle

Adduction: Motion: 0-30º Aligment of goniometer is

same for abduction.

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External rotation: Motion: 0-90º Position: Supine. Shoulder

is abducted to 90º. Elbow flexed with forearm in neutral and perpendicular to table top such that the palm is facing the feet. Elbow not supported. Humerus is fully supported on the table. Stabilize the distal humerus, thorax, and scapula.

Goniometer: Axis at olecranon process of the ulna.

Stationary arm placed parallel to the table top or perpendicular to the floor.

Moving arm along the ulnar shaft aligned with the styloid process of the ulna.

Internal rotation: Motion: 0-65~90º Positioning and

goniometer alignment is same as in external rotation

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Radio-ulnar ROMSupination: Motion: 0- 80º~ 90º Position: Subject sitting

or supine, with the elbow flexed to 90º. Shoulder in zero degrees of its’ ROM. Position starts midway between Supination and Pronation.

Goniometer: Axis is medial to the ulnar styloid process.

Stationary arm is aligned parallel to the anterior midline of the humerus.

Moving arm across the ventral aspect of the wrist on a line between and proximal to the styloid process of the radius and the ulna. 

Pronation: Motion: 0- 80º~ 90º Position: same for supination Goniometer: Axis is

lateral to the ulnar styloid process.

Stationary arm is aligned parallel to the anterior midline of the humerus.

Moving arm across the dorsum of the wrist on a line between and proximal to the styloid process of the radius and the ulna.

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Wrist ROMFlexion: Motion: 0-60º~80º Position: Subject

sitting, shoulder in 90º of abduction; elbow flexed to 90º. The forearm placed in between supination and pronation such that the palm of the hand parallels the floor.

Goniometer: Axis is distal to the ulnar styloid process or over the lateral aspect of the wrist over the triquetrum

Stationary arm parallel to and over the lateral midline of the ulna, in line with the olecranon.

Moving arm along the lateral midline of the 5th MC.

Extension: Motion: 0-60º~70º Position and goniometer:

same for flexionUlnar deviation: Motion: 0-30º~35ºRadial deviation: Motion: 0-20º Position: same for wrist

flexion Goniometer: Axis is at the

middle of the dorsal aspect of the wrist over the capitate.

Stationary arm midline on the dorsal surface of the forearm in line with the lateral epicondyle of the humerus.

Moving arm along midline of the dorsal surface of the 3rd MC.

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HAND JOINTS ROM705/01/2023

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Hip ROMFlexion: Motion: 0-100º~125º Position: Supine or side

lying on the opposite limb to be measured; limb in anatomical position with knee flexed at the end of the motion.

Goniometer: Place the axis at the lateral aspect of the hip joint over the greater trochanter.

stationary arm is parallel to the long axis of the trunk in line with the greater trochanter or the lateral midline of the pelvis

moving arm is placed along the lateral midline of the femur in line with lateral epicondyle of the femur

Extension: Motion: 0-10º~30º Position: Prone or Side lying

on the opposite limb to measured; the limb in anatomical position

Goniometer alignment is the same for hip flexion.

*Stabilise the pelvis when measuring hip flexion and extension.

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Abduction: Motion: 0 - 40º~50º Position: Supine with the

limb in anatomical position (0º of all limb joints ROM)

Goniometer: axis at the anterior superior iliac spine(ASIS) of the measured limb.

Stationary arm is at an imaginary horizontal line extending from one ASIS to the other.

Moving arm is with the anterior midline of the femur, in line with the midline of the patella.

Adduction: Motion: 0-20º~30º Position: Supine, with

opposite limb abducted Goniometer alignment is

same as for hip abduction*Stabilise the pelvis

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External Rotation: Motion: 0-40º~50º Position: Supine, with

knees extended over the table OR Prone with knee flexed OR High sitting with 90º flexion of hip and knee, 0º of hip abduction and adduction

Goniometer: axis over the anterior mid patella

Stationary arm is parallel to the supporting surface or the floor

Moving arm is placed along the anterior surface of the tibia midway between the malleoli.

 

Internal Rotation: Motion: 0-40º~45º Positioning and

goniometer alignment is same as in hip external rotation

*Stabilise the femur pelvis

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Knee ROMFlexion: Motion: 0-135º~150º Position: Supine, knees

in extension with hip flexed to 90o at end of the motion OR prone lying with knee extended foot over the edge of the supporting surface.  

Goniometer: Axis is placed over the lateral epicondyle of the femur

Stationary arm is parallel to the lateral midline of the femur in line with the greater trochanter

Moving arm is placed lateral at the midline of the fibula in line with the lateral malleolus.

Extension: Motion: note any

hyperextension Positioning and

goniometer alignment is same with knee flexion.

Extension is an opposite motion to flexion

*The thigh should be stabilized in flexion motion measurement

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Ankle ROMDorsiflexion: Motion:0-20º Position: Subject was

sitting with legs off the table or on high sitting with lower leg at right angle to the thigh and the foot at right angle to the lower leg as the zero starting position.

Goniometer: fulcrum was aligned slightly inferior to the lateral malleolus.

Stationary arm is with the midline of the lateral aspect of the lower leg, in line with the head of fibula.

Moving arm was parallel to the 5th metatarsal.

Plantarflexion: Motion:0-40º~50º Positioning and goniometer

alignment is same with dorsiflexion

Inversion: Motion:0-15º~20º Position: same with

dorsiflexion Goniometer: axis is midway

between the two malleoli at the anterior aspect of the ankle

Stationary arm is with the anterior midline of tibia in line with the tibial tuberosity

Moving arm is with the anterior midline of the 2nd metatarsal.

