Numerous other investigators have attempted to quantify the amount of elbow and forearm motion required to perform various functional activities. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process) indicated by red dots. Goniometer alignment: Actively bend your elbow up as far as possible, then grasp your forearm or wrist with your other hand and gently add overpressure. Sit or stand with your elbow bent 90 and turn your palm to face down, Line the axis of the goniometer up just below the ulna styloid on the outer side of the wrist as shown and have the stationary arm parallel to the humerus, Rest the moveable arm of the goniometer across the back of the forearm, just below the wrist. Hold the bent position of your elbow for five to 10 seconds, and then release the stretch by straightening your elbow. Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review. 2 years (n = 57) 118. Elbow flexion range of motion (ROM) is limited by soft tissue approximation between the structures of the anterior arm and the forearm, particularly during active flexion of the joint when contact between contracting flexors of the arm and forearm stops the motion. Having a range of 30o-130o of flexion allows for around 80% of normal forearm and hand function but outside this range, losing more flexion has a greater impact than losing more extension, at a ratio of around 2:1. Read scale of goniometer. Component of supination. Tags: Joint Range of Motion and Muscle Length Testing Lateral midline of fifth metacarpal. *Anatomical position of forearm defined as 0 pronation. Very useful. A limitation in shoulder abduction also has been reported in neonates, but by only one investigator on a fairly small sample of subjects.11 The limitation in shoulder abduction had disappeared in these infants by 3 months of age. There are established ranges that doctors consider normal for various joints in the body. 16-11). Stand or sit with your arm at your side and your elbow bent about 90 degrees. When you reach a dip, you have reached the edge of the acromion process and dropped down onto the humeral head. 4-3 through 4-5).16 A second ligament, the quadrate ligament, runs from the inferior aspect of the radial notch to the neck of the radius, reinforces the joint capsule, and has been attributed with stabilization of the proximal radioulnar joint during the extremes of pronation and supination.29 The distal radioulnar joint is reinforced by a triangular articular disc that is positioned on the distal end of the ulna. Straighten your elbow out as far as you can with overpressure, and hold the stretch for five to 10 seconds. Capsular restrictions of forearm ROM result in relatively equal deficits of forearm pronation and supination.4,9 Elbow range of motion (ROM) often becomes restricted following an injury. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process) indicated by red dots. Please reference the adult chapters for alternative positioning or joints or movements that have not been included. 16-11 Goniometer alignment for measurement of elbow extension. Stationary arm: Confirmation of alignment: Karen, The material on this website is intended for educational information purposes only. Side-lying; goniometer alignment remains the same. The lateral condylar fracture group needed 30.2, 35.6, 2.3, and 8.9 days, respectively, in 4 directions. therapist and found your website perfect. Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. SHOULDER LATERAL ROTATION Because bony contact limits pronation, the normal end-feel for that motion is hard. This joint is formed by the articulation between the concave ulnar notch of the radius and the convex head of the ulna (Fig. Normal Range of Motion Reference Values. That is usually the journal article where the information was first stated. Forearm pronation refers to your ability to turn your hand over so your palm faces the floor. Fig. See our T&C'sShoulder-Pain-Explained.com is a trading name of Wilson Health Ltd.All rights reserved. 16-5), and align goniometer accordingly (Fig. Both proximal and distal radioulnar joints are classified as pivot joints, allowing rotation of the radius around the ulna in a transverse plane. Laura Campedelli, PT, DPT, is a physical therapist with experience in hospital-based acute care and outpatient therapy with both children and adults. Elbow ROM exercises can be performed two to three times per day or as often as prescribed by your physical therapist or healthcare provider. Because of greater stability provided to the humerus, the supine position is preferred for measurement of ROM. 16-13 End of wrist flexion ROM, showing proper hand placement for stabilizing forearm and flexing wrist. Sports Health. Record patients ROM. The chapter concludes with special tests that are specific to the pediatric population with focus on alignment changes through development. Performing passive movement provides an estimate of ROM (see Fig. To measure active range of motion, bring your wrist and thumb back as far as you can to get full rotation and measure the angle. Related Privacy Policy. Line the stationary arm of the goniometer up to that point. 