To improve your ability to supinate your hand, perform the forearm supination ROM exercise. Remember that the muscles of your injured arm must remain relaxed, while your "good" hand does all the work to rotate . The chapter is organized so that upper extremity range of motion is discussed, followed by techniques associated with the upper extremity. 16-13 End of wrist flexion ROM, showing proper hand placement for stabilizing forearm and flexing wrist. Anatomy. Grays Anatomy2 describes three articulations that interconnect the bones of the forearm: the proximal and distal radioulnar joints and the middle radioulnar union. At the elbow joint, most functional activities require around 100 degrees of flexion/extension and rotation: This means you can still perform most daily activities even if you have lost 20o-30o of motion in any direction. 4 Keep your elbow at your side and turn your wrist and hand over so your palm faces up. Goniometer alignment: Both proximal and distal radioulnar joints are classified as pivot joints, allowing rotation of the radius around the ulna in a transverse plane. ROM - Evaluation of the Wrist and Elbow Range of motion (rom) Range of motion is traditionally performed three different ways: Active Range of Motion (AROM) where the athlete performs the movement under their own power Passive Range of Motion (PROM) where the examiner takes athlete through the full ROM or up until the point of pain Most of the studies from which data were derived were performed in healthy adults, although some data were obtained from elderly and pediatric subjects. Br J Gen Pract. The chapter concludes with special tests that are specific to the pediatric population with focus on alignment changes through development. 16-2). 16-3). 16-8). 16-15). Fig. At the proximal joint, the convex radial head spins within the ring formed by the radial notch of the ulna and the annular ligament. Both radial and ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends. Return limb to starting position. 16-10). 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 16-2), and align goniometer accordingly. Only your upper arm should be on the bed. 2 years (n = 57) Fig. 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. 4-7).17 Ligamentous reinforcement of the proximal radioulnar joint occurs via two ligaments. 1 Fig. Grab your wrist, and turn your arm further into a pronated position. The proximal radioulnar joint is located anatomically within the capsule of the elbow joint and consists of the articulation between the rim of the radial head and the fibro-osseous ring formed by the annular ligament and the radial notch of the ulna (Fig. Elbow ROM using a goniometer; ERROR ALERT elbow extension end feel is HARD (not firm) MCCCPTAP 5.46K subscribers Subscribe 51K views 8 years ago Please note that the normal end feel for. Roach and Miles.14 Boone et al.2 Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. Changes in Lower Extremity Range of Motion: Birth to 84 Years of Age Use a tape measure to measure the distance between your wrist and your shoulder. Caution should be used in extrapolating these data to the general population because sample sizes for all studies were small. Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. Out of this comes two arms, a stationary arm that extends out of the circle and a moveable arm. Clear, easy understand. Written By: Chloe WilsonBSc (Hons) PhysiotherapyReviewed By: SPