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Shoulder Horizontal Abduction
- TP: Supine č the hips & knee bent & the shoulder abducted 90° & the elbow flexed 90°
- Stabilization: @ the thorax to prevent lateral lumbar flexion or trunk roll
- Fulcrum: Superior surface of the acromion
- Stationary Arm: Perpendicular to the floor projecting towards the floor
- Moving Arm: // to the longitudinal axis of the humerus pointing toward the lateral epicondyle
- Expected ROM: 45°
- Substitutions: Trunk Rotation
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Shoulder Extension
- TP: Prone, the face turned away from shoulder being tested. *pillow is not used. Palm of hand faces the body.
- Stabilizeation: @ the inferior angel of the scapula or @ the aceromion to prevent elevation & anterior tilting
- Fulcrum: Lateral aspect of the of the greater tubrical
- Stationary Arm: // to mid-axillary line of the trunk
- Moving Arm: // to longitudinal axis of the humerus pointing toward the lateral epicondyle
- Expected ROM: 60°
- Substitutions: scapular elevation & anterior tilting
- *Maintain slight elbow flexion so that long head of triceps does not restrict motion
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Shoulder Abduction
- vTP: Supine č the hips & knees bent. Arm is in the anatomical position č the shoulder externally rotated
- Stabilization: @ the scapula/thorax
- Fulcrum: Anterior aspect of the shoulder, close to the acromion process
- Stationary Arm: // to mid-line of the sternum
- Moving Arm: Anterior aspect of the upper arm // to longitudinal axis of the humerus
- Expected ROM: 90° of pure GH abd; 150° č GH, AC, SC, & scapulothoracic contribution; 180° if lumbar lateral flexion is allowed
- Substitutions: Lumbar lateral flexion
- *Excessive scapular ↑ rotation contribution to movement
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Shoulder IR
- vTP: Supine č the shoulder & elbow abd 90°. The forearm is midway between pronation/supination č the entire humerus supported by the table.
- Stabilization: @ the distal humerus through the full ROM & @ the thorax/scapula @ the end ROM
- Fulcrum: The olecranon process of the ulna projecting through the humeral shaft toward the humeral head
- Stationary Arm: // to the supporting surface or perpendicular to the floor
- Moving Arm: // to the longitudinal axis of the ulnar pointing toward the styloid process
- Expected ROM: 70° internal rotation; 90° external rotation
- Substitutions: Elbow extension, scapular elevation, tilting, or protraction
- *The amount of motion available is influenced by the position of abd in the frontal plane & whether the measurements are performed in the scapular or frontal planes. Specifically record the position during measurement.
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Shoulder Flexion
- TP: Supine č hips & knees bent & lumbar spine flat. Arm is @ the side č the palm in & the thumb ↑
- Stabilization: Body weight should stabilize scapula but manual stabilization may be required to prevent excessive scapular rising & tipping posteriorly
- Fulcrum: Lateral aspect of the of the greater tubrical
- Stationary Arm: // to mid-axillary line of the trunk
- Moving Arm: // to longitudinal axis of the humerus pointing toward the lateral epicondyle
- Expected ROM: 120° of pure GH flexion; 150° č GH, AC, SC, & scapulothoracic contribution;180° if lumbar hyperextension permitted
- Substitutions: Lumbar hyperextension, Scapular tipping
- *Maintain slight elbow flexion so that long head of triceps does not restrict motion
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Elbow Flexion
- TP: Supine or sitting č the arm // to the midline & the forearm in the anatomical position
- Stabilization: @ the humerus
- Fulcrum: Over the lateral epicondyle of the humerus
- Stationary Arm: // to the longitudinal axis of the humerus pointing towards the tip of the acromion
- Moving Arm: // to longitudinal axis of the radius pointing toward the styloid process of the radius
- Expected ROM: 150°
- Stabilization: Prevent shoulder flexion
- *Note: If he forearm cannot be placed in full supination, note the position of testing
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Elbow Extension
- TP: Supine or sitting č the arm // to the midline & the forearm in the anatomical position.
- Stabilization: Examiner manually stabilizes the humerus
- Fulcrum: Over the lateral epicondyle of the humerus
- Stationary Arm: // to the longitudinal axis of the humerus pointing towards the tip of the acromion
- Moving Arm: // to the longitudinal axis of the radius pointing towards the styloid process of the radius
- Expected ROM: 0° in males; 10-15° in females is common.
- Stabilization: Prevent scapular tilting
- *Note: if hyperextension range is available, a towel roll can be placed under the humerus
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Forearm Pronation/Supination
- TP: Sitting č the shoulder add to the side & the elbow flexed 90° č the forearm in the neutral “hand shake” midposition.
