Measurement of joint motion : a guide to goniometry

592 Pages·2016·57.09 MB·English

by  Norkin, Cynthia C., White, D. Joyce

Fifth Edition
MEASUREMENT
OF JOINT MOTION
A GUIDE TO GONIOMETRY
Cynthia C. Norkin, PT, EdD
Associate Professor Emerita
Division of Physical Therapy
College of Health Sciences and Professions
Ohio University
Athens, Ohio
D. Joyce White, PT, DSc
Associate Professor
Department of Physical Therapy
College of Health Sciences
University of Massachusetts Lowell
Lowell, Massachusetts
Photographs by Jason Torres, Jocelyn Greene Molleur, and Lucia Grochowska Littlefield
Illustrations by Timothy Wayne Malone and Graphic World Illustration Services
F. A. DAVIS COMPANY • Philadelphia
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Library of Congress Cataloging-in-Publication Data
Names: Norkin, Cynthia C., author. | White, D. Joyce, author.
Title: Measurement of joint motion : a guide to goniometry / Cynthia C.
Norkin, D. Joyce White; photographs by Jason Torres, Jocelyn Greene
Molleur, and Lucia Grochowska Littlefield; technical advisor, George
Kalem, III ; illustrations by Timothy Wayne Malone.
Description: Fifth edition. | Philadelphia : F.A. Davis Company, [2016] |
Includes bibliographical references and index.
Identifiers: LCCN 2016026126 | ISBN 9780803645660 | ISBN 080364566X
Subjects: | MESH: Arthrometry, Articular—methods | Joints—physiology |
Joint Diseases—diagnosis
Classification: LCC RD734 | NLM WE 300 | DDC 612.7/5—dc23 LC record available at
https://lccn.loc.gov/2016026126
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Preface
The measurement of joint motion is an important compo- provided and updated with each edition. Current evidence of
nent of a thorough physical examination of the extremities the effects on range of motion of an individual’s characteris-
and spine, one which helps health professionals determine tics such as age, gender, body mass, and recreational/occupa-
function, identify impairments, and assess rehabilitative sta- tional activities, as well as the effects of the testing process
tus. The need for a comprehensive text with sufficient writ- such as testing position and type of measuring instrument
ten detail and photographs to allow for the standardization of have been consistently included in each edition. In this man-
goniometric measurement methods—both for the purposes of ner, clinicians have been supported in their efforts to integrate
teaching and clinical practice—led to the development of the evidence-based practice as they determine an individual’s
first edition of the Measurement of Joint Motion: A Guide to impairments and set rehabilitative goals.
Goniometry in 1985. Our approach included a discussion and We have made some changes in the fifth edition as part
photographs of testing position, stabilization, end-feel, and of our ongoing search for ways to present current informa-
goniometer alignment for each measurable joint in the body. tion in an easily accessible format. New tables and text have
The resulting text was extremely well received by a variety of been added that summarize up-to-date research findings on
health professional educational programs and was used as a the reliability of the assessment of joint motion with universal
reference in many clinical settings and research studies. goniometers and, where appropriate, inclinometers and smart
Subsequent editions were expanded to include muscle phone applications. For the first time, these tables include
length testing at joints where muscle length is often a fac- absolute measures of reliability such as standard error of
tor affecting range of motion. This addition integrated the measurement (SEM) and minimal detectable change (MDC)
measurement procedures used in this book with the Ameri- that allow clinicians to estimate their measurement error to
can Physical Therapy Association’s Guide to Physical Ther- decide whether changes in range of motion values reflect real
apy Practice. Illustrations and anatomical descriptions were changes in their patients. Two exercises have been added to
added so that the reader had a visual reminder of the joint Chapter 3 that will help the reader understand and apply these
structures and muscles involved in range of motion. Informa- statistical tests. Extensive new tables have been included that
tion on osteokinematics, arthrokinematics, and capsular and make it easy to find current research results on joint motions
noncapsular patterns of limitation was included. Illustrations needed to perform a wide variety of functional tasks. Sum-
of bony anatomical landmarks and photographs of surface mary Guides for each joint that include essential information
anatomy were added to help the reader align the goniometer about testing positions, stabilization, and goniometer and/
accurately. Inclinometer techniques for measuring range of or inclinometer placement can be quickly located in a new
motion of the spine and some alternative positions and align- Appendix B. In addition, readers will benefit from the more
ments for goniometric measurement of the range of motion of than 80 new photographs and illustrations that are included to
certain extremity joints were presented to coincide with cur- better explain concepts and enhance learning.
