![]() If we then place the shoulder into extension, and our range of motion is now limited, all arrows point to triceps flexibility as our probable source of problems. In our elbow flexion example, if we have triceps muscle (long head) shortening, and we test the elbow range of motion with the shoulder in flexion, where the triceps is on slack, the elbow will have a normal ROM. Problems associated with decreased flexibility are most often noticed in muscles that cross two joints. ![]() ROM refers to joint motion while flexibility refers to muscle length, so there is no such thing as 'joint flexibility'. The first issue that we must address in this example is the difference between ROM and flexibility. If, in our example of elbow flexion, our patient is reluctant to flex the elbow in normal activity ('decreased AROM in elbow flexion'), but we can get normal, non-painful range of motion on flexing the elbow for him ('normal PROM'), what might our differential diagnosis be? It is this type of problem-solving which the physical therapist applies to the patient. The moving arm would be placed along the ulna, using the lateral styloid process as the distal landmark. Using elbow flexion as an example, the stable arm of the goniometer would be placed on the humerus, using the greater tubercle as the proximal landmark, with the fulcrum at the lateral epicondyle. When measuring ROM, the stable arm of the goniometer is placed on the proximal segment the hinge, or fulcrum, is placed over the joint axis, and the moving arm is placed over the distal segment. The goniometer is composed of two parts with a central hinge. It is PROM that we measure in our canine patients using a goniometer. AROM is defined as motion performed by the patient, while PROM is motion performed by the therapist. The difference between these two can be an important diagnostic tool. There are two kinds of osteokinematics, active range of motion (AROM) and passive range of motion (PROM). This range of motion is measured in degrees, using a goniometer. Elbow flexion is an example of osteokinematics. ![]() Osteokinematics (osteo = bone kinematics = motion) is the gross motion which occurs when bony segments move around a joint axis. Range of motion (ROM) is determined by osteokinematics and arthrokinematics. A physical therapist approaches a patient in a way that focuses upon the soft tissues surrounding the bones and joints and upon the interaction of joint surfaces during movement. In order to diagnose a problem, we must be very familiar with what is normal in joint, ligament, muscle and tendon behaviour. When we are presented with a patient who is lame, but radiographs are negative, what tests do we have to determine the source of lameness? This is an area where understanding physical therapy diagnostic techniques can be of great benefit to veterinarians.
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