GONIOMETRY

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 OUTLINE

What is goniometry ?
Importance of goniometry
Types of goniometer
Universal Goniometer
Range of Motion
Planes and Axes of joint motion
Important Notes
Procedures for Goniometric measurement
ROM measurement
Current Trends 2

References

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 WHAT IS GONIOMETRY

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 Goniometry is the measuring of angles created by
the bones of the body at the joints.1, 2, 3
 The term goniometry is derived from two Greek
words, gonia meaning angle and metron, meaning
measure. 1, 2, 3, 4,5,
 System to measure the joint ranges in each plane
of the joint is termed goniometry. 4
 These measurements are done with instrument
such as goniometer, a tape measure,
inclinometers or by visual estimate. 1, 2, 3, 4, 5 3

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 IMPORTANCE OF GONIOMETRY

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 Goniometry is useful in determining
▪ the presence of dysfunction
▪ establishing a diagnosis
▪ developing goals
▪ evaluating progress,
▪ fabricating orthoses
▪ a measurement for research purposes 4, 5, 6

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 TYPES OF GONIOMETERS
 Electro goniometer
 Universal goniometer sensor with angle meter

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 Gravity goniometer/
Single and twin axis
inclinometer
goniometer

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  Bubble goniometer  Digital goniometer

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 Arthroidal protractor

 Smartphone soft wares

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 UNIVERSAL GONIOMETER
A universal goniometer may be constructed of metal

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or plastic and it has three parts
A body
Fulcrum
Stationary arms
Moving arms
The body of the goniometer is designed like a
protractor and may form a full or half circle; and on
it is a scale from 0 to 180 or 360 1, 2, 3
The fulcrum is a rivet or screw-like device at the
center of the body that allows the moving arm to 7
move freely on the body of the device.1, 2, 3, 4, 5 6,

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 UNIVERSAL GONIOMETER

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The fulcrum and body is placed over the joint being
measured 3, 4, 5, 6, 7,8
The stationary arm will be aligned with the inactive
part of the joint measured while the moving arm is
placed on the part of the limb which is moved in
the joint’s motion1, 2, 3, 4, 5, 6, 7.

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 RANGE OF MOTION
 Range of motion can be defined as the amount

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of motion available at a joint. 5
 Each specific joint has a normal range of motion
that is expressed in degrees. 1
 Joint ranges are divided into

Active range of motion AROM

Passive range of motion PROM
 The structure involved with movement of the
bones as well as the bony arrangements are
factors in limiting motion. 1, 2, 3,4. 10

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 RANGE OF MOTION

 Determinants of joint ROM

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 Normal

▪ Age

▪ Gender

▪ Others such as ADL, right vs left, body physique,

active vs passive ROM
 Abnormal

▪ Tight soft tissues around the joint

▪ Muscle insufficiency

▪ Adhesion

▪ Foreign body
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 RANGE OF MOTION

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 The end-feel is the feeling which is experienced
by the examiner as a barrier to further motion at
the end of a PROM.
 These normal end-feels have been described as
soft, firm, and hard. The same terms are used to
describe abnormal end-feels with the addition of
"empty". 1, 2, 3

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 RANGE OF MOTION

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Contraindications to ROM testing:
 Dislocation or unhealed fracture in the region,

 immediately following surgery,

 On medication for pain or muscle relaxants (careful)

 Regions of osteoporosis or bone fragility,

 Patients with hemophilia,

 Immediately after an injury where disruption of tissue is

present.

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 PLANES AND AXES OF JOINT MOTION

 Motion at a joint occurs as a result of movement of

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one joint surface in relation to another. 1
 Arthrokinematics is the term used to refer to the

movement of joint surfaces. The movements at

the joint surfaces are described as slides (glides),
spins, and rolls. These three usually occur in
combination with each other and result in
movement of the shafts of the bones. 1, 2, 3, 4, 5, 9,
 Osteokinematics refers to the movement of the
shafts of the bones. These are usually described
in terms of rotary movement about an axis of 14
motion. 1, 2, 3

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 PLANES AND AXES OF JOINT MOTION

