Range of Motion (ROM) Tests

Relevant Social Security Medical Listings

  • Listing 1.02      Major Dysfunction of a Joint (Adults)
  • Listing 101.02 Major Dysfunction of a Joint (Children)
  • Listing 1.03      Reconstructive Surgery or Arthrodesis of a Major Weight-Bearing Joint (Adults)
  • Listing 101.03 Reconstructive Surgery or Arthrodesis of a Major Weight-Bearing Joint (Children)
  • Listing 1.04      Disorders of the Spine (Adults)
  • Listing 101.04 Disorders of the Spine (Children)
  • Listing 1.08      Soft Tissue Injury (Adults)
  • Listing 101.08 Soft Tissue Injury (Children)
  • Listing 14.09   Inflammatory Arthritis (Adults)
  • Listing 114.09 Inflammatory Arthritis (Children)

Type

Objective/Physical Examination (Joints and Spine)

Can SSA Purchase?

Yes, as part of physical examination. No orthopedic or other physical examination of bones and joints is complete without ROM testing.

Purpose

Range of motion (ROM) tests may be used to:

  • Determine range of motion (ROM) of joints or spine.
  • Determine the angular deviation of the spine caused by abnormalities such as kyphosis.

General

See Cervical Spine (Plain X-ray).

Technique

Range of motion (ROM) refers to the angular distance in degrees that the spine or a joint can be moved through. (ROM) should always be tested passively, except for testing of the spine. Passive testing means that the examining physician moves the tested limb through its joint motions, rather than relying on the effort of the patient. However, testing the ROM of the spine cannot be done passively and requires the cooperation of the patient.

The simplest but least precise method of testing ROM is observation by the examining physician without actual measurement of the ROM with instruments. However, use of measurement instruments are more objective and accurate.

Inclinometers are simple instruments used for measuring angles either electronically or by means of pendulums or bubbles that respond to the direction of gravity. A carpenter’s level is actually a type of bubble inclinometer. Inclinometers are of particular value in measuring the ROM of the spine as well as the severity of abnormal curvatures of the spine such as kyphosis. Inclinometers can be used to measure the ROM in the cervical, thoracic, and lumbar areas of the spine. Such ROM is forward or lateral flexion, extension, and rotation of the spine. Forward flexion simply refers to forward bending; lateral flexion refers to bending to the left or right sides; extension refers to bending backward; and rotation refers to turning of the spine around its axis. Measurements usually require two inclinometers. The inclinometers are placed so that one will move with the spine when ROM is tested, while the other will maintain its original position.

Goniometers are simple mechanical instruments consisting of two arms that are movable around a central section marked out in degrees. One arm of the goniometer is kept at the starting position of the joint, while the other arm moves with the joint.

Interpretation

If the ROM observed is full, i.e., without loss or limitation of motion (LOM), then observation by the examining physician is reasonably acceptable without resorting to actual measurement with goniometers or inclinometers. In any case, true ROM cannot be determined if ROM testing is limited by lack of patient cooperation or pain.

The difference in the two inclinometer readings discussed under “Technique” is used to determine the ROM in degrees of the part of the spine tested.

The amount of separation between the two arms of the goniometer discussed under “Technique” is used to determine the ROM in degrees of the joint tested.

Some basic ranges of motion are given below. It should be recognized that the range of motion (ROM) of joints is not exactly the same among reporting authorities. For example, the reported normal flexion of the lumbar spine may vary between 80° and 100°. The value cited below is 90°, but 80° flexion should not interpreted as abnormal.

The range of “normal” motion also decreases with age, particularly in the spine. Unfortunately, data are limited regarding ranges of motion in particular age groups. Some values below are expressed in a range of “normal” because of confounding factors from various medical references such as age, measurement error (about 10%), techniques of measurement, unspecified passive vs. active motion, and positions of various other body parts or trunkal positions during measurement. It should also be pointed out that the maximum possible range of motion of the spine or peripheral joints is not necessarily required for “normal” function in the sense of being able to perform the majority of work or daily living or hobby tasks without significant restriction.

SPINE

Cervical Spine
Forward Flexion 40 – 60°
Lateral Flexion 30 – 45°
Extension 30°
Rotation 45 – 80°

Thoracic Spine
Lateral Flexion 50°
Rotation 30°

Lumbar Spine
Flexion 80 – 90°
Extension 30°
Lateral Flexion 20°
Rotation 45°

EXTREMITIES

Shoulders
Abduction 170 – 180°
Forward Elevation 150 – 180°

Elbows 145 – 150°

Forearm
Pronation/Supination 70 – 80°

Wrists
Dorsiflexion (Extension) 65 – 85°
Palmar Flexion 65 – 70°
Radial Deviation 20°
Ulnar Deviation 30 – 35°

Hands
Distal Interphalangeal Joint (DIP) 80°
Proximal Interphalangeal Joint (PIP) 100°
Metacarpophalangeal Joint (MP) 65 – 90°
Thumb Basal Joint Abduction/Adduction 100 – 105°

Hips
Forward Flexion 100 – 120° (90° with knee extended)
Rotation Internal 40 – 45°
Rotation External 40 – 50°
Abduction 60 – 70°
Adduction 20 – 30°

Knees
120 – 150° flexion

Ankles
Dorsiflexion 20°
Plantar Flexion 50°
Eversion 20°
Inversion 30°