APPENDIX A: Sample Numerical Recording Form 495

Range of Motion Assessment

and Measurement
Patient’s Name _____________________________________ Date of Birth/Age ____________________________________

Diagnosis __________________________________________ Date of Onset _______________________________________

Therapist Name ____________________________________ AROM ❒ PROM ❒

Signature ____________________________________
Recording:
1. The Neutral Zero Method defined by the American
Academy of Orthopaedic Surgeons1 is used for mea-
surement and recording.
2. Average ranges defined by the American Academy of
Orthopaedic Surgeons,1 are provided in parentheses.
3. The columns designated with asterisks (*) are used for
indicating limitation of range of motion and referenc-
ing for summarization.
4. Space is left at the end of each section to record hyper-
mobile ranges and comments regarding positioning of
the patient or body part, measuring instrument,
edema, pain, and/or end feel.

Left Side Right Side

* * Therapist Initials * *

Date of Measurement

Head, Neck, and Trunk

Mandible: Depression

Protrusion

Lateral deviation

Neck: Flexion (0–45°)

Extension (0–45°)

Lateral flexion (0–45°)

Rotation (0–60°)

Trunk: Flexion (0–80°, 10 cm)

Extension (0–20–30°)

Lateral flexion (0–35°)

Rotation (0–45°)

Hypermobility:

Comments:

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 496 SECTION III Appendices

Patient’s Name ________________________________________

Left Side Right Side

* * Therapist Initials * *

Date of Measurement

Scapula

Elevation

Depression

Abduction

Adduction

Shoulder Complex

Elevation through Flexion (0–180°)

Elevation through Abduction (0–180°)

Shoulder (Glenohumeral) Joint

Flexion (0–120°)2

Abduction (0–90° to 120°)2

Extension (0–60°)

Horizontal abduction (0–45°)

Horizontal adduction (0–135°)

Internal rotation (0–70°)

External rotation (0–90°)

Hypermobility:

Comments:

Elbow and Forearm

Flexion (0–150°)

Supination (0–80°)

Pronation (0–80°)

Hypermobility:

Comments:

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 APPENDIX A: Sample Numerical Recording Form 497

Patient’s Name ________________________________________

Left Side Right Side

* * Therapist Initials * *

Date of Measurement

Wrist

Flexion (0–80°)

Extension (0–70°)

Ulnar deviation (0–30°)

Radial deviation (0–20°)

Hypermobility:

Comments:

Thumb

CM flexion (0–15°)

CM extension (0–20°)

Abduction (0–70°)

MCP flexion (0–50°)

IP flexion (0–80°)

Opposition

Hypermobility:

Comments:

Fingers

MCP digit 2 flexion (0–90°)

extension (0–45°)

abduction

adduction

MCP digit 3 flexion (0–90°)

extension (0–45°)

abduction (radial)

adduction (ulnar)

MCP digit 4 flexion (0–90°)

extension (0–45°)

abduction

adduction

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 498 SECTION III Appendices

Patient’s Name ________________________________________

Left Side Right Side

* * Therapist Initials * *

Date of Measurement

MCP digit 5 flexion (0–90°)

extension (0–45°)

abduction

adduction

PIP digit 2 flexion (0–100°)

3 flexion (0–100°)

4 flexion (0–100°)

5 flexion (0–100°)

DIP digit 2 flexion (0–90°)

3 flexion (0–90°)

4 flexion (0–90°)

5 flexion (0–90°)

Composite finger abduction/thumb extension—

Distance between:

Thumb–digit 2

Digit 2–digit 3

Digit 3–digit 4

Digit 4–digit 5

Composite flexion—Distance between:

Finger pulp-distal palmar crease

Finger pulp-proximal palmar crease

Hypermobility:

Comments:

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 APPENDIX A: Sample Numerical Recording Form 499

Patient’s Name ________________________________________

Left Side Right Side

* * Therapist Initials * *

Date of Measurement

Hip

Flexion (0–120°)

Extension (0–30°)

Abduction (0–45°)

Adduction (0–30°)

Internal rotation (0–45°)

External rotation (0–45°)

Hypermobility:

Comments:

Knee

Flexion (0–135°)

Tibial rotation

Patellar mobility—Distal glide

Patellar mobility—Medial-lateral glide

Hypermobility:

Comments:

Ankle

Dorsiflexion (0–20°)

Plantarflexion (0–50°)

Inversion (0–35°)

Eversion (0–15°)

Hypermobility:

Comments:

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 500 SECTION III Appendices

Patient’s Name ________________________________________

Left Side Right Side

* * Therapist Initials * *

Date of Measurement

Toes

MTP great toe flexion (0–45°)

extension (0–70°)

abduction

MTP digit 2 flexion (0–40°)

extension (0–40°)

MTP digit 3 flexion (0–40°)

extension (0–40°)

MTP digit 4 flexion (0–40°)

extension (0–40°)

MTP digit 5 flexion (0–40°)

extension (0–40°)

IP great toe flexion (0–90°)

PIP digit 2 flexion (0–35°)

PIP digit 3 flexion (0–35°)

PIP digit 4 flexion (0–35°)

PIP digit 5 flexion (0–35°)

Hypermobility:

Comments:

Summary of Limitation:

Additional Comments:

1
American Academy of Orthopaedic Surgeons: Joint Motion: Method of Measuring and Recording. Chicago: AAOS; 1965.
2
Levangie PK, Norkin CC. Joint Structure and Function: A Comprehensive Analysis. 3rd ed. Philadelphia: FA Davis; 2001.

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