rent practice in some clinical settings. In spite of the many changes over the years, this book
In the years following initial publication, a consider- continues to present goniometry logically and clearly. Chap-
able amount of research on the measurement of joint motion ter 1 discusses basic concepts regarding the use of goniom-
appeared in the literature. Consequently, later editions have etry to assess range of motion and muscle length in patient
included a chapter on the reliability and validity of joint mea- evaluation. Arthrokinematic and osteokinematic movements,
surement, as well as joint-specific research sections in each elements of active and passive range of motion, hypomo-
chapter that focus on measurement procedures. Research bility, hypermobility, and factors affecting joint motion are
findings to establish normative range-of-motion values and included. The inclusion of end-feels and capsular and noncap-
the motion needed for a variety of functional tasks have been sular patterns of joint limitation introduces readers to current
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iv Preface
concepts in orthopedic manual therapy and encourages them position, stabilization, testing motion, normal end-feel, and
to consider joint structure and muscle length while measuring goniometer alignment for each joint and motion follows in
joint motion. a format that reinforces a consistent approach to evaluation.
Chapter 2 takes the reader through a step-by-step process The extensive use of photographs, illustrations, and captions
to master the techniques of goniometric evaluation including eliminates the need for repeated demonstrations by an instruc-
positioning, stabilization, instruments used for measurement, tor and provides the reader with a permanent reference for
goniometer alignment, and the recording of results. Exercises visualizing the procedures. At the end of each chapter there
that help develop necessary psychomotor skills and demon- is a review of current literature regarding normal range of
strate direct application of theoretical concepts facilitate motion values; the effects of age, gender, and other factors
learning. on range of motion; functional range of motion; and the reli-
Chapter 3 discusses the validity and reliability of mea- ability and validity of measurement procedures. This structure
surement. The results of the most contemporary validity and makes it easy for readers who are focused on learning mea-
reliability studies on the measurement of joint motion are surement techniques, as well as readers who are focused on
summarized to help the reader focus on ways of improving reviewing the research literature for evidence-based practice,
and interpreting goniometric measurements. Mathematical to find what they are seeking.
methods of evaluating reliability are shown along with exam- We believe that the fifth edition provides a comprehen-
ples and exercises so that the reader can assess their reliability sive coverage of the clinical measurement of joint motion and
in taking measurements. muscle length that supports evidence-based practice. We hope
Chapters 4 through 13 present detailed information on that this book will make the teaching and learning of goni-
goniometric testing procedures for the upper and lower extrem- ometry easier and improve the standardization and thus the
ities, spine, and temporomandibular joint. When appropriate, reliability and validity of this examination tool. Readers are
muscle length testing procedures are also included. In each encouraged to provide us with feedback on our current efforts
chapter, a logical sequence progresses from an overview of to bring you a high-quality, user-friendly text.
joint structures, osteokinematic and arthrokinematic motions,
and capsular patterns of limitation to specific measurement CCN
procedures. Information on anatomical landmarks, testing DJW
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Contributing Authors
Erin Hartigan, PT, DPT, PhD, OCS, ATC David A. Scalzitti, PT, PhD
Associate Professor Assistant Professor
Physical Therapy Department Program in Physical Therapy
University of New England George Washington University
Portland, Maine Washington, DC
Reviewers
Becca D. Jordre, PT, DPT, GCS Mary T. Marchetti, PT, PhD, GCS
Associate Professor Assistant Professor
Physical Therapy Department Physical Therapy Department
The University of South Dakota Duquesne University
Vermillion, South Dakota Pittsburgh, Pennsylvania
Heather MacKrell, PT, PhD Rebecca A Reisch, PT, PhD, DPT, OCS
Physical Therapist Assistant Program Director Associate Professor
Health Sciences Department Physical Therapy Department
Calhoun Community College Pacific University
Tanner, Alabama Hillsboro, Oregon
Jill Manners, MS, MPT, LAT, ATC, PT Kimberly Varnado, PT, DPT, OCS, FAAOMPT
Program Director and Professor Assistant Professor
Athletic Training Education Program Physical Therapy Department
Western Carolina University Midwestern University
Cullowhee, North Carolina Glendale, Arizona
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Acknowledgments
We are very grateful for the contributions of the many people the photographs or provided painstaking research support for
who were involved in the development and production of Mea- the fifth edition.