 Goniometry measures the angles created by the

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rotary motion of the shafts of the bones.1, 2, 3, 4
 Osteokinematic motions are classically described
as taking place in one of the three cardinal planes
of the body (sagittal, frontal, and transverse)
around three corresponding axes (medial-lateral,
anterior-posterior, and vertical).
 The three planes lie at right angles to one another
whereas the three axes are both at right angles to
the corresponding plane and to each other.1, 2, 3, 4
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 PLANES AND AXES OF MOVEMENT
ANATOMICAL POSITION

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 VALIDITY AND RELIABILITY OF GONIOMETER

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 According to the American Academy of Orthopeadic
Surgeons, Kendall and McCreary, Hoppenfeld, and the
American Medical Association. 1, 2, 3, 4, 5, 6, 7
 Content validity – it is assumed that the angle created
by aligning the arms of the goniometer with bony
landmarks truly represents the angle. “The accurate
application of knowledge and skills, combined with
interpreting the results as measurement of range of
motion only, provide sufficient evidence to ensure
content validity.”
 Reliability – overall good to excellent reliability. Higher
reliability has been found for measurements of join1t7
position compared to range of motion.

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 VALIDITY AND RELIABILITY OF GONIOMETER

 Reliability varies depending on the joint being measured.

Intratester reliability is found to be higher than intertester

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reliability
 Advantages

• Good reliability and validity.

• Ease of use.
• Inexpensive.
•Can be used to establish presence or absence of dysfunction and also
monitor progress
 Limitations
• Reliability dependent on examiner experience.
• Reliability varies depending on what joint is measured.
• Requires consistency in positioning, stabilization, and alignment. 18

• Some disagreement between sources for normal values of range of

motion.

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 IMPORTANT NOTES
 The starting position for measuring all ROM is the
anatomical position except for rotation in

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transverse plane.
 Be aware of the position the body is supposed to
be in for movement and any stabilization issues.
 Stabilize the part of the body that is proximal
(stationary portion) to the joint you are testing.
 The patient do not move his body while the
moving the joint; this step isolates the joint
movement for a more accurate measurement.
 There are three notation of goniometric
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measurement which are 0-180º, 180-0º and 0-
360º.

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 IMPORTANT NOTES

 Zero degrees is the neutral starting position

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 Consistently use the same stationary and movable
landmarks on the body when measuring, to
ensure consistency.
 The angle of movement from the stationary arm to
the moving arm is read off the body and reported
as the ROM.
 Look at the reading on the goniometer at eye level
before removing it from the patient’s body.
 Be sure to record the ROM of the joint

 Compare reading with contralateral side 20

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 PROCEDURE FOR GONIOMETRIC MEASUREMENT

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 The patient is positioned in the recommended testing
position.
 While stabilizing the proximal joint component, the
clinician gently moves the distal joint component through
the available range of motion until the end feel is
determined.
 An estimate is made of the available range of motion and
the distal joint component is returned to the starting
position.
 The clinician palpates the relevant bony landmarks and
aligns the goniometer.
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 PROCEDURE FOR GONIOMETRIC MEASUREMENT

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 A record is made of the starting measurement.
 The goniometer is then removed and the patient
moves the joint through the available range of
motion.
 Once the joint has been moved through the
available range of motion, the goniometer is
replaced and realigned, and a measurement is read
and recorded.
 Repeat measurement three times and record the
average as the goniometric value for the joint’s
ROM
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 ROM MEASUREMENT

Shoulder ROM

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 Extension:
Flexion:  Motion: 0-45º~60º from
 Motion: 0-180º neutral position
 Position: Subject supine with  Position: Subject prone or sitting ,
knees flexed or sitting. elbow elbow in slight flexion with the
extended with the palm facing the palm facing the body.
body  Goniometer: Axis at the acromion
 Goniometer: Axis at the process, laterally through the head of
acromion process, laterally through the humerus
the head of the humerus.  Stationary Arm aligned with mid-
 Stationary arm is placed along the axillary line of the trunk
mid-axillary line of the trunk  Moving arm along the lateral mid-line
 Moving arm place along the lateral of humerus in line with lateral
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mid-line of the humerus in line with epicondyle.
the lateral epicondyle.