- Stabilization: @ the humerus & does not allow abd or add
- Fulcrum: Just medial & posterior (supination) or lateral & posterior (pronation) to the ulnar styloid process
- Stationary Arm: // to the long axis of the humerus
- Moving Arm: // to the dorsal forearm surface in pronation & volar surface in supination
- Expected ROM: 80-90° of pronation and supination
- Substitutions:
- Supination: wrist extension & or radial deviation, add & ER of the shoulder, & ipsilateral trunk lateral flexion
- Pronation: wrist flexion &/or ulnar deviation, abd & IR of the shoulder, &/or contralateral trunk lateral flexion
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Wrist Flexion-Extension
- TP: Elbow flexed 90°; Wrist over edge of table č forearm in full pronation
- Stabilization: Forearm stabilized to prevent pronation or supination
- Fulcrum: Lateral placement over the triquetrum
- Proximal Arm: // č the ulna bisecting the ulnar styloid, radial head, & lateral epicondyle
- Distal Arm: // to longitudinal axis of the 5th metacarpal
- Expected ROM: 75° for both flexion & extension
- Substitutions: Excessive radial or ulnar deviation
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Wrist Radial-Ulnar Deviation
- TP: Elbow flexed 90°; Wrist over edge of table č forearm in full pronation
- Stabilization: @ Forearm to prevent pronation, supination, or shoulder rotation
- Fulcrum: Dorsal aspect over the capitate
- Proximal Arm: Dorsal midline of the forearm
- Distal Arm: // to longitudinal axis of the 3rd metacarpal
- Expected ROM: 20° radial deviation & 30° ulnar deviation
- Substitutions: MCP abduction or adduction
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Hip Flexion
- TP: Supine č hips & knees in neutral rotation
- Stabilization: Trunk stabilized by body position
- Fulcrum: Femoral Greater Trochanter
- Proximal Arm: // to mid~axillary line of the trunk
- Distal Arm: // to longitudinal axis of the femur in line č lateral femoral condyle
- Expected ROM: 120°
- Substitutions: Lumbar Spine flexion
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Hip Extension
- TP: Prone č hips & knees in neutral & feet extending off end of the table
- Stabilization: @ Pelvis through straps or manual fixation
- Fulcrum: Greater Trochanter
- Proximal Arm: // to mid-axillary line of the trunk
- Distal Arm: // to longitudinal axis of femur in line č lateral femoral condyle
- Expected ROM: 30°
- Substitutions: Lumbar spine extension
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Hip Abduction
- TP: Supine č hips & knees in neutral & pelvis level
- Stabilization: Opposite hip
- Fulcrum: ASIS on measured side
- Proximal Arm: Along a line between the two ASIS’s
- Distal Arm: // to the long axis of the femur
- Expected ROM: 45°
- Substitutions: Hip external rotation, knee flexion/internal rotation, or lateral pelvic tilt
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Hip Adduction
- TP: Supine č the opposite extremity abd
- Stabilization: prn
- Fulcrum: ASIS on measured side
- Proximal Arm: Along a line between the two ASIS’s
- Distal Arm: // to the long axis of the femur
- Expected ROM: 30°
- Substitutions: Hip IR or lateral pelvic tilt
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Hip Internal & External Rotation
- TP: Sitting č the hip & knee flexed 90°. Opposite extremity abd & resting on a foot stool
- Stabilization: prevent thigh abd/add
- Fulcrum: mid-patella
- Proximal Arm: Perpendicular to the floor
- Distal Arm: // to long axis of the tibia
- Expected ROM: 45° internal and external ROM
- Substitutions: thigh abd/add
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Knee Flexion
- TP: Supine or reclined č hip & knee in neutral rotation
- Stabilization: Trunk & pelvis stabilized by body weight & position
- Fulcrum: Lateral epicondyle of the femur
- Proximal Arm: // to the long axis of the femur & pointing @ the greater trochanter
- Distal Arm: // to the long axis of the fibula & pointing @ the lateral malleolus
- Expected ROM: 135°
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Knee Extension
- TP: Supine č hips & knees in neutral rotation; distal leg on bolster
- Stabilization: Trunk & pelvis stabilized by body weight & position
- Fulcrum: Lateral Epicondyle of the femur
- Proximal Arm: // to the long axis of the femur & pointing @ the greater trochanter
- Distal Arm: // to the long axis of the fibula & pointing @ the lateral malleolus
- Expected ROM: 0°. Hyperextension may be present up to 10-15°
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Tibial Internal/External Rotation
- TP: Prone č knee flexed 90°
- Stabilization: @ the femur
- Fulcrum: //to the long axis of the tibia
- Stationary Arm: // to the long axis of the tibia
- Moving Arm: // to & in line č the bisection of the heel & the 2nd metatarsal shaft
- Expected ROM: 30° internal & 40° external ROM. It is difficult to establish neutral rotation & it may be more test-retest reliable to record the total ROM
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Dorsiflexion
- TP: Prone č ankle off edge of table & knee extended
- Stabilization: @ tibia against the supporting surface
- Fulcrum: Lateral calcaneus @ bisection of fibula & 5th metatarsal
- Proximal Arm: // to the long axis of the fibula & pointing towards the fibular head
- Distal Arm: // to the long axis of the 5th metatarsal
- Expected ROM: 10° č knee extended; increased to 20° č the knee flexed
- Substitutions: Therapist must monitor for subtalar pronation. Watching for calcaneal eversion can monitor this.
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Plantarflexion
- TP: Prone or supine č the knee in slight flexion
- Stabilization: @ the lower leg
- Fulcrum: Lateral calcaneus @ bisection of fibula & 5th metatarsal
- Proximal Arm: // to the long axis of the fibula & pointing towards the fibular head
- Distal Arm: // to the long axis of the 5th metatarsal
- Expected ROM: 30-50°
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Inversion/Eversion
- TP: Standing č bilateral stance
- Stabilization: Not necessary
- Fulcrum: Just proximal to the achilles insertion on the calcaneus
- Proximal Arm: // to the distal bisection of the lower leg
- Distal Arm: // to the bisection of the calcaneus
- Expected ROM: Approximately 10° of calcaneal eversion (pronation) & 20° of calcaneal inversion (supination) from the subtalar neutral position
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