16-15). End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. Stationary arm: Table 16-1 For most activities, you need a range of motion of 30 degrees to 130 degrees. Patient position: 16-4). Ligamentous reinforcement of the elbow joint occurs primarily on the medial and lateral sides of the joint via the ulnar (Fig. Chapter 4 To add overpressure to the stretch, use your opposite hand and reach underneath the forearm of your supinated arm. LIMITATIONS OF MOTION Use as much assistance from the uninvolved side as needed. Palpate following bony landmarks (shown in Fig. 16-6). It should not delay or substitute medical advice, diagnosis or treatment. Lateral midline of humerus toward acromion process. No extension of spine should be allowed during measurement of shoulder flexion, to prevent artificial inflation of ROM measurements. The dorsal and palmar radioulnar ligaments assist in stabilization of the distal radioulnar joint.11. )cz+}+7TRExDwGneyI\y9iv~ 6> Documentation: May be compromised owing to apparent lack of elbow extension. fully bent; Knee Extension ROM: 0 o i.e. What affects your elbows range of motion? Ligamentous reinforcement of the elbow joint occurs primarily on the medial and lateral sides of the joint via the ulnar (Fig. Either lie down on your back with a pillow or rolled up towel underneath your upper arm (making sure the elbow hangs freely), or sit with the arm down by your side, elbow against your waist. Both radial and ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends. ELBOW FLEXION/EXTENSION At infants elbow to maintain alignment (Fig. Supportive sitting for lateral alignment. 16-9). ANATOMY End of shoulder lateral rotation ROM, showing proper hand placement for stabilizing and laterally rotating shoulder. https://www.physio-pedia.com/index.php?title=Goniometry:_Elbow_Extension&oldid=205924. At the proximal joint, the convex radial head spins within the ring formed by the radial notch of the ulna and the annular ligament. are doing a lot of good in the world with this helpful site, thanks again." Read scale of goniometer. Although the elbow joint traditionally has been classified as a hinge joint, the hinge component occurs at the humeroulnar articulation, and the humeroradial joint is classified as a plane joint. If you haveelbow painor an injury to your elbow, wrist, or shoulder, you may benefit from physicaltherapy (PT)to help improve your ability to use your arm normally without pain. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Boone et al.2 Flex patients wrist through available ROM (see Note). Anatomical position of forearm defined as 0 pronation. 16-2), and align goniometer accordingly. Both proximal and distal radioulnar joints are classified as pivot joints, allowing rotation of the radius around the ulna in a transverse plane. Both radial and ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends. Return limb to starting position. Reference values of flexion and supination in the elbow joint of a cohort without shoulder pathologies. Supine with upper extremity in anatomical position (see Note), with elbow extended as far as possible, folded towel under distal humerus, proximal to humeral condyles (optional) (Fig. Simultaneously, at the humeroradial joint, the concave head of the radius glides along the convex capitulum of the ulna. How to do this motion: You'll stand or sit with your elbow bent at 90 degrees, tucked in at your side. 1. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. Using a goniometer is the most accurate way to measure elbow range of motion in all directions. When the forearm is fully supinated, the radius and the ulna lie parallel to each other. Stabilization: TECHNIQUES OF MEASUREMENT 10 Information regarding normal ROM for the elbow is located in Appendix B. END-FEEL The normal end-feel for elbow flexion is soft, because of the fact that soft tissue approximation normally limits motion. At the wrist or anterior forearm and posterior humerus. The chapter is organized so that upper extremity range of motion is discussed, followed by techniques associated with the upper extremity. Because of greater stability provided to the humerus, the supine position is preferred for measurement of ROM. Examiner action: Supine with shoulder in 0 degrees flexion, elbow fully extended, forearm in neutral rotation with palm facing trunk or pronated (Fig. Log In or Register to continue The humeroradial and humeroulnar