Testing Arom: A Comprehensive Guide To Success

Active Range of Motion (AROM) is a type of range of motion exercise used in physiotherapy to assess and improve a patient's joint movement. It involves the patient actively contracting their muscles to move a joint through its range of motion, with the goal of detecting symptoms like pain and determining their location, quality, and intensity. AROM is typically assessed during physical therapy to evaluate the patient's condition and progress. It helps identify issues such as strained muscles, sprained ligaments, or spasmed antagonist muscles. By understanding the patient's AROM, physiotherapists can develop tailored treatment plans to improve joint function and increase the range of motion.

Active Range of Motion (AROM)

AROM is typically assessed during physical therapy or treatment. The patient performs the movement independently, voluntarily contracting, controlling, and coordinating their motion. The therapist evaluates the movement and its quality, as well as the patient's compensation strategies.

During an AROM assessment of the shoulder, for example, the therapist evaluates the degrees of freedom in the shoulder complex, looking for compensation and movement quality. This includes assessing movements such as elevation through abduction and forward flexion, extension, lateral or external rotation, medial or internal rotation, adduction, horizontal adduction or crossed flexion, scapular protraction, scapular retraction, shoulder elevation, and shoulder depression.

Another example is the wrist and hand AROM assessment, which includes evaluating movements such as pronation, supination, wrist flexion, wrist extension, radial deviation, ulnar deviation, finger abduction, finger adduction, thumb abduction, thumb adduction, and thumb opposition.

The presence of pain during AROM assessments is an important indicator. It can signify strained "mover" muscles, sprained ligaments or joint capsules, or strained/spasmed antagonist muscles. Additionally, the actual amount of ROM measured in degrees is considered, comparing it to standard values to determine if the patient's motion is normal, hypermobile, or hypomobile.

Passive Range of Motion (PROM)

The goal of PROM is to assess the osteokinematic movements of a joint, evaluate its range of motion in degrees, and if motion is limited, assess the end feel. PROM is usually performed when the patient is unable or not permitted to move the body part. It is often used in physiotherapy to aid with limited range of motion at a joint, providing benefits such as healing and recovery from soft tissue and joint lesions, maintaining existing joint and soft tissue mobility, and enhancing synovial movement.

• Legs: Gently support the entire limb and slowly begin to move and flex each joint, starting with the toes and working upwards towards the body. Only flex and extend one joint at a time.
• Hips and shoulders: Support the body with your arm under the belly or while the patient is lying on their side. Slowly stretch the leg backward, then forward, then up (or out), and finally in (or towards the body). Try to keep the leg as close to the hip or shoulder as possible so that only this joint is moving. Remember that the shoulders and hips are ball joints and can move in almost any direction.
• Head: While gently supporting the muzzle (nose) and neck to keep it from moving, slowly push the head upwards towards the ceiling, then downwards toward the floor. Next, move it to the left and then the right.
• Neck: The same as the head, but move the head and neck together.
• Spine: With the patient standing, slowly turn them in a tight circle in one direction, then the other. With the patient on their side, slowly stretch the body out so that the spine is curved in a slight C-shape, or curve the body as if the patient were curled up and sleeping.

It is important to note that you should not cause pain during PROM exercises. If the joint or spine is painful, only flex or extend as much as is comfortable for the patient. After the exercises, use ice packs to reduce pain and swelling.

Active Assisted Range of Motion (AAROM)

AAROM is typically performed when a patient needs assistance with movement from an external force due to weakness, pain, or changes in muscle tone. For example, a patient recovering from a shoulder rotator cuff surgery may be allowed to move their arm, but a physiotherapist may also assist the arm during the motion to help limit the amount of stress on the joint.

AAROM is used after injury or surgery when some healing has occurred and the muscle can contract, but protection is still required to prevent damage to the healing body part. It is a crucial step in the recovery process, helping to improve joint health and mobility, and allowing patients to regain their range of motion.

