Validity of Goniometric Elbow Measurements: Comparative Study with a Radiographic Method

  • Julien Chapleau
  • Fanny Canet
  • Yvan Petit
  • G-Yves Laflamme
  • Dominique M. Rouleau
Clinical Research
First Online:
Received:
Accepted:

Abstract

Background

A universal goniometer is commonly used to measure the elbow’s ROM and carrying angle; however, some authors question its poor intertester reliability.

Questions/purposes

We (1) assessed the validity of goniometric measurements as compared with radiographic measurements in the evaluation of ROM of the elbow and (2) determined the reliability of both.

Methods

The ROM and carrying angle of 51 healthy subjects (102 elbows) were measured using two methods: with a universal goniometer by one observer three times and on radiographs by two independent examiners. Paired t-test and Pearson’s correlation were used to compare and detect the relationship between mean ROM. The maximal error was calculated according to the Bland and Altman method.

Results

The intraclass correlation coefficients (ICC) ranged from 0.945 to 0.973 for the goniometric measurements and from 0.980 to 0.991 for the radiographic measurements. The two methods correlated when measuring the total ROM in flexion and extension. The maximal errors of the goniometric measurement were 10.3° for extension, 7.0° for flexion, and 6.5° for carrying angle 95% of the time. We observed differences for maximum flexion, maximal extension, and carrying angle between the methods.

Conclusion

Both measurement methods differ but they correlate. When measured with a goniometer, the elbow ROM shows a maximal error of approximately 10°.

Clinical Relevance

The goniometer is a reasonable and simple clinical tool, but for research protocols, we suggest using the radiographic method because of the higher level of precision required.

