PEDIATRIC RANGE of MOTION

Chapter 16


PEDIATRIC RANGE of MOTION


The focus of this chapter is to examine differences in range of motion values and techniques for the pediatric patient compared with the adult. The chapter is organized so that upper extremity range of motion is discussed, followed by techniques associated with the upper extremity. Lower extremity range of motion then is discussed, followed by techniques associated with the lower extremity. The chapter concludes with special tests that are specific to the pediatric population with focus on alignment changes through development.



UPPER EXTREMITY RANGE OF MOTION


Range of motion of many upper extremity joints appears to differ in infants and young children compared with adults (Table 16-1). Measurements reported in a study of more than 300 Japanese infants and children from birth to 2 years of age demonstrated an increased range of shoulder extension and lateral rotation, forearm pronation, and wrist flexion, along with a decreased range of elbow extension, in this age group compared with adults.19 The amount of shoulder lateral rotation present in the neonate appears to decrease as the child ages, with the range of shoulder rotation approaching adult levels by the age of 2 years (Table 16-2). As a child ages, elbow extension range of motion also changes to approach adult levels, but more quickly than does the range of shoulder lateral rotation.




Table 16-2


Upper Extremity Motions Demonstrating Significant Change In Amplitude During The First 2 Years*































AGE SHOULDER LATERAL ROTATION ELBOW EXTENSION
Birth (n = 62) 134° −14°
2-4 weeks (n = 57) 126° −6°
4-8 months (n = 54) 120°
8-12 months (n = 45) 124°
1 year (n = 64) 116°
2 years (n = 57) 118°

*Source: Watanabe et al.19


The limitation in elbow extension seen in the neonate appears to resolve by the age of 3 to 8 months (see Table 16-2),11,19 progresses to hyperextension in many children by the age of 2 to 3 years,5,19,21 (Fig. 16-1) and then gradually resolves to adult levels. 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.




TECHNIQUES OF MEASUREMENT: UPPER EXTREMITY


We have not included techniques for every joint of the upper extremity, because the focus of the chapter is to examine changes in the pediatric population compared with the adult. The techniques that are included focus on joints with an increased or decreased range of motion and alternative positions that are used compared with those used for the adult. Please reference the adult chapters for alternative positioning or joints or movements that have not been included. As in the adult, follow standard procedures for measuring range of motion that have been outlined in Chapter 1.




Shoulder Flexion













Shoulder Lateral Rotation











Elbow Extension











Wrist Flexion













Lower Extremity ROM


Normal range of motion in the lower extremity joints is not static but changes across the life span, from birth until the later decades of life (Table 16-3).* Studies in the pediatric population have demonstrated increased hip flexion, abduction, and rotation range of motion in infants and young children compared with the adult population (see Table 16-3). Extension of the hip is decreased in neonates, resulting in a hip flexion contracture that appears to resolve by the age of 2 years. A similar flexion contracture is seen at the knee of neonates,3,7,19,20 but this contracture appears to resolve fairly quickly, with knee extension approaching adult values by the time the infant reaches 3 to 6 months of age (Table 16-3)3,11 and progressing to hyperextension in some children by 3 years of age. 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


Stay updated, free articles. Join our Telegram channel

Aug 10, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on PEDIATRIC RANGE of MOTION

Full access? Get Clinical Tree

Get Clinical Tree app for offline access