Frozen Shoulder

The prevalence of frozen shoulder is estimated to be between 2% and 5.3% in the general population, with a peak at 55 years of age. It is more common in women, especially those with diabetes, thyroid dysfunction, or a history of shoulder issues. The condition is rare in people under 40.

The pathoanatomical features of frozen shoulder include angiogenesis into the capsule tissue, which produces collagen fibre proliferation, granulation, and contracture of the capsular ligamentous complex. The symptoms of frozen shoulder typically progress through three stages: the freezing stage, marked by the onset of pain and restricted motion; the frozen stage, when motion is severely limited; and the thawing stage, during which the shoulder gradually regains mobility.

To diagnose frozen shoulder, a physical examination is conducted to evaluate the range of motion in the affected shoulder. The first step is to examine external rotation in the zero position and compare it to the other side. This can be done by fixating the scapula and the coracoid process on the anterior side with the upper arm. A loss of external rotation of at least 50% compared to the other side, or less than 30 degrees of rotation, is indicative of frozen shoulder. Additionally, the range of motion should be reduced in at least two other planes by at least 25% compared to the unaffected side.

There are also some simple self-tests that can provide an indication of frozen shoulder. One such test involves standing in front of a mirror or having someone watch as you slowly raise both arms in front of you and overhead. If you have a frozen shoulder, your arm may stop just above parallel with the floor, and your shoulder and shoulder blade will rise towards your ear unnaturally. This movement may also cause pain in the shoulder joint. Another self-test is to slowly lift your arm out to the side. If your shoulder is level with the floor and it's painful, it may indicate a frozen shoulder.

Rotator Cuff Pathology

Rotator cuff injuries are among the most common causes of shoulder pain. They can manifest as bursitis, tendonitis or tendon tears. The patients usually complain of pain and reduced function of the affected shoulder. In young patients, a rotator cuff tear is usually traumatic, and the symptoms show an acute onset. In older patients, a tendon tear is usually caused by a chronic degenerative process related to aging, and the pain is more gradual in onset.

When rotator cuff pathology is suspected, doctors can use one of more than 25 functional tests during a physical exam to diagnose a torn rotator cuff. Some of these tests directly indicate a rotator cuff injury, while others rule out similar injuries like nerve impingement or torn labrum.

Range of Motion Testing

Using a goniometer, the patient's active and passive range of motion is assessed. The patient is asked to perform various movements, such as flexion, abduction, internal and external rotation, and cross-body adduction. If movement in a specific direction is painful or limited, this may indicate pathology in a specific structure of the shoulder.

Strength Testing

Using a dynamometer, the strength of the rotator cuff muscles can be assessed. The patient is asked to exert force against resistance in various positions to test the strength of specific muscles. For example, external rotation tests the infraspinatus muscle, abduction tests the supraspinatus muscles, and internal rotation tests the subscapularis muscle.

Special Tests for Rotator Cuff Tears

There are several special tests that can be performed to assess for rotator cuff tears:

• The shoulder shrug sign: The patient is passively helped to elevate their arm above 90 degrees to see if they can actively elevate it.
• The drop arm test: The patient's arm is passively elevated, and they are asked to hold that position without the arm dropping or shrugging.
• The rotator cuff lag signs: The patient's ability to hold the arm against gravity in external rotation is assessed.
• The empty can test: The patient abducts both arms to 90 degrees, then brings them anteriorly with a 30-degree forward flexion, pushing upwards against resistance.
• The hornblower's sign test: The doctor raises the patient's arm to their side and bends their elbow to 90 degrees. The patient then externally rotates their arm against the doctor's resistance.
• The apprehension test: The doctor stabilizes the patient's arm at the shoulder while gently pulling on their arm.
• The relocation test: After the apprehension test, down pressure is applied over the shoulder to stabilize it and relieve discomfort.

Imaging Tests

In some cases, a doctor may recommend imaging tests such as X-rays, ultrasounds, or magnetic resonance imaging (MRI) to diagnose a torn rotator cuff.

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