Keywords

Intraclass Correlation Coefficient Radiographic Measurement Bony Landmark Distal Humerus Elbow Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJ. Reliability of range-of-motion measurement in the elbow and forearm. J Shoulder Elbow Surg. 1998;7:573–580.PubMedCrossRefGoogle Scholar
  2. 2.
    Awan R, Smith J, Boon AJ. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil. 2002;83:1229–1234.PubMedCrossRefGoogle Scholar
  3. 3.
    Bland JM, Altman DG. A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Comput Biol Med. 1990;20:337–340.PubMedCrossRefGoogle Scholar
  4. 4.
    Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003;22:85–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Boone DC, Azen SP. Normal range of motion of joints in male subjects. J Bone Joint Surg Am. 1979;61:756–759.PubMedGoogle Scholar
  6. 6.
    Docherty MA, Schwab RA, Ma OJ. Can elbow extension be used as a test of clinically significant injury? South Med J. 2002;95:539–541.PubMedGoogle Scholar
  7. 7.
    Fish DR, Wingate L. Sources of goniometric error at the elbow. Phys Ther. 1985;65:1666–1670.PubMedGoogle Scholar
  8. 8.
    Glasgow C, Wilton J, Tooth L. Optimal daily total end range time for contracture: resolution in hand splinting. J Hand Ther. 2003;16:207–218.PubMedCrossRefGoogle Scholar
  9. 9.
    Golden DW, Wojcicki JM, Jhee JT, Gilpin SL, Sawyer JR, Heyman MB. Body mass index and elbow range of motion in a healthy pediatric population: a possible mechanism of overweight in children. J Pediatr Gastroenterol Nutr. 2008;46:196–201.PubMedCrossRefGoogle Scholar
  10. 10.
    Goodwin J, Clark C, Deakes J, Burdon D, Lawrence C. Clinical methods of goniometry: a comparative study. Disabil Rehabil. 1992;14:10–15.PubMedCrossRefGoogle Scholar
  11. 11.
    Greene BL, Wolf SL. Upper extremity joint movement: comparison of two measurement devices. Arch Phys Med Rehabil. 1989;70:288–290.PubMedGoogle Scholar
  12. 12.
    Gunal I, Kose N, Erdogan O, Gokturk E, Seber S. Normal range of motion of the joints of the upper extremity in male subjects, with special reference to side. J Bone Joint Surg Am. 1996;78:1401–1404.PubMedGoogle Scholar
  13. 13.
    Hayes K, Walton JR, Szomor ZR, Murrell GA. Reliability of five methods for assessing shoulder range of motion. Aust J Physiother. 2001;47:289–294.PubMedGoogle Scholar
  14. 14.
    Jaeger GH, Marcellin-Little DJ, Depuy V, Lascelles BD. Validity of goniometric joint measurements in cats. Am J Vet Res. 2007;68:822–826.PubMedCrossRefGoogle Scholar
  15. 15.
    Lee J, Koh D, Ong CN. Statistical evaluation of agreement between two methods for measuring a quantitative variable. Comput Biol Med. 1989;19:61–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Lennon RI, Riyat MS, Hilliam R, Anathkrishnan G, Alderson G. Can a normal range of elbow movement predict a normal elbow x ray? Emerg Med J. 2007;24:86–88.PubMedCrossRefGoogle Scholar
  17. 17.
    London JT. Kinematics of the elbow. J Bone Joint Surg Am. 1981;63:529–535.PubMedGoogle Scholar
  18. 18.
    Macedo LG, Magee DJ. Differences in range of motion between dominant and nondominant sides of upper and lower extremities. J Manipulative Physiol Ther. 2008;31:577–582.PubMedCrossRefGoogle Scholar
  19. 19.
    Macedo LG, Magee DJ. Effects of age on passive range of motion of selected peripheral joints in healthy adult females. Physiother Theory Pract. 2009;25:145–164.PubMedCrossRefGoogle Scholar
  20. 20.
    Mayerson NH, Milano RA. Goniometric measurement reliability in physical medicine. Arch Phys Med Rehabil. 1984;65:92–94.PubMedGoogle Scholar
  21. 21.
    Morrey BF, Sanchez-Sotelo J. The Elbow and its Disorders. Ed 4. Philadelphia, PA: Saunders Elsevier; 2008.Google Scholar
  22. 22.
    Paraskevas G, Papadopoulos A, Papaziogas B, Spanidou S, Argiriadou H, Gigis J. Study of the carrying angle of the human elbow joint in full extension: a morphometric analysis. Surg Radiol Anat. 2004;26:19–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Park W, Ramachandran J, Weisman P, Jung ES. Obesity effect on male active joint range of motion. Ergonomics. 2010;53:102–108.PubMedCrossRefGoogle Scholar
  24. 24.
    Petherick M, Rheault W, Kimble S, Lechner C, Senear V. Concurrent validity and intertester reliability of universal and fluid-based goniometers for active elbow range of motion. Phys Ther. 1988;68:966–969.PubMedGoogle Scholar
  25. 25.
    Pique-Vidal C, Maled-Garcia I, Arabi-Moreno J, Vila J. Radiographic angles in hallux valgus: differences between measurements made manually and with a computerized program. Foot Ankle Int. 2006;27:175–180.PubMedGoogle Scholar
  26. 26.
    Riddle DL, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther. 1987;67:668–673.PubMedGoogle Scholar
  27. 27.
    Rothstein JM, Miller PJ, Roettger RF. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther. 1983;63:1611–1615.PubMedGoogle Scholar
  28. 28.
    Shaaban H, Pereira C, Williams R, Lees VC. The effect of elbow position on the range of supination and pronation of the forearm. J Hand Surg Eur Vol. 2008;33:3–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Shiba R, Sorbie C, Siu DW, Bryant JT, Cooke TD, Wevers HW. Geometry of the humeroulnar joint. J Orthop Res. 1988;6:897–906.PubMedCrossRefGoogle Scholar
  30. 30.
    Steindler A. Kinesiology of the Human Body Under Normal and Pathological Conditions. Ed 5. Springfield, IL: Charles C. Thomas; 1977.Google Scholar
  31. 31.
    Szulc P, Lewandowski J. Verification of selected anatomical landmarks used as reference points for universal goniometer positioning during elbow joint mobility range measurements. Folia Morphol (Warsz). 2003;62:353–355.Google Scholar
  32. 32.
    Terwee CB, De Winter AF, Scholten RJ, Jans MP, Deville W, van Schaardenburg D, Bouter LM. Interobserver reproducibility of the visual estimation of range of motion of the shoulder. Arch Phys Med Rehabil. 2005;86:1356–1361.PubMedCrossRefGoogle Scholar
  33. 33.
    van de Pol RJ, van Trijffel E, Lucas C. Inter-rater reliability for measurement of passive physiological range of motion of upper extremity joints is better if instruments are used: a systematic review. J Physiother. 2010;56:7–17.PubMedCrossRefGoogle Scholar
  34. 34.
    Zampagni ML, Casino D, Zaffagnini S, Visani AA, Marcacci M. Estimating the elbow carrying angle with an electrogoniometer: acquisition of data and reliability of measurements. Orthopedics. 2008;31:370.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Julien Chapleau
    • 1
  • Fanny Canet
    • 2
    • 3
  • Yvan Petit
    • 2
    • 3
  • G-Yves Laflamme
    • 2
  • Dominique M. Rouleau
    • 2
  1. 1.Université de MontrealMontrealCanada
  2. 2.Orthopedic Research C2095, Hôpital du Sacré-Coeur de MontréalMontrealCanada
  3. 3.École de Technologie SupérieureMontrealCanada

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