AROM/PROM

Question 1

What to look for in AROM?

Answer 1

Quality - smoothness, coordination

Willingness to move - fear/pain behaviours, unable to move limb (neural), tense/rigid

Range - goniometer or bony points to measure (use objective markers for later examination to determine clinical changes)

Pain response - where and when - location of pain site and how far did they go move before pain came on, type of pain, does it match what they said? Are there any pain behaviours?

Occurrence of muscle spasm

Question 2

What does AROM test?

Answer 2

TESTS ALL STRUCTURES (CONTRACTILE AND INERT)

Muscles and tendons (contractile tissue)

Joint, ligaments, capsule (inert tissue)

Stretches and pulls

Load transference/acceptance

Biopsychosocial - willingness to move, pain behaviours, fear avoidance, reluctance (possible subjective marker)

Question 3

What does PROM test?

Answer 3

INERT TISSUES ONLY (MAYBE TENSION SOME CONTRACTILE TISSUE TOWARDS END RANGE)

Inert tissues (joints, capsule, ligaments) - there should be no active muscle contraction during PROM so contractile tissues should be pain free.

Joint problem would hurt on AROM and PROM the same.

If full and pain free then over pressure can be applied - helps to clear the joint

Question 4

What to look for in PROM?

Answer 4

What limits the movement - resistance or pain

Joint - end feel

Pain response

ROM achieved

Any other symptoms produced

Question 5

What are normal end feels (PROM)?

Answer 5

Soft - soft tissue approximation (skin, fat, muscle - biceps in elbow flexion, hamstrings in knee flexion)

Hard - bony approximation (elbow in extension)

Spongy - inflamed or effused joints

Soft with hard end feel - capsular, ligament or muscle stretch

Question 6

What are abnormal end feels (PROM)?

Answer 6

Hard - bone to bone

Muscle spasm

Capsular/elastic - late end feel due to laxity of ligaments in a sprain

Empty - no end feel (when pain limits the movement - you can’t get to an end feel) - could signify a serious injury or fracture, perhaps BSP

Springy block - meniscal tear/intraarticular tears, osteocondral defects

Question 7

What is a capsular pattern?

Answer 7

Restrictions in particular directions which signify problems in the joint or joint capsule.

Only joints controlled directly by muscles have a capsular pattern.

Can be used to diagnose arthritis and joint inflammation/sprains

(Cyriax)

Question 8

How to document AROM/PROM?

Answer 8

• The joint being tested - L or R
• The movement (flexion/extension etc)
• Active or passive - Test position (eg. seated/lying)
• Start position (eg. side lying, hip extended)
• End position (eg. side lying, hip flexed)
• ROM (eg. 0°-100°, how much movement is lost)
• Limiting factors (eg. pain, soft tissue approximation)
• Quality of movement (eg. resistance, pain - which comes first?) (PROM)
• ROM - End feel