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Trainer’s tip: Measuring joint mobility

LTC Nursing Assistant Trainer, January 26, 2012

Assess joint range of motion on the initial (admission) assessment and quarterly thereafter. For accuracy, a therapist should measure joint mobility with a goniometer. Some nursing forms have pictures that show degrees of joint mobility. These are used for screening by comparing the resident’s degree of joint mobility to the picture. If the angle is abnormal, the resident is referred to therapy for follow up and possible intervention. If the resident is at risk, a restorative nursing program is developed to prevent or reverse the contractures. Restorative care of the resident involves using pillows, props, and supportive devices, maintaining good body alignment, and providing range of motion exercises two to three times daily.

To determine the degree of impairment, the nurse must know the normal range of motion for each joint:

• Neck: Flexion 45 degrees, extension 55 degrees, lateral bending 40 degrees, rotation 70 degrees
• Shoulder: Flexion 160 degrees, extension 50 degrees
• Elbow: Flexion 160 degrees, extension 160 degrees to 0 degrees
• Wrist: Flexion 90 degrees, extension 70 degrees, abduction 55 degrees, adduction 20 degrees
• Thumb: Proximal phalange: flexion 70 degrees; Distal phalange: flexion 90 degrees
• Fingers: Proximal phalange: flexion 90 degrees, extension 30 degrees; Middle phalange: flexion 120 degrees; Distal phalange: flexion 80 degrees
• Hip: Flexion (knee bent) 120 degrees, flexion (knee straight) 90 degrees, abduction 45 degrees, adduction 45 degrees
• Knee: Flexion 120 degrees
• Ankle: Dorsiflexion 20 degrees, plantar flexion 45 degrees, inversion 30 degrees, eversion 20 degrees
• Great toe: Distal phalange: flexion 50 degrees; Proximal phalange: flexion 35 degrees, extension 80 degrees

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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