Range of Movement

Introduction

Normal joints allow a range of purposeful movements as well as easy shifting from one position to another. They have active and passive ranges of movement or motion (ROM). In a healthy joint the active range of motion is almost as full as passive. If there are no major complaints or apparent limitations of movement, checking four important positions will provide rough estimates of the range of movement of the major joints (Fig. 8.59-8.62).

Screening Positions

Neutral position (general) (Fig. 8.59) The patient stands upright with the legs straight and parallel. The feet are together, the arms hanging down at the sides, with elbows, wrists, and fingers extended, and the palms of the hands facing forward. The back, knees, and trunk are straight. This position excludes limitation of full extension of the hips, knees, elbows, and wrists. It also indicates that the ankles, shoulders, and back can achieve a normal resting position.

Figure 8.59 Range of movement—neutral position.

Squatting position (Fig. 8.60) The patient is asked to sit on the calves and ankles, with hands folded behind the neck. This position excludes limitation of flexion of the knees or the ankle joints. It also demonstrates limitation of abduction or external rotation of the shoulder joint, limitation of flexion in the elbow joint, and limitation of pronation of the lower arms.

Figure 8.60 Range of motion— squatting position.

Figure 8.60 Range of motion— squatting position.

Shoulder and hip stretch position (Fig. 8.61) The patient is asked to stand with the legs apart and the backs of the hands held on the lower back. This position gives an estimate of abduction of the hips, internal rotation of the joints, and back flexibility.

Range Movement

Arm stretch position (Fig. 8.62) The patient is asked to stand with straight legs, turning toes inward, and to stretch the arms out to the side at shoulder level with the hands stretched out as far as possible, then to separate the fingers and rotate the hand into pronation, then to make a fist and rotate the forearm into supination. This position excludes forearm, wrist, and finger limitations. The position also evaluates hip adduction and internal rotation, and shoulder rotation. If the fingers easily reach the inner palm, there is no limitation of flexion in the finger joints.

Figure 8.62 Range of movement—arm stretch position.

Figure 8.62 Range of movement—arm stretch position.

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