surement of Joint Motion. We wish to thank David Scalzitti We wish to express our appreciation to these dedicated
and Erin Hartigan who added their considerable expertise as professionals at F. A. Davis: Margaret Biblis, Editor in Chief,
researchers and educators to update Chapter 3: Validity and Melissa Duffield, Senior Acquisitions Editor, and Laura
Reliability of Goniometric Measurement, and Chapter 8: Horowitz, Developmental Editor, for their encouragement
The Hip, respectively. Photographer Jason Torres of J. Tor- and commitment to excellence. Our thanks are also extended
res Photography in New York used his skills and experience to George Lang, Director of Content Development; Jennifer
to produce the new high-quality photographs that appear in Pine, Manager of Developmental Editing; Cindy Breuninger,
this fifth edition. We are appreciative of the access provided Managing Editor; Sharon Lee, Production Manager; Caro-
by the University of Massachusetts Lowell to take these pho- lyn O’Brien, Manager of Art and Design; Daniel Domzalski,
tographs in the teaching laboratories of the Department of Illustration Coordinator; Elizabeth Stepchin, Project Editor;
Physical Therapy. The late Jocelyn Molleur, who assiduously Nichole Liccio, Administrative Assistant; and Marsha Hall,
took the photographs for the third and fourth editions, and Project Manager, Progressive Publishing Services. We are
Lucia Grochowska Littlefield, who produced the photographs very grateful to the numerous, faculty, students, and clini-
for the first and second editions, are also responsible for this cians who over the years have used the book or formally
important feature of the book. Timothy Malone, an artist from reviewed portions of the manuscript and offered insight-
Ohio, used his talents and knowledge of anatomy to create ful comments and helpful suggestions that have improved
the excellent illustrations that appear in this as well as past this text.
editions. We also offer our thanks to colleagues Erika Lewis Finally, we wish to thank our families: Cynthia’s daugh-
and Kyle Coffey, as well as Jessica LeBlanc, Conor Norden- ter, Alexandra, and her daughters, Taylor and Kimberly; and
gren, Samantha Rollings, Rachel Blakeslee, Chris Fournier, Joyce’s husband, Jonathan, and sons, Alexander and Ethan,
Colleen DeCotret, Rebecca D’Amour, Alexander White, and for their continuing encouragement and support. We will
Claudia Van Bibber, who graciously agreed to participate in always be appreciative.
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About the Authors
Dr. Cynthia C. Norkin is Dr. D. Joyce White is
Associate Professor Emerita, A ssociate Professor, Depart-
School of Physical Therapy, ment of Physical Therapy,
Ohio University. She holds University of Massachusetts
a Doctorate of Education Lowell. She holds a Doctor-
degree and an Advanced ate of Science degree in Epi-
Master of Science in Phys- demiology and an Advanced
ical Therapy degree from Master of Science degree in
Boston University, a Bach- Physical Therapy from Bos-
elor of Science degree from ton University, and a Bach-
Tufts University, and Cer- elor of Science degree in
tificate in Physical Ther- Physical Therapy from the
apy from the Bouvé-Boston University of Connecticut.
School. She founded the School of Physical Therapy at Ohio Dr. White’s research, teaching, and clinical experience have
University and served as Director for 11 years. Previously, predominantly focused on the assessment, treatment, and con-
she spent 10 years at Boston University as an Assistant Pro- tributing causes of musculoskeletal conditions of the upper
fessor of Physical Therapy, Sargent College, where she and and lower extremities. She has authored research articles and
Dr. White initially wrote Measurement of Joint Motion: A book chapters, and presented numerous conference papers in
Guide to Goniometry. Dr. Norkin is the co-editor and contrib- these areas. The American Physical Therapy Association has
uting author of the book Joint Structure and Function: A Com- presented her with the Dorothy Briggs Memorial Scientific
prehensive Analysis, currently in its fifth edition. Inquiry Award. Dr. White is a recipient of the University of
Massachusetts Lowell Award for Teaching Excellence where
she has taught for over 25 years. She has also held academic
appointments at Boston University, Sargent College.
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