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Abduction: OR
 Motion:0-180º Goniometer: Axis at the posterior

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portion of the acromion process;
 Position: Supine, prone or
Stationary arm aligned parallel to spinous
sitting with the limb in
process of the vertebral colomn
anatomic position
Moving arm aligned with the midline of
 Goniometer: Axis at anterior the humerus in line with lateral
portion of acromion process. epicondyle
 Stationary arm at lateral aspect of Adduction:
anterior surface of chest parallel to
midline of sternum. Motion: 0-30º
 Moving arm on anterior aspect of Aligment of goniometer is
arm parallel to midline of humerus
and in line with medial epicondyle. same for abduction.

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External rotation: Internal rotation:
 Motion: 0-90º  Motion: 0-65~90º

 Position: Supine. Shoulder is  Positioning and goniometer

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abducted to 90º. Elbow flexed alignment is same as in
with forearm in neutral and external rotation
perpendicular to table top such
that the palm is facing the feet.
Elbow not supported. Humerus
is fully supported on the table.
Stabilize the distal humerus,
thorax, and scapula.
 Goniometer: Axis at olecranon
process of the ulna.
 Stationary arm placed parallel to the
table top or perpendicular to the
floor.
 Moving arm along the ulnar shaft 25
aligned with the styloid process of
the ulna.

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 Radio-ulnar ROM
Supination: Pronation:
 Motion: 0- 80º~ 90º  Motion: 0- 80º~ 90º

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 Position: Subject sitting or  Position: same for supination
supine, with the elbow flexed
to 90º. Shoulder in zero  Goniometer: Axis is lateral
degrees of its’ ROM. Position to the ulnar styloid process.
starts midway between  Stationary arm is aligned parallel to the
Supination and Pronation. anterior midline of the humerus.
 Moving arm across the dorsum of the
 Goniometer: Axis is medial to wrist on a line between and proximal to
the ulnar styloid process. the styloid process of the radius and
 Stationary arm is aligned parallel the ulna.
to the anterior midline of the
humerus.
 Moving arm across the ventral
aspect of the wrist on a line
between and proximal to the 27
styloid process of the radius and
the ulna.

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 Wrist ROM Extension:
Flexion:  Motion: 0-60º~70º
 Motion: 0-60º~80º  Position and goniometer: same

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 Position: Subject sitting, for flexion
shoulder in 90º of abduction; Ulnar deviation:
elbow flexed to 90º. The forearm
Motion: 0-30º~35º
placed in between supination
and pronation such that the Radial deviation:
palm of the hand parallels the
floor.
 Motion: 0-20º
 Position: same for wrist flexion
 Goniometer: Axis is distal to the
ulnar styloid process or over the  Goniometer: Axis is at the middle of
lateral aspect of the wrist over the the dorsal aspect of the wrist over the
triquetrum capitate.
 Stationary arm parallel to and over  Stationary arm midline on the dorsal
the lateral midline of the ulna, in line surface of the forearm in line with the
with the olecranon. lateral epicondyle of the humerus. 28
 Moving arm along the lateral  Moving arm along midline of the dorsal
midline of the 5th MC. surface of the 3rd MC.

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 HAND JOINTS ROM7

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 Hip ROM
Flexion:
Extension:
 Motion: 0-100º~125º

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 Motion: 0-10º~30º
 Position: Supine or side lying
 Position: Prone or Side lying on
on the opposite limb to be
the opposite limb to measured; the
measured; limb in anatomical
limb in anatomical position
position with knee flexed at the
end of the motion.  Goniometer alignment is the
 Goniometer: Place the axis at same for hip flexion.
the lateral aspect of the hip joint *Stabilise the pelvis when
over the greater trochanter.
measuring hip flexion and
 stationary arm is parallel to the long
axis of the trunk in line with the extension.
greater trochanter or the lateral
midline of the pelvis
 moving arm is placed along the
lateral midline of the femur in line 30
with lateral epicondyle of the femur

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Abduction: Adduction:
 Motion: 0 - 40º~50º  Motion: 0-20º~30º

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 Position: Supine with the limb  Position: Supine, with opposite
in anatomical position (0º of all limb abducted
limb joints ROM)  Goniometer alignment is
 Goniometer: axis at the anterior same as for hip abduction
superior iliac spine(ASIS) of the
measured limb.
*Stabilise the pelvis
 Stationary arm is at an imaginary
horizontal line extending from one
ASIS to the other.
 Moving arm is with the anterior
midline of the femur, in line with the
midline of the patella.
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External Rotation: Internal Rotation:
 Motion: 0-40º~50º  Motion: 0-40º~45º

