REIDER PART 1 20
8__Chapter 1_Terms and Technigues
Figurę 1-5, cont'd. Eand F, Tran$ver$e piane.
are further modified to dorsiflexion and volar flexion; in the ankle, they are modified to dorsiflexion and plantar flexion.
Abduction and adduction refer to motion within the coronal piane of the body, which may also be described as motion about an anteroposterior axis (Fig. 1-6C and D). Abduction describes movements that take the limb away from the midline of the body, whereas adduction describes movements that bring the limb back toward the midline. The spine is a midline structure; therefore, similar movements in the spine are described as right and left lateral bending.
External rotation and internal rotation describe movements that take place within the transverse piane, that is, motion about a longitudinal axis (Fig. 1-6 E and F). External rotation describes movements in which the limb rotates away from the midline when viewed from an ante-rior perspective, whereas internal rotation describes move-ments in which the limb rotates toward the midline when viewed from an anterior perspective. In the spine, similar movements are described as right and left lateral rotation.
Needless to say, this method of analysis is a simpli-fication of the complex motion possible at many joints. In the hip and shoulder, motion is possible in an infi-nite variety of planes; the three-plane method of motion analysis merely serves to simplify and therefore summarize the motions possible. Several joints are capable of movements that resist being forced into this system of classification. This has given rise to other dcscriptive terms particular to specific parts of the anatomy, such as opposition, inversion/eversion, and pronation/supination.
For most movements, an attempt should be madę to quantitate the amount of motion. This can be estimated or measured. For many routine purposes, estimation is satisfactory. Most cxaminers can learn to estimate flexion angles fairly accurately by comparing the angle being measured with an imaginary right angle, which is 90°. When greater accuracy is necessary, a pocket goniometer is aligned with the axis of the limb segments that consti-tute the joint and a reading is obtained (Fig. 1-7). The reader must remember that normal ROM varies consid-erably, especially in particular joints. In each chapter, the average ROM is described and movements that show sub-stantial variation among individuals are identified.
In any given joint, ROM may be measured both actively and passively. Active rangę of motion refers to the rangę through which the patients own muscles can move the joint; passive rangę of motion refers to the rangę through which an outside force, such as the exam-iner, can move the joint. In the interests of time and patient comfort, it is not always necessary to measure both active and passive motion in every given situation. For examplc, if active flexion and extension of the knees appear fuli and symmetric, measuring passive ROM is probably superfluous. In generał, active ROM is evalu-ated first, and passive ROM is assessed if the active ROM appears to be defkient.
The ROM examination is not just a time to systemat-ically record numbers, it is a time to obtain valuable diag-nostic information. Differences between active and passive ROM raise diagnostic questions that require further evalu-ation. For examplc, the inability of the patient to fully extend the knee against gravity may be duc to a mechani-cal błock, quadriceps weakness or injury, tendon rupture, or patellofemoral pain. Additional tests allow the examiner to determine the specific cause in each patient. In the Rangę of Motion section of each chapter, the text describes the possible implications of decreased motion and alludes to supplementary tests that can be performed to further define the diagnostic significance of the lost motion.
Excessive joint motion has traditionally been described as a sign of ligamentous laxity. This may not be strictly accurate because factors other than ligaments may
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