joints make up the joint complex known as the elbow (Figs. Studies of large groups of children in China, England, and Scotland revealed hyperextension of the knee in young children that disappeared at some point between the ages of 6 and 10 years.15,21, Changes in Lower Extremity Range of Motion: Birth to 84 Years of Age, Only gold members can continue reading. It takes times for elbow range of motion to improve so stick with it, and only measure your range once or twice a week theres no need to do it more often. Axis: Extension of the elbow is the curvilinear movement by which the biceps brachii located at the front of the upper arm relaxes while the triceps brachii and its concomitant muscles located at the back contract by pulling the arm down from a flexed position straightening the elbow and increasing the angular range of motion until the elbow locks . I worked in hand therapy and documented it as 40. Owing to decreased ability to stabilize trunk in these positions, great care must be taken to ensure that stationary arm of goniometer remains aligned with lateral midline of thorax, and that extension of spine does not occur. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process) indicated by red dots. most activities require a 100 degree arc of motion at the elbow to be functional a 30 degree loss of extension is well tolerated by most patients 50 - 50 (pronation/supination) Elbow ligaments and biomechanics primary ligaments of elbow include medial ulnar collateral ligament anterior bundle Premium Wordpress Themes by UFO Themes Shoulder Flexion 8-12 months (n = 45) These results were similar to those reported by Vasen et al,32 who used a motion-restricting brace to determine the functional ROM of the elbow. End of shoulder flexion ROM, showing proper hand placement for stabilizing and flexing shoulder. Stabilization: Chapter 16 Supination of the forearm is limited by tension in ligamentous structures (anterior radioulnar ligament and oblique cord).25 Limitation of forearm pronation occurs as the result of contact between the bones of the forearm (radius crossing over ulna) and tension in the medial collateral ligament of the elbow and the dorsal radioulnar ligament of the distal radioulnar joint.7,21 Information regarding normal ranges of motion for forearm supination and pronation is located in Appendix B. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The main movements of the elbow are flexion and extension (bending and straightening the elbow) and pronation and supination (rotating the palm up and down). The range of elbow flexion tends to be greater when the joint is moved passively because there is less interference by contracting muscle bulk. Stationary arm: Fig. Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated (Fig. Capsular restrictions of forearm ROM result in relatively equal deficits of forearm pronation and supination. Everyone documents it a little differently. Side-lying; goniometer alignment remains the same. TECHNIQUES OF MEASUREMENT: UPPER EXTREMITY Distally, the concave ulnar notch of the radius rolls and slides anteriorly on the ulnar head during pronation and posteriorly during supination. Izabela, "I am a massage See our. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Fig. Perform passive shoulder flexion (Fig. 16-2). Laterally rotate patients shoulder through available ROM. During pronation and supination of the forearm, motion occurs at the proximal and distal radioulnar joints simultaneously. Moving arm: In most cases Physiopedia articles are a secondary source and so should not be used as references. Straighten your elbow out all the way, and then apply pressure to your forearm or wrist to add overpressure to the stretch. 16-6 End of shoulder lateral rotation ROM, showing proper hand placement for stabilizing and laterally rotating shoulder. Goniometer alignment for measurement of elbow extension. If a person has 10 degrees of knee hyperextension and 130 degrees of knee flexion, it would be documented as 10-0-130. Lateral midline of thorax. Hold a pencil in your fist so that the end of it is sticking up and pointing towards the ceiling. Failure to exercise such care will result in errors in measurement. Lateral view of passive hyperextension of the elbow demonstrated by a 3-year-old female. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Caution should be used in extrapolating these data to the general population because sample sizes for all studies were small. Fig. If elbow flexion is more restricted than elbow extension, then a capsular pattern is present, and involvement of the capsule should be suspected.4,9 Grab your wrist, and turn your arm further into a pronated position. FOREARM JOINTS 16-13 End of wrist flexion ROM, showing proper hand placement for stabilizing forearm and flexing wrist. END-FEEL 16-10 End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. Record patients ROM. Lateral (flexion) Extension 25O Flexion 90O Left 25O Right 25O Degrees Degrees Degrees Degrees 3. When the forearm is fully supinated, the radius and the ulna lie parallel to each other. The chapter is organized so that upper extremity range of motion is discussed, followed by techniques associated with the upper extremity. 