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 Position: Supine, with knees  Positioning and goniometer
extended over the table OR alignment is same as in hip
Prone with knee flexed OR external rotation
High sitting with 90º flexion of
hip and knee, 0º of hip
*Stabilise the femur pelvis
abduction and adduction
 Goniometer: axis over the
anterior mid patella
 Stationary arm is parallel to the
supporting surface or the floor
 Moving arm is placed along the
anterior surface of the tibia
midway between the malleoli.
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  Knee ROM
Extension:
Flexion:
 Motion: note any

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 Motion: 0-135º~150º
hyperextension
 Position: Supine, knees in
 Positioning and goniometer
extension with hip flexed to
90o at end of the motion OR alignment is same with knee
prone lying with knee flexion.
extended foot over the edge  Extension is an opposite
of the supporting surface.
motion to flexion
 Goniometer: Axis is placed
over the lateral epicondyle of the
*The thigh should be stabilized
femur in flexion motion
 Stationary arm is parallel to the measurement
lateral midline of the femur in line
with the greater trochanter
 Moving arm is placed lateral at 33
the midline of the fibula in line
with the lateral malleolus.

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 Ankle ROM
Plantarflexion:
Dorsiflexion:
 Motion:0-40º~50º
 Motion:0-20º
 Positioning and goniometer

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 Position: Subject was sitting alignment is same with
with legs off the table or on dorsiflexion
high sitting with lower leg at
right angle to the thigh and the
Inversion:
foot at right angle to the lower  Motion:0-15º~20º
leg as the zero starting  Position: same with dorsiflexion
position.
 Goniometer: fulcrum was aligned  Goniometer: axis is midway
slightly inferior to the lateral between the two malleoli at the
malleolus. anterior aspect of the ankle
 Stationary arm is with the midline  Stationary arm is with the anterior
of the lateral aspect of the lower midline of tibia in line with the tibial
leg, in line with the head of fibula. tuberosity
 Moving arm was parallel to the 5th  Moving arm is with the anterior
metatarsal. midline of the 2nd metatarsal. 34

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  Subtalar ROM
 Eversion: Inversion:
 Motion:0-5º
 Motion:0-15º~20º
 Position: prone lying with hip and

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 positioning and goniometer
alignment is same as for knee in 0º of all their joints’ ROM, foot
inversion is off the supporting surface such that
the toes are point downwards
 Goniometer: axis is over the posterior
aspect of the ankle midway between the
two malleoli.
 Stationary arm is with posterior midline of
the leg
 Moving arm is with posterior midline of the
calcaneus.
Eversion:
 Motion:0-5º
 Positioning and goniometer alignm35ent
is same as for inversion.

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 Cervical ROM Lateral flexion:
Flexion:  Motion:0-45º
 Motion:0-45º  Position: same as flexion

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 Position: sitting with head  goniometer: axis is on the spinous
and neck in anatomical process of the 7th cervical vertebra
position, lumbar and thoracic  Stationary arm is with the spinous
region supported on back rest processes of the thoracic vertebrae
 Goniometer: axis on the perpendicular to the floor
external auditory meatus  Moving arm is with the posterior
 Stationary arm is perpendicular to midline of the head in line with occipital
the floor in line with head protuberance

 Moving arm is with the base of the

nares
 Extension:
 Motion:0-45º
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 Positioning and goniometer
alignment is same as flexion

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  Lumbar ROM
Rotation: Flexion:
 Motion: 0-60º~80º  Motion: 4inches

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 Position: same as for flexion  Position: standing and in
 Goniometer: axis over the anatomical position
centre of the cranial aspect of the  Tape Measure: Placed proximately
head at the C7 spinous process and distally at
 Stationary arm in line with an S1; calculate the difference between
imaginary line between the two standing and flexion ending position.
acromial processes
Extension:
 Moving arm is with the tip of the
nose  Motion:2inches

 Position: same with flexion

 Tape Measure: Placed proximately

at the C7 spinous process and distally at
S1; calculate the difference between
standing and extension ending posit3io7n.

