Recently when I was auditing a file, I came across a blunder where ankle dorsiflexion was typed as 0 degrees to 200 degrees, which is just impossible. The MT and the QC just had no idea what the dictator was dictating. This prompted me to post the below article for ready reference.
Normal Range of Motion:
All joint Range of Motion measurements must be made using a
goniometer.
For
example, if the veteran lacks 10 degrees of full knee extension and has normal
flexion, show the range of motion as extension to minus 10 degrees (or lacks 10
degrees of extension) and flexion 10 to 140 degrees.
1. Hip range of motion: (Movement of femur as it rotates
in the acetabulum.)
a. Normal range of motion, using the anatomical position as
zero degrees.
Flexion
= 0 to 125 degrees (To gain a true picture of hip flexion, i.e., movement between
the pelvis and femur in the hip joint, the opposite thigh should be extended to
minimize motion between the pelvis and spine.)
Extension
= 0 to 30 degrees.
Adduction
= 0 to 25 degrees.
Abduction
= 0 to 45 degrees.
External
rotation = 0 to 60 degrees.
Internal
rotation = 0 to 40 degrees.
2. Knee range of motion:
a. Normal range of motion, using the anatomical position as
zero degrees.
Flexion
= 0 to 140 degrees.
Extension
- zero degrees = full extension. Show loss of extension by describing the
degrees in which extension is not possible. (e.g., Show range of motion as
extension to minus 10 degrees and flexion 10 to 140 degrees when full extension
is limited by 10 degrees and full flexion is possible.)
b. Stability.
Medial
and Lateral Collateral Ligaments: Varus/valgus
in neutral and in 30 degrees of flexion - normal is no motion.
Anterior
and Posterior Cruciate Ligaments: Anterior/posterior
in 30 degrees of flexion with foot stabilized - normal is less than 5 mm. of
motion (1/4 inch - Lachman's test) or in 90 degrees of flexion with foot
stabilized - normal is less than 5mm. of motion (1/4 inch - anterior and
posterior drawer test).
Medial
and Lateral Meniscus: Perform McMurray's test.
3. Ankle
range of motion:
a. Neutral
position is with foot at 90 degrees to ankle. From that position, dorsiflexion
is
0 to 20
degrees; plantar flexion is 0 to 45 degrees.
b. Describe
any varus or valgus angulation of the os calcis in relationship to the long
axis
of the
tibia and fibula.
4. Shoulder,
elbow, forearm, and wrist range of motion:
a. Normal range of motion is measured with zero degrees in the anatomical position except for
2 situations:
i. Supination and pronation of the forearm is measured with
the arm against the body, the elbow flexed to 90 degrees, and the forearm in
mid position (zero degrees) between supination and pronation
ii. Shoulder rotation is measured with the arm abducted to
90 degrees, the elbow flexed to 90 degrees, and the forearm reflecting the
midpoint (zero degrees) between
internal and external rotation of the shoulder.
b. Shoulder
forward flexion = zero to 180 degrees.
c. Shoulder
abduction = zero to 180 degrees.
d. Shoulder
external rotation = zero to 90 degrees.
e. Shoulder
internal rotation = zero to 90 degrees.
f. Elbow
flexion = zero to 145 degrees.
g. Forearm
supination = zero to 85 degrees.
h. Forearm
pronation = zero to 80 degrees.
i. Wrist
dorsiflexion (extension) = zero to 70 degrees.
j. Wrist
palmar flexion = zero to 80 degrees.
k. Wrist
radial deviation = zero to 20 degrees
l. Wrist
ulnar deviation = zero to 45 degrees.
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