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Eversion: Motion:0-15º~20º positioning and

goniometer alignment is same as for inversion

Subtalar ROMInversion: Motion:0-5º Position: prone lying with hip

and knee in 0º of all their joints’ ROM, foot is off the supporting surface such that the toes are point downwards

Goniometer: axis is over the posterior aspect of the ankle midway between the two malleoli.

Stationary arm is with posterior midline of the leg

Moving arm is with posterior midline of the calcaneus.

Eversion: Motion:0-5º Positioning and goniometer

alignment is same as for inversion.

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Cervical ROMFlexion: Motion:0-45º Position: sitting with

head and neck in anatomical position, lumbar and thoracic region supported on back rest

Goniometer: axis on the external auditory meatus

Stationary arm is perpendicular to the floor in line with head

Moving arm is with the base of the nares

Extension: Motion:0-45º Positioning and goniometer

alignment is same as flexion

Lateral flexion: Motion:0-45º Position: same as flexion goniometer: axis is on the

spinous process of the 7th cervical vertebra

Stationary arm is with the spinous processes of the thoracic vertebrae perpendicular to the floor

Moving arm is with the posterior midline of the head in line with occipital protuberance

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Rotation: Motion: 0-60º~80º Position: same as for

flexion Goniometer: axis over the

centre of the cranial aspect of the head

Stationary arm in line with an imaginary line between the two acromial processes

Moving arm is with the tip of the nose

Lumbar ROMFlexion: Motion: 4inches Position: standing and in

anatomical position Tape Measure: Placed

proximately at the C7 spinous process and distally at S1; calculate the difference between standing and flexion ending position.

Extension: Motion:2inches Position: same with flexion Tape Measure: Placed

proximately at the C7 spinous process and distally at S1; calculate the difference between standing and extension ending position.

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Lateral flexion: Motion: 0-25º~35º Position: same as

flexion Goniometer: axis over

the spinous process of 1st sacral vertebra

Stationary arm is perpendicular to the floor

Moving arm is in line with the spinous process of the of the 7th cervical vertebra

Tape Measure: Placed proximally at the finger tips and distally at the lateral malleolus; calculate the difference between sides when standing and with side bending.

Rotation: Motion:0-30º~45º Position: same as flexion Goniometer: axis at the

centre of the cranial aspect of the head

Stationary arm is parallel with the imaginary line between the two prominent tubercles on the iliac crest.

Moving arm is with an imaginary line between the two acromial processes

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CURRENT TRENDS The use of inclinometer software to measure ROM in

a joint. In a study by Brian et al, (2013), it was inferred that Smart phones have good correlation with the “gold standard” goniometer for measuring shoulder range of motion. Additionally, there is good correlation amongst different levels of providers with measurements obtained using the smart phone

Drgoniometer 12 The use of sensor and goniometer probe setup to

measure joint ROM. It usually convenient for large joints

It is designed as a sensor pad connected to a potentiometer or a probe connected to a sensor angle meter 7, 8

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Example of goniometric measurement using DrGoniometer as it appears on the smartphone screen

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CONCLUSION Goniometric measurement is an important skill all

physiotherapist must have as it employed in almost all area of physiotherapy practice.

There are different instrument for measurement of joint’s range of motion but the universal goniometre remains the gold standard due to it’s excellent validity and reliability in most articles. It also has advantages such as ease of use, inexpensive, easily available and accuracy.

Though some other instrument are as reliable and valid as the universal goniometer but the cost of purchase, availability and ease of use may not be met.

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REFERNCES1. Norkin, C.C. & White, D.C. (1988) Techniques and procedures, in Measurement of

joint motion: A guide to goniometry. In Norkin & White, Eds. FA Davis: Philadelphia. p. 9-24.

2. Norkin, & White.(1995) Measurement of Joint Motion: A Guide to Goniometry. 2nd ed. Philadelphia, PA: F.A. Davis Company.

3. Norkin, & White.(2003) Measurement of Joint Motion: A Guide to Goniometry. 3rd ed. Philadelphia, PA: F.A. Davis Company;.

4. The British Orthopaedic Association (1983) Joint motion: method of measuring and recording. In Heck, C.V., Hendryson, I.E., Rowe, C.R. (eds). Edinburg: Churchill Livingstone.

5. Gadjosik, & Bohannon(1987) Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical Therapy; 67: 1867-1872.

6. Gogia, Braatz, Rose, & Norton.(1987) Reliability and validity of goniometric measurements at the knee. Physical Therapy; 67: 192-195.

7. Nadeau, Kovacs, Gravel, Piotte, Moffet, Gagnon, & Hebert.(2007) Active movement measurements of the shoulder girdle in healthy subjects with goniometer and tape measure techniques: A study on reliability and validity. Physiotherapy Theory and Practice.; 23: 179-187.

8. Brian, C.W., Chris, M.K., Justin, W.G., Matthew, L.L., Joseph, M.H., & Stephen F.B.(2013) Shoulder Range of Motion: Validation of an Innovative Measurement Method Using a Smartphone The Orthopaedic Journal of Sports Medicine, 1(4)(suppl 1)

9. MacDermid, et al.(1999) Range of motion measurement. Journal of Hand Therapy; 12:187-192.

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REFERNCES10. Rasmussen, O.(1985) Stability of the ankle joint. Acta Orthop. Scandinavica;

Suppl. 211: p. 56-78.11. Seto, J.L. & Brewster,C.E.(1985) Treatment approaches following foot and

ankle injury. Clinical Sports Medicine; 13: p. 29512. Ferriero,G., Sartorio, F., Foti,C., Primavera,D., Brigatti, E.& Vercelli, S.

(2012) Reliability of a New Application for Smartphones (DrGoniometer) for Elbow Angle Measurement. The American Academy of Physical Medicine and Rehabilitation; Vol. 3:1153-1154

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THANK YOU

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