Measurement of Joint Motion: A Guide to Goniometry

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2019.09.10.五版三刷

Preface

The measurement of joint motion is an important component of a thorough physical examination of the extremities and spine, one which helps health professionals determine
function, identify impairments, and assess rehabilitative status. The need for a comprehensive text with sufficient written detail and photographs to allow for the standardization of
goniometric measurement methods—both for the purposes of teaching and clinical practice—led to the development of the first edition of the Measurement of Joint Motion: A Guide to Goniometry in 1985. Our approach included a discussion and photographs of testing position, stabilization, end-feel, and goniometer alignment for each measurable joint in the body. The resulting text was extremely well received by a variety of
health professional educational programs and was used as a reference in many clinical settings and research studies.

Subsequent editions were expanded to include muscle length testing at joints where muscle length is often a factor affecting range of motion. This addition integrated the
measurement procedures used in this book with the American Physical Therapy Association’s Guide to Physical Therapy Practice. Illustrations and anatomical descriptions were
added so that the reader had a visual reminder of the joint structures and muscles involved in range of motion. Information on osteokinematics, arthrokinematics, and capsular and
noncapsular patterns of limitation was included. Illustrations of bony anatomical landmarks and photographs of surface anatomy were added to help the reader align the goniometer
accurately. Inclinometer techniques for measuring range of motion of the spine and some alternative positions and alignments for goniometric measurement of the range of motion of
certain extremity joints were presented to coincide with current practice in some clinical settings.

In the years following initial publication, a considerable amount of research on the measurement of joint motion appeared in the literature. Consequently, later editions have
included a chapter on the reliability and validity of joint measurement, as well as joint-specific research sections in each chapter that focus on measurement procedures. Research findings to establish normative range-of-motion values and the motion needed for a variety of functional tasks have been provided and updated with each edition. Current evidence of the effects on range of motion of an individual’s characteristics
such as age, gender, body mass, and recreational/occupational activities, as well as the effects of the testing process such as testing position and type of measuring instrument have been consistently included in each edition. In this manner, clinicians have been supported in their efforts to integrate evidence-based practice as they determine an individual’s impairments and set rehabilitative goals.

We have made some changes in the fifth edition as part of our ongoing search for ways to present current information in an easily accessible format. New tables and text have
been added that summarize up-to-date research findings on the reliability of the assessment of joint motion with universal goniometers and, where appropriate, inclinometers and smart
phone applications. For the first time, these tables include absolute measures of reliability such as standard error of measurement (SEM) and minimal detectable change (MDC)
that allow clinicians to estimate their measurement error to decide whether changes in range of motion values reflect real changes in their patients. Two exercises have been added to
Chapter 3 that will help the reader understand and apply these statistical tests. Extensive new tables have been included that make it easy to find current research results on joint motions
needed to perform a wide variety of functional tasks. Summary Guides for each joint that include essential information about testing positions, stabilization, and goniometer and/
or inclinometer placement can be quickly located in a new Appendix B. In addition, readers will benefit from the more than 80 new photographs and illustrations that are included to
better explain concepts and enhance learning.

In spite of the many changes over the years, this book continues to present goniometry logically and clearly. Chapter 1 discusses basic concepts regarding the use of goniometry to assess range of motion and muscle length in patient evaluation. Arthrokinematic and osteokinematic movements, elements of active and passive range of motion, hypomobility, hypermobility, and factors affecting joint motion are included. The inclusion of end-feels and capsular and noncapsular patterns of joint limitation introduces readers to current concepts in orthopedic manual therapy and encourages them to consider joint structure and muscle length while measuring joint motion.

Chapter 2 takes the reader through a step-by-step process to master the techniques of goniometric evaluation including positioning, stabilization, instruments used for measurement, goniometer alignment, and the recording of results. Exercises that help develop necessary psychomotor skills and demonstrate direct application of theoretical concepts facilitate learning.

Chapter 3 discusses the validity and reliability of measurement. The results of the most contemporary validity and reliability studies on the measurement of joint motion are
summarized to help the reader focus on ways of improving and interpreting goniometric measurements. Mathematical methods of evaluating reliability are shown along with examples and exercises so that the reader can assess their reliability in taking measurements.

Chapters 4 through 13 present detailed information on goniometric testing procedures for the upper and lower extremities, spine, and temporomandibular joint. When appropriate,
muscle length testing procedures are also included. In each chapter, a logical sequence progresses from an overview of joint structures, osteokinematic and arthrokinematic motions,
and capsular patterns of limitation to specific measurement procedures. Information on anatomical landmarks, testing position, stabilization, testing motion, normal end-feel, and
goniometer alignment for each joint and motion follows in a format that reinforces a consistent approach to evaluation. The extensive use of photographs, illustrations, and captions eliminates the need for repeated demonstrations by an instructor and provides the reader with a permanent reference for visualizing the procedures. At the end of each chapter there is a review of current literature regarding normal range of motion values; the effects of age, gender, and other factors on range of motion; functional range of motion; and the reliability and validity of measurement procedures. This structure makes it easy for readers who are focused on learning measurement techniques, as well as readers who are focused on
reviewing the research literature for evidence-based practice, to find what they are seeking.

We believe that the fifth edition provides a comprehensive coverage of the clinical measurement of joint motion and muscle length that supports evidence-based practice. We hope that this book will make the teaching and learning of goniometry easier and improve the standardization and thus the reliability and validity of this examination tool. Readers are
encouraged to provide us with feedback on our current efforts to bring you a high-quality, user-friendly text.
CCN
DJW
Contents

PART I INTRODUCTION TO GONIOMETRY AND MUSCLE LENGTH TESTING, 1
Chapter 1 Basic Concepts, 3
Chapter 2 Procedures, 19
Chapter 3 Validity and Reliability of

PART II UPPER-EXTREMITY TESTING, 65
Chapter 4 The Shoulder, 66
Chapter 5 The Elbow and Forearm, 115
Chapter 6 The Wrist, 149
Chapter 7 The Hand, 187

PART III LOWER-EXTREMITY TESTING, 253
Chapter 8 The Hip, 255
Chapter 9 The Knee, 315
Chapter 10 The Ankle and Foot, 345

PART IV TESTING OF THE SPINE AND TEMPOROMANDIBULAR JOINT, 409
Chapter 11 The Cervical Spine, 411
Chapter 12 The Thoracic and Lumbar
Chapter 13 The Temporomandibular

APPENDIXES
A: Normative Range of Motion Values, 537
B: Summary Guides for Measuring Range of Motion, 543
C: Joint Measurements by Body Position, 553
D: Numerical Recording Forms, 555

Index, 561