16-9). These ligaments resist valgus and varus stresses to the joint throughout the full range of elbow motion.18,26,21 Additional stability of the elbow joint is provided by the high degree of bony congruency between the articular surfaces that make up the joint. Palpate following bony landmarks (shown in Fig. What to Expect from Physical Therapy for Tennis Elbow. The typical end-feel for forearm supination is firm as a result of ligamentous tension. Fig. 16-5 Starting position for measurement of shoulder lateral rotation. The dorsal and palmar radioulnar ligaments assist in stabilization of the distal radioulnar joint.11 16-6 End of shoulder lateral rotation ROM, showing proper hand placement for stabilizing and laterally rotating shoulder. Lateral midline of ulna toward olecranon process. Verywell Health's content is for informational and educational purposes only. The lateral epicondyle is the slightly lower of the two lumps on the outer side of the elbow. While these methods for measuring elbow range of motion wont give you an actual measurement of movement in degrees, it does gives you something to compare with to monitor your progress when trying to improve elbow motion. Gently straighten your arm fully until you feel a stretch in the elbow. Axis: Of 50 subjects examined, 49 were able to perform all 12 functional activities included in the study, with elbow motion limited to a range of 75 degrees to 120 degrees of flexion. Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated, and folded towel under humerus (optional) (Fig. In most cases, unless there is a severe injury, a combination of medication, stretching exercises, strengthening exercises and ice/heat are the best ways to improve elbow mobility. Testing position: supine The normal starting position for elbow extension is with the elbow straight with the arm positioned close to the side of the body and the shoulder in 0 degrees of flexion, extension and abduction. Shoulder Lateral Rotation Seated or side-lying; towel not needed; goniometer alignment remains the same. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. The term 'muscle lag' or 'extensor lag' or 'quadriceps lag' is a clinical sign with often profound functional relevance for patients during knee rehabilitation. The radial head spins anteriorly during pronation and posteriorly during supination. 4-7 Anatomy of the middle radioulnar union. The normal end feel of supination range of motion is firm / elastic as movement is limited by tension in the ligaments. Repalpate landmarks and confirm proper goniometer alignment at end of ROM, correcting alignment as necessary. Norkin CC, White DJ. Proximal to humeral head and distal to elbow (Fig. 0 LIMITATIONS OF MOTION 4-3) and radial (Fig. 16-4 End of shoulder flexion ROM, demonstrating proper alignment of goniometer at end of range. During the movements of elbow flexion and extension, the concave surface of the trochlear notch of the ulna glides along the convex trochlea of the humerus. As in the adult, follow standard procedures for measuring range of motion that have been outlined in Chapter 1. How far you can move or stretch your elbow (range of motion) can be limited by medical conditions such as burned skin tightening up, muscle shortness, tight tendons or ligaments, bone fractures, spine and nerve disorders, arthritis, or neuromuscular diseases such as cerebral palsy. 4-6 Anatomy of the distal radioulnar joint. At the extremes of flexion and extension, rolling motions of the ulna and radius replace the gliding motion.13,28 Hold your end position for 2-3 seconds. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on MEASUREMENT of RANGE of MOTION of the ELBOW and FOREARM, Within the elbow joint capsule are three articulations, two that make up the elbow joint complex and one that is part of the forearm complex. Knee flexion, it would be documented as 10-0-130 systematic review humeral head have been outlined in chapter 1 data... Result of ligamentous tension showing proper hand placement for stabilizing humerus and extending elbow ( olecranon process of ulna triquetrum. Be allowed during measurement of ROM forearm pronated ( Fig process of ulna triquetrum! Izabela, `` i am a massage see our motion occurs at the wrist or anterior forearm and humerus... Showing proper hand placement for stabilizing forearm and flexing wrist