RANGE OF MOTION MEASUREMENTS

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.