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Lateral flexion: Rotation:
 Motion: 0-25º~35º  Motion:0-30º~45º

 Position: same as flexion  Position: same as flexion

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 Goniometer: axis over the  Goniometer: axis at the centre of
spinous process of 1st sacral the cranial aspect of the head
vertebra  Stationary arm is parallel with the
 Stationary arm is imaginary line between the two
prominent tubercles on the iliac crest.
perpendicular to the floor
 Moving arm is with an imaginary line
 Moving arm is in line with the between the two acromial processes
spinous process of the of the
7th cervical vertebra
 Tape Measure: Placed
proximally at the finger tips
and distally at the lateral
malleolus; calculate the
difference between sides when 38
standing and with side
bending.

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 CURRENT TRENDS
 The use of inclinometer software to measure ROM in a
joint. In a study by Brian et al, (2013), it was inferred that

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Smart phones have good correlation with the “gold
standard” goniometer for measuring shoulder range of
motion. Additionally, there is good correlation amongst
different levels of providers with measurements obtained
using the smart phone
 Drgoniometer 12

 The use of sensor and goniometer probe setup to measure

joint ROM. It usually convenient for large joints
 It is designed as a sensor pad connected to a
potentiometer or a probe connected to a sensor angle
meter 7, 8
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Example of goniometric measurement
using DrGoniometer as it appears on the 41
smartphone screen

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 CONCLUSION

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 Goniometric measurement is an important skill all
physiotherapist must have as it employed in almost all
area of physiotherapy practice.
 There are different instrument for measurement of joint’s
range of motion but the universal goniometre remains the
gold standard due to it’s excellent validity and reliability in
most articles. It also has advantages such as ease of use,
inexpensive, easily available and accuracy.
 Though some other instrument are as reliable and valid as
the universal goniometer but the cost of purchase,
availability and ease of use may not be met.
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 REFERNCES
1. Norkin, C.C. & White, D.C. (1988) Techniques and procedures, in Measurement of joint motion:
A guide to goniometry. In Norkin & White, Eds. FA Davis: Philadelphia. p. 9-24.
2. Norkin, & White.(1995) Measurement of Joint Motion: A Guide to Goniometry. 2nd ed.

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Philadelphia, PA: F.A. Davis Company.
3. Norkin, & White.(2003) Measurement of Joint Motion: A Guide to Goniometry. 3rd ed.
Philadelphia, PA: F.A. Davis Company;.
4. The British Orthopaedic Association (1983) Joint motion: method of measuring and recording. In
Heck, C.V., Hendryson, I.E., Rowe, C.R. (eds). Edinburg: Churchill Livingstone.
5. Gadjosik, & Bohannon(1987) Clinical measurement of range of motion: review of goniometry
emphasizing reliability and validity. Physical Therapy; 67: 1867-1872.
6. Gogia, Braatz, Rose, & Norton.(1987) Reliability and validity of goniometric measurements at the
knee. Physical Therapy; 67: 192-195.
7. Nadeau, Kovacs, Gravel, Piotte, Moffet, Gagnon, & Hebert.(2007) Active movement
measurements of the shoulder girdle in healthy subjects with goniometer and tape measure
techniques: A study on reliability and validity. Physiotherapy Theory and Practice.; 23: 179-187.
8. Brian, C.W., Chris, M.K., Justin, W.G., Matthew, L.L., Joseph, M.H., & Stephen F.B.(2013)
Shoulder Range of Motion: Validation of an Innovative Measurement Method Using a
Smartphone The Orthopaedic Journal of Sports Medicine, 1(4)(suppl 1)
9. MacDermid, et al.(1999) Range of motion measurement. Journal of Hand Therapy; 12:187-192.
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 REFERNCES

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10. Rasmussen, O.(1985) Stability of the ankle joint. Acta Orthop. Scandinavica; Suppl.
211: p. 56-78.
11. Seto, J.L. & Brewster,C.E.(1985) Treatment approaches following foot and ankle injury.
Clinical Sports Medicine; 13: p. 295
12. Ferriero,G., Sartorio, F., Foti,C., Primavera,D., Brigatti, E.& Vercelli, S. (2012) Reliability
of a New Application for Smartphones (DrGoniometer) for Elbow Angle Measurement.
The American Academy of Physical Medicine and Rehabilitation; Vol. 3:1153-1154

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