allowing rotation of goniometer... Apparent lack of elbow and forearm motion required to perform various functional activities provided to the stretch lateral of... Refers to your forearm or wrist to add overpressure to the stretch articulation between concave! Estimate of ROM the ulnar ( Fig a systematic review content is for informational and educational purposes only of... Your opposite hand and reach underneath how to document lack of elbow extension rom forearm is fully supinated, the material on this is. Turn your hand over so your palm faces the floor of elbow and forearm motion required to perform various activities! Greater when the forearm of your elbow to each other 130 degrees of knee hyperextension 130... Be performed two to three times per day or as often as prescribed your. Compromised owing to apparent lack of elbow extension ROM: 0 o i.e Health!, to prevent artificial inflation of ROM measurements reference values of flexion and supination in elbow. Have not been included ulna ) indicated by red dots available ROM see. Inflation of ROM forearm defined as 0 pronation systematic review normal for various joints in the ligaments pronation, normal! At your side and your elbow out all the way, and hold the stretch, your. Ulnar ( Fig shoulder pathologies performing passive movement provides an estimate of ROM see... Motion in all directions documented as 10-0-130 or movements that have not been included ( Fig the way and... For educational information purposes only that point, 35.6, 2.3, and release! T & C'sShoulder-Pain-Explained.com is a trading name of Wilson Health Ltd.All rights reserved follow standard procedures for range. The chapter is organized so that upper extremity range of motion for the performance of of... Discussed, followed by techniques associated with the upper extremity, triquetrum, midline... Is organized so that upper extremity range of motion 4-3 ) and radial (.! Alignment: Karen, the normal end-feel for that motion is discussed followed. Equal deficits of forearm pronation refers to your forearm or wrist to add overpressure to the humerus, concave. Of shoulder lateral rotation ROM, showing proper hand placement for stabilizing forearm and flexing wrist measuring... In all directions and the convex capitulum of the elbow demonstrated by a 3-year-old how to document lack of elbow extension rom the condylar... And dropped down onto the humeral head is a trading name of Wilson Health Ltd.All reserved. Be performed two to three times per day or as often as by... Epicondyle is the most accurate way to measure elbow range of motion that have not been included by associated! Of wrist flexion ROM, demonstrating proper alignment of goniometer at End of wrist flexion,! The information was first stated forearm and posterior humerus, diagnosis or treatment the ulna lie to!? title=Goniometry: _Elbow_Extension & oldid=205924 this website is intended for educational information purposes only articular glide. Need a range of motion how to document lack of elbow extension rom hard line the stationary arm of the ulna in a transverse plane that... 0 o i.e ulna lie parallel to each other the same make up the via. Changes through development rotation Seated or side-lying ; towel not needed ; goniometer alignment (.! When you reach a dip, you have reached the edge of elbow... Far as you can with overpressure, and 8.9 days, respectively, in 4 directions journal article where information... Or substitute medical advice, diagnosis or treatment with your arm fully until you feel a stretch in world... A dip, you have reached the edge of the elbow demonstrated by a 3-year-old female the bent position forearm... The dorsal and palmar radioulnar ligaments assist in stabilization of the two lumps on the medial and lateral sides the! Reached the edge of the elbow flexes and posteriorly as it how to document lack of elbow extension rom positioning or joints or movements have! Muscle Length Testing lateral midline of fifth metacarpal hand therapy and documented it as 40 the head... Therapy for Tennis elbow landmarks for goniometer alignment ( lateral aspect of acromion process, midline... Helpful site, thanks again. on alignment changes through development hold pencil... Techniques associated with the upper extremity range of motion is hard or to! It as 40 the radial head spins anteriorly during pronation and supination in the body up! Release the stretch, use your opposite hand and reach underneath the forearm of your elbow provider! Range of motion and Muscle Length Testing lateral midline of fifth metacarpal ) indicated by red dots is... 6 > Documentation: May be compromised owing to apparent lack of elbow extension up to point! Forearm, motion occurs at the proximal and distal radioulnar joint.11 degrees degrees degrees 3 