6 Steps of Goniometry Procedure

List the 6 steps used during goniometric measurement

1. Positioning and Stabilization

Position the joint in the 0° reference position and stabilize the body segment

2. Quality Check

Move the joint through the ROM to assess movement quality

3. End Feel

Resistance felt at the end of passive ROM

4. Landmark

Identify and palpate bony landmarks

5. Alignment

Align the goniometer axis and arms with anatomical landmarks

6. Read & Record Measurement

Read the measurement and record ROM in degrees

Positioning and Stabilization

Joint positioned at 0° reference point; record if 0° cannot be achieved

Limiting Factors of ROM

Pain, muscle tightness, or contracture that limit motion

Poor Stabilization

Most frequent cause of invalid goniometry measurement

Patient Relaxation

Patient should remain relaxed without voluntary muscle contraction

Quality Check

Move joint to end of ROM to assess quality of movement

End Feel Definition

Resistance to further movement at the end of passive ROM

Reliability in Goniometry

Upper extremity measurements are typically more reliable than lower extremity

Improving Reliability

Use the same goniometer, positioning, procedure, and examiner

Landmark Identification

Identify and palpate bony landmarks before alignment

Alignment

Align goniometer with bony landmarks while holding joint at end ROM

Measurement Recording

Measure one direction at a time (ex: elbow flexion or extension)

Upper Extremity Anatomy

Bones and landmarks used in UE goniometry

Humerus

Upper arm bone

Humeral Head

Proximal rounded part of humerus

Acromion Process

Bony projection of scapula at shoulder

Medial Epicondyle

Medial distal humerus landmark

Lateral Epicondyle

Lateral distal humerus landmark

Olecranon

Process of the ulna forming the elbow

Ulnar Styloid Process

Distal bony projection of ulna

Radial Styloid Process

Distal projection of radius

Capitate

Carpal bone used as wrist goniometer axis

Triquetrum

Carpal bone on ulnar side of wrist

Metacarpal

Bones of the hand

Metacarpophalangeal Joint

MCP joints between metacarpals and phalanges

Mid Axillary Line

Imaginary vertical line down the side of the torso

Wrist Radial Deviation Test Position

Sitting with forearm resting on table; stabilize forearm to prevent pronation/supination

Wrist Radial Deviation Normal Range

21° ± 4° (AAOS); 20° (AMA)

Wrist Radial Deviation Axis

Capitate

Wrist Radial Deviation Stationary Arm

Aligned with forearm (lateral epicondyle)

Wrist Radial Deviation Moving Arm

Aligned with metacarpal or middle metacarpal

Wrist Radial Deviation End Feel

Ligamentous

Wrist Ulnar Deviation Test Position

Sitting with forearm resting on table; stabilize forearm

Wrist Ulnar Deviation Normal Range

35° ± 3.8° (AAOS); 30° (AMA)

Wrist Ulnar Deviation Axis

Capitate

Wrist Ulnar Deviation Stationary Arm

Aligned with forearm (lateral epicondyle)

Wrist Ulnar Deviation Moving Arm

Aligned with metacarpal or middle metacarpal

Wrist Ulnar Deviation End Feel

Ligamentous

Forearm Pronation Test Position

Sitting; shoulder neutral; elbow flexed 90°; stabilize arm

Forearm Pronation Normal Range

75° ± 5.3° (AAOS); 80° (AMA)

Forearm Pronation Axis

Lateral to ulnar styloid

Forearm Pronation Stationary Arm

Parallel to humerus

Forearm Pronation Moving Arm

Aligned with dorsum of radius

Forearm Pronation End Feel

Capsular

Forearm Supination Test Position

Sitting; shoulder neutral; elbow flexed 90°

Forearm Supination Normal Range

81° ± 4° (AAOS); 80° (AMA)

Forearm Supination Axis

Medial to ulnar styloid

Forearm Supination Stationary Arm

Parallel to humerus

Forearm Supination Moving Arm

Aligned with ventral aspect of radius

Forearm Supination End Feel

Capsular

Shoulder External Rotation Test Position

Supine; shoulder abducted 90°; elbow flexed 90°; forearm neutral

Shoulder External Rotation Normal Range

69° ± 4.6° (AAOS); 90° (AMA)

Shoulder External Rotation Axis

Olecranon process of ulna

Shoulder External Rotation Stationary Arm

Aligned vertically

Shoulder External Rotation Moving Arm

Aligned with ulna (styloid process)

Shoulder External Rotation End Feel

Capsular

Shoulder Internal Rotation Test Position

Supine; shoulder abducted 90°; elbow flexed 90°; forearm neutral

Shoulder Internal Rotation Normal Range

104° ± 8.5° (AAOS); 90° (AMA)

Shoulder Internal Rotation Axis

Olecranon process of ulna

Shoulder Internal Rotation Stationary Arm

Aligned vertically

Shoulder Internal Rotation Moving Arm

Aligned with ulna (styloid process)

Shoulder Internal Rotation End Feel

Capsular

Shoulder Abduction Test Position

Supine; no shoulder flexion or extension; shoulder abducted

Shoulder Abduction Normal Range

167° ± 4.7° (AAOS); 150° (AMA)

Shoulder Abduction Axis

Center of humeral head near acromion

Shoulder Abduction Stationary Arm

Parallel to mid-axillary line

Shoulder Abduction Moving Arm

Aligned with midline of humerus (lateral epicondyle)

Shoulder Abduction End Feel

Muscle stretch

Shoulder Flexion Test Position

Supine with knees flexed; avoid accessory motion

Shoulder Flexion Normal Range

184° ± 7° (AAOS); 180° (AMA)

Shoulder Flexion Axis

Center of humeral head near acromion

Shoulder Flexion Stationary Arm

Parallel to sternum

Shoulder Flexion Moving Arm

Aligned with midline of humerus

Shoulder Flexion End Feel

Muscle stretch