Deck 23: Joint Range of Motion

Question 1

An OT practitioner is evaluating a 58-year-old client who sustained a stroke that resulted in hemiplegia of his right arm 3 months ago.While beginning to assess ROM,the therapist observes that the client's right wrist and hand are swollen and tender.The client reports having fallen in his bedroom the previous day.With regard to the wrist and hand,the therapist should do which of the following?

A) Measure active ROM and passive ROM.
B) Measure passive ROM only.
C) Measure active ROM only.
D) Defer measurements until a later time.

Answer 1

D
Although swelling may be a consequence of hemiplegia,the most important thing for the therapist to consider is the client's history of a recent fall.Because there are signs of a possible acute injury,the therapist should be prudent and defer ROM measurements until the client can be evaluated by a physician to rule out an injury such as a fracture or dislocation.Measuring joint ROM is contraindicated in the presence of an unhealed fracture or dislocation.

Question 2

An OT practitioner is measuring the starting position of passive proximal interphalangeal (PIP)joint flexion in a client who has increased flexor tone in his wrist and fingers after a traumatic brain injury.The therapist should place the client's wrist in which position?

A) Neutral or flexion
B) Slight extension
C) Full extension
D) Any position, because wrist position has no effect on finger motion

Answer 2

A
Placing the wrist in neutral or flexion will put the tight long flexors on slack,thus reducing the effect of muscle tightness on extending the PIP joints.Placing the wrist in extension will cause passive insufficiency where PIP extension will be limited by the length of the long flexor muscles crossing the wrist and fingers.

Question 3

An OT practitioner is reassessing a client's shoulder external rotation active ROM at discharge.During the initial evaluation,ROM measurements (0-15)were taken with the client seated and the humerus adducted because of the presence of shoulder pain.The client's pain has since resolved,and ROM has improved so that the client is now able to abduct the humerus to assume the alternative testing position.To document discharge ROM,what should the OT do?

A) State that the ROM has improved but measurements were not taken because pain has resolved.
B) Observe the motion and estimate the ROM.
C) Measure external rotation with the humerus abducted.
D) Measure external rotation with the humerus adducted.

Answer 3

D
Because there was a documented ROM limitation on initial evaluation,ROM should be reassessed by measurement to demonstrate the efficacy of treatment.For the most reliable measurements and for comparative purposes,the same measurement protocol should be used.Thus ROM should be reassessed at discharge with the humerus in adduction to replicate the way it was measured initially.

Question 4

An OT practitioner has measured a client's passive thumb metacarpophalangeal (MP)flexion.The recorded ROM is -30 to 0 to 35.What does this tell the therapist?

A) That the joint has normal hyperextension and normal flexion
B) That the joint has limited hyperextension and limited flexion
C) That the joint has abnormal hyperextension and limited flexion
D) That the joint has abnormal hyperextension and normal flexion

Question 5

An occupational therapy (OT)practitioner is evaluating a 14-year-old client who sustained metacarpal fractures of her left ring and small fingers during a gymnastics competition.The fractures were treated with cast immobilization that ended last week.The OT practitioner should establish what normal range of motion (ROM)is for this client by doing which of the following?

A) Looking up published normative data
B) Measuring the client's right hand
C) Comparing the client with other clients who had similar injuries
D) Asking the physician what the expected ROM is