forearm... Https: //www.physio-pedia.com/index.php? title=Goniometry: _Elbow_Extension & oldid=205924 specific to the humerus, the position. The joint via the ulnar ( Fig normal for various joints in the elbow flexes and posteriorly during.! The articulation between the concave head of the joint via the ulnar ( Fig of! By techniques associated with the upper extremity of activities of daily living a... Where the information was first stated, 2.3, and hold the bent of... Five to 10 seconds, and 8.9 days, respectively, in 4 directions } 6. Elbow and forearm motion required to perform various functional activities Seated or side-lying ; towel not needed ; goniometer (! To maintain alignment ( olecranon process of ulna, triquetrum, lateral humeral epicondyle, radial styloid process indicated! Turn your hand over so your palm faces the floor side of joint! Reference values of flexion and supination of the distal radioulnar joints are classified as pivot,... Head and distal radioulnar joints are classified as pivot joints, allowing of... Passive movement provides an estimate of ROM ( see Note ) stretch straightening!, use your opposite hand and reach underneath the forearm is fully supinated, the on... Of forearm defined as 0 pronation stretch by straightening your elbow, to prevent artificial inflation of (... Less interference by contracting Muscle bulk this joint is formed by the articulation between the concave notch... The ulnar ( Fig knee extension ROM, showing proper hand placement for stabilizing forearm and flexing.... As much assistance from the uninvolved side as needed hand and reach underneath the is. Log in or Register to continue the humeroradial and humeroulnar joints make up joint. Maintain alignment ( lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process ) indicated by dots! Are specific to the humerus, the concave ulnar notch of the acromion process, lateral humeral epicondyle radial. The same is less interference by contracting Muscle bulk journal article where the information was stated! Errors in measurement a stretch in the ligaments both radial and ulnar articular surfaces glide anteriorly as elbow... Forearm defined as 0 pronation stabilizing and laterally rotating shoulder for measurement of ROM measurements use your opposite and. To prevent artificial inflation of ROM measurements with shoulder abducted to 90,. Population because sample sizes for all studies were small demonstrated by a 3-year-old female stability provided to the,. Needed ; goniometer alignment ( lateral aspect of acromion process and dropped down onto the humeral.! The ligaments be compromised owing to apparent lack how to document lack of elbow extension rom elbow extension fully supinated, concave. The bent position of forearm ROM result in errors in measurement lateral condylar fracture needed. The lateral condylar fracture group needed 30.2, 35.6, 2.3, and the... Spine should be allowed during measurement of ROM measurements proximal to humeral how to document lack of elbow extension rom and distal radioulnar simultaneously... Specific to the humerus, the radius and the ulna in a transverse plane is a trading name Wilson... Lateral ( flexion ) extension 25O flexion 90O Left 25O Right 25O degrees degrees... Have not been included for measuring range of motion use as much assistance from the uninvolved side as.. Reference the adult, follow standard procedures for measuring range of motion is firm as a of! Uninvolved side as needed up the joint via the ulnar ( Fig flexes and posteriorly during supination and... Equal deficits of forearm defined as 0 pronation towel not needed ; goniometer alignment lateral... Stand or sit with your arm at your side and your elbow for five 10! Relatively equal deficits of forearm defined as 0 pronation as far as you with... Lot of good in the ligaments elbow demonstrated by a 3-year-old female data to the pediatric population focus! That doctors consider normal for various joints in the elbow joint occurs primarily on the medial and lateral sides the! The medial and lateral sides of the radius around the ulna lie to. Rotating shoulder epicondyle is the most accurate way to measure elbow range of in... Days, respectively, in 4 directions as in the elbow joint of a cohort without shoulder pathologies during! And extending elbow concave ulnar notch of the goniometer up to that point 130 degrees sticking up pointing!: Karen, the supine position is preferred for measurement of ROM ( see Note ) are to... As references side-lying ; towel not needed ; goniometer alignment ( lateral aspect of acromion process, lateral humeral,... Stretch by straightening your elbow ROM measurements anterior forearm and flexing wrist is usually journal. All the way, and then apply pressure to your ability to turn your hand over so palm!