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Recording: Patient's Name Diagnosis Therapist Name Age Date of Onset AROM or PROM The Neutral Zero Method defined by the American

Academy of Orthopaedic Surgeons1 _{is used for}

measurement and recording. 1.

Average ranges defined by the American Academy of Orthopaedic Surgeons1 _{are provided in}

parentheses. 2.

The columns designated with asterisks (*) are used for indicating limitation of range of motion and referencing for summarization.

3.

Space is left at the end of each section to record hypermobile ranges and comments regarding positioning of the patient or body part, edema, pain, and/or end feel.

4.

Left Side Right Side

Date of Measurement

Shoulder Complex

Shoulder Glenhumeral Joint

Elevation through flexion Elevation through abduction Extension Horizontal abduction Horizontal adduction Internal rotation External rotation (0–180˚) (0–60˚) (0–45˚) (0–135˚) (0–70˚) (0–90˚) (0–180˚)

Elbow and Forearm

Flexion Supination Pronation (0–150˚) (0–80˚) (0–80˚) Hypermobility: Hypermobility: Hypermobility: Knee Flexion Tibial rotation (0–135˚) Comments: Comments: Comments: Signature

A

B

C

Figure 1-46 Examples of recording range of motion (ROM) using a pictorial recording form: (A) right shoulder flexion and extension, (B) right elbow flexion and extension/hyperextension, and (C) left hip internal and external rotation. The use of shading to show the available elbow flexion ROM is illustrated in B.

If the ROM is less than or greater than the normal ROM, the existing ROM is indicated on a pictorial chart, or the number of degrees of motion is recorded on a numerical chart.

Every space on the ROM recording form should include an entry. 8 _{If the measurement was not performed,} not tested (NT) should be entered and a line may be drawn from the fi rst such entry to the end of several adja- cent entries so that NT does not have to be recorded in every space. 8

Any changes from the standard method of assessing joint ROM as presented in this text should be noted on the assessment form.

The ranges of motion are recorded on the numerical

chart as follow ( Fig. 1-45 ).

• When it is possible to begin the movement at the 0 ° start position, the ROM is recorded by writing the num- ber of degrees the joint has moved away from 0 ° —for example, right shoulder elevation through fl exion (i.e., shoulder fl exion) 160 ° or 0 ° –160 ° , right knee fl exion 75 ° or 0 ° –75 ° , right knee extension 0 ° .

• When it is not possible to begin the movement from the 0 ° start position, the ROM is recorded by writing the number of degrees the joint is away from the 0 ° at the beginning of the ROM, followed by the number of degrees the joint is away from 0 ° at the end of the ROM— for example, the patient cannot achieve 0 ° right elbow extension due to a contracture (abnormal shortening) of the elbow fl exor muscles; the end feel is fi rm. More spe- cifi cally, the right elbow cannot be extended beyond 10 ° of elbow fl exion and can be fl exed to 120 ° . The ROM would be recorded as right elbow fl exion 10 ° –120 ° .

• For a joint that is in a fi xed position or ankylosed, this is recorded on the chart along with the position of the joint.

On pictorial charts ( Fig. 1-46 ), the therapist extends lines from the joint axis on the diagram to the appropri- ate number of degrees marked on the arc of movement at the start and end positions for the movement. The area between the two lines may be shaded in to provide a visual image of the ROM (see Fig. 1-46 B). The date is recorded at the end of each line drawn to a degree mark- ing on the arc of movement.

Figure 1-46 provides examples of ranges of motion recorded using a pictorial chart for the following:

• Right shoulder elevation through fl exion (i.e., shoulder fl exion) 160 ° or 0 ° –160 ° and right shoulder extension 60 ° or 0 ° –60 ° as assessed on July 12, 2011. The patient was reassessed on August 2, 2011, and the ROM for right shoulder elevation through fl exion increased to 170 ° or 0 ° –170 ° , and there was no change in the ROM for right shoulder extension.

• Right elbow fl exion 10 ° –120 ° assessed on July 12, 2011.

• The July 12, 2011 assessment of left hip external rota- tion of 30 ° or 0 ° –30 ° and left hip internal rotation of 45 ° or 0 ° –45 ° .

The SFTR Method 62 _{is a less commonly used method of} recording joint ROM. The letters S, F, and T represent the

plane of motion (sagittal, frontal, and transverse, respec- tively; see Fig. 1-13 ) of the joint ROM assessed; the R rep- resents rotational motions. To record ROM, the letter identifying the plane of motion or rotational motion is noted. The letter is followed by three numbers that repre- sent the start position, 0 ° with normal movement, and the ROM present on either side of the start position. The start position is recorded as the middle number. The ROM present on either side of the start position is recorded before and after the start position using the conventions indicated below. 62 _{If a joint is ankylosed, only two num-} bers are recorded, 0 ° and the joint position to either the right or left of 0 ° using the conventions.

Conventions and examples of recording ROM using the SFTR method are as follows:

• Motion occurring in the S (i.e., sagittal plane) is exten- sion and fl exion. The number to the left of the start position represents extension ROM, and the number to the right represents fl exion ROM.

Example: Shoulder left S:60-0-180 ° right S:60-0-80 ° .

Interpretation: Left shoulder ROM is WNL, with 60 ° extension and 180 ° shoulder elevation through fl exion. Right shoulder extension is 60 ° and shoulder elevation through fl exion 80 ° .

Example: Elbow left S:0-0-150 ° right S: 0-10-120 ° .

Interpretation: The ROM recorded indicates motion in the sagittal plane. Left elbow ROM is WNL with a start posi- tion of 0 ° , 0 ° extension, and 150 ° fl exion. Right elbow extension and fl exion has a start position of 10 ° , elbow fl exion is 10 ° to 120 ° , or right elbow fl exion is 120 ° .

Example: Knee right S: 0-15 ° .

Interpretation: The use of only two numbers indicates the knee joint is ankylosed. The S indicates the anky- losed position is in the sagittal plane; therefore, the joint is in either an extended or fl exed position. The number is to the right of the 0 and by convention represents fl exion. Thus, the knee is ankylosed in 15 ° fl exion.

• Motion occurring in the F (i.e., frontal plane) is abduc- tion and adduction. The number to the left of the start position represents abduction, eversion, or left spinal lateral fl exion ROM and the number to the right of the start position represents adduction, inversion, or right spinal lateral fl exion ROM.

Example: Hip right F:45-0-30 ° .

Interpretation: Right hip abduction is 45 ° and adduction is 30 ° .

• Motion occurring in the T (i.e., transverse plane) is horizontal abduction and horizontal adduction, and retraction and protraction. The number to the left of the start position represents horizontal abduction or retraction ROM and the number to the right of the start position represents horizontal adduction or protraction ROM.

Example: Shoulder left T(F90):35-0-90 ° .

Interpretation: (F90) following the T indicates frontal plane 90 ° , meaning the motions of horizontal abduction

and adduction were performed with the left shoulder in a start position of 90 ° abduction. Left shoulder horizon- tal abduction is 35 ° and horizontal adduction is 90 ° .

• An R indicates rotational motion. The number left of the start position represents external rotation, forearm supination, or spinal rotation to the left. The number right of the start position represents internal rotation, forearm pronation, or spinal rotation to the right.

Example: Hip right R(S90):45-0-30 ° .

Interpretation: The (S90) after the R indicates hip rota- tion was measured with the hip in the sagittal plane 90 ° (i.e., with the hip fl exed 90 ° ). Right hip external rotation ROM is 45 ° and internal rotation is 30 ° .

Assessing and Measuring Joint ROM with a