RANGE

OF

MOTION

569 MOTION
PA.

MEASUREMENT
BY

OF
DAVID

THE
SILVER,

RANGE
M.D.,

OF

IN

JOINTS.*

PITTSBURGH,

MEASUREMENT

of control Considerable which the

to be any

of the in treatment

range of motion in a joint and of record in military seems to exist as is to be estimated, best and most

is of value as a means and medico-legal work. point from not appear of measureeasy arm, a hearta is or of is

uncertainty degree of motion agreement

to the proper and there does accurate method as with this

as to the

ment. The following method is therefore suggested, execution, and sufficiently accurate. Protractor. A protractor of the simplest kind,
necessary.

simple, a long arm is

At

the

proper

place

in

the

centre

of

shaped opening with a hinged manner plane

arranged

through upright, it
that

which the scale is read. to which the protractor be moved

in

A stand is attached, in This

either of ita

is provided in such the vertical adjustment

that or folded
so

can
the positions

upward the
so

and be
the used center

downward plane.
in

so as to lie
protractor and

horizontal
may

the arc

vertical corresponds
one

the

horizontal

that

with the center Requirements

ment of

of the joint measured. as to Position. For which

fixed in is to be the same

accurate

measurement,

seg-

the

joint by patient

measured
plane.

and
This

the segment position;

base

of the

protractor
most

should

be firmly

is ordinarily

easily on a
is

accomplished table, the

then

resting being

the entire upper in the recumbent

center of of

of the joint the protractor until

must

with The a zero

sidered

placed beside it and the the center of the joint. mensuration plane.
to

its

arc
in

raised
joints

it coincides
start from

of The zero the be shall

extension to

the

degrees in the the

of

motion

plane joint considered be

be an hip and shall motion the

measuring joint plane of the long lateral the and planes from the of the

motion shall be conbone or bones immeantero-posterior planes spine, centre the of

diately In of the degrees

gravity This though

proximal

in question. zero. zero In of the the

the

the

shoulder,

trunk of
of

measured

body.
of the mensuration for publication
of joints In the was hope devised that it during the war, but,

method approved

by
now

the

Surgeon-General

on
may

May
aid

16,
in

1919,
the

never published. It Is presented lishment of a standard. Acknowledgment Is made of the

was estab-

in the Kendall

designing
Emerson,

of

the

Robert

valuable1 protractor, and B. Osgood, and

assistance
also of the R. Tunstall

given
helpful Taylor.

by Dr.

criticism

R. B. Maddox of Drs.

570

DAVID

SILVER

SHOULDER

JOINT.

Abduction.
arms so that at its base

Position:

patient folded
with side

lying on points its

line

on
of

back
body

with and
and

body laid
the

straight the registers movement

of protractor of its

and
arc

side; protractor
coincides

stand toward to note 90

on
center

shoulder zero. to move: of

is

with
In this

center
position

of
should

joint; be kept
abduction

indicator on the

hand when

and without

A finger the scapula. Forward

scapula

it begins

is normally
Position as of above;

degrees
inner and the

Elevation.
outer with
zero.

surface

placed to

against

surface of

shoulder

center

of

its

arc

raised

coincide

center

shoulder;

registers

In

this

position

indicator points forward elevation

toward hand and is normally about

110

degrees.

Fro.

1.

Tl original protractor, reduced to about one-third actual size, seen from the front. The protractor itself is shown l)antlY raised on the hinged upright of the stand. The indicator, which is provided with a sliding extension, is shown closed.

RANGE

OF

MOTION

571 back; arm

to right is degrees,

Rotation.
angles and outer zero. from

Position: body perpendicular; of elbow. at

Patient shoulder;
inner

lying forearm
surface

on
of

abducted
angle placed

at
at

right
elbow against as

flexed

held
surface In

protractor

Scale outward

is

read

from

90 rotation

considered

this

position

and

inward

are

practically

about

90 degrees.

The

original

protractor,

seen

from

Fm. 2, the back.

The

indicator

is shown

opened.

572

DAVID

SILVER

AIkMm

V1[D$CALP1,(ut1

3-

k..

Upper: Middle: Lower:

Position
Position Position

in measuring
In measuring

Fro. abduction forward

rotation

3. of the elevation
of the

shoulder. of the
shoulder.

shoulder.

in measuring

RANGE

OF

MOTION

573

AP1

l(OCAL

MVjtu,1

Fio Upper: Middle Position

4.

in measuring
Position in in measuring

fiexion
measuring fiexion

tion

(pro-

(Left): Position and supination).

(Right): Position

In measuring

and extension of the elbow. rotation In the nadio-ulnar

ab- and adduction and extension at at the wrist.

articula-

Middle Lower:

wrist.

the

574

DAVID

SILVER

ELBOW

JOINT.

Flexion
extended

and
at side

Extension.
and palm

Position
upward

: patient
; inner

lying
surface

on
of

back of its
toward is

with arc

arm
is

protractor

placed
to

against
with

outer
center

condyle
of

of humerus
elbow joint

and and

the

center
points

raised
hand.

coincide

; indicator

Full
about

extension 140 degrees.

is indicated

by

0 degrees

full

flexion

normally

Rotation patient
pointing

in Ra.diO-uinar lying
upward,

Articulation with
sitting

(Proresting
elbow of axis of

and on
flexed

Supination). border
a right the is placed so that

Position:

on

back
or

hand
with surface to long finger. in this

ulnar
to

and
angle against center

thumb
and ends of its

resting
of arc fingers

on a low
at right with as zero.

table;
angles end

inner
of little Measured

protractor arm,

coincides

The
way,

scale
pronation

is read
and

from

90 degrees,
are

considered

supination

each

normally

nearly

80 degrees.
HAND.

Flexion ing
inner center towards degrees. is turned of

and
upward

Extension. table,
in of raised Flexion

Position:

patient with
and with

sitting, arms extended

in outside of each joint; are

with .at
testing of normally

forearm sides.
and about extension; wrist indicator

restPalm
the

on a low
surface its

or

lying
testing to

on
is coincide and

back
placed

flexion,

downward against center

protractor

arc

points

fingers.

extension

70

Abduction
at sides so of this and
that

and
hands
its

Adduction.
fully base pronated. is opposite

Position:

patient

lying and are at each

on

back

with to about

arms long

Fold
wrist joint

protractor is opposite

and
right

place
angles

it under finger. 35

arm
axis In degrees.

arm,

and

so that
abduction

the

90 degree
and

point

the
normally

middle

position,

adduction

FINGERS.

Flexion the more Hart back of

and the

extension proximal to Toronto use (see

may joint instead,

be the

measured on special Reclaiming the

with table;
finger

this but the

same it will

instrument, be devised p. found at

resting

convenient House,

protractor

McKenzie:

Maimed,

68).

RANGE

OF

MOTION

575

AtM

r1OiAi.

F1v(u1

dc,

Fro.
Upper: Lower Lower Position (Left): (Right): in measuring fiexion Position in measuring Position in measuring

5.
of the hip. rotation of the hip. ab- and adduction

of the

hip.

576

DAVID

SILVER

PRMY

r1OIjLr1uSt.JM

Upper: Middle:

Position Position

in measuring

Fm. fiexion

6. and
and

extension
extension

of the
at the

knee.
ankle.

Lower:

Position

in measuring in measuring

fiexion
aband

adduction

of the

foot.

RANGE

OF

MOTION

577

HIP.

Flexion
pointing

and
directly

Extension.
upward

Position
; inner

: patient
surface of

lying
protractor

on

back,
resting

with

toes and
flexes

against

outer
indicator

surface hip 0 degrees

of hip,
pointing

with
toward

center
center

of arc
of

opposite
outer

center
condyle

of trochanter
; assistant

opposite from

to

disclose in full

concealed
extension to

fiexion.
about

Normal 130
patient

range in full
before;

of

motion flexion.
protractor

is

degrees
as is pressed

Abduction
is

and
a ruler

Adduction.
is so placed

Position: that its

folded; lower

edge

closely

against

the tractor

surfaces is laid on the

of

the hip

two so that

anterior
its

spinous base
rests

processes
against

and the ruler leg

the and

prothe

center position to 90
degrees.

of its arc lies over center of hip-joint. (the toes pointing directly upward) degrees. Abduction and adduction are

With the each

the

indicator

in the middle will point about 45

normally

Rotation.
angle; place

Position:
protractor

patient
so angles

lying

on

face

with

knee

flexed

to

a right

that
to

it
the

rests
long

against
axis of

the
the

anterior thigh. Outward manner It

surface

of is in-

the read

lower each

leg way

at

right

The

scale and

from are but

90

degrees,

considered

as

zero.

ward rotation Hyperextension. and extension about 10-15

each normally about 45 This may be estimated with the patient lying

degrees. in a similar on the face.

to flexion is normally

degrees.

KNEE.

Flexion
surface of of arc

and
raised by

Extension.
resting to coincide

Position:
against

patient
outer

lying
surface

on
of

face,
knee

with
and

inner
center

protractor

its

with and full

center flexion

of

knee

joint. about

Full 130

extension degrees.

is indicated

0 degrees

is normally

FOOT.

Flexion protractor
to scale normally coincide

and rests
with

Extension. against
center the

outer
of

Position: surface
ankle.

patient of ankle,
Patient

standing; center
bends

inner surface of of arc being raised

for planter

backward

flexion

and
is read

forward,
from about

keeping
middle

the and

knee dorsal

position

straight, for (90 degrees). flexion about

dorsal flexion. The Plantar flexion is 20 degrees.

60 degrees,

578 These patient

tractor

DAVID

SILVER

measurements lying,
is then

may

be a board

taken

in

similar

manner

with

the

by

placing

against

the

foot

on

which

the

pro-

rested.

Abduction
protractor

and
placed

Adduction.
against sole

Position: of foot

patient with the

lying;

inner

surface

of

90 leg

degree must 10 be and

point, held adduction

confirmly

sidered
to prevent

as

zero, it from

opposite
rotating.

the

middle Abduction

toe.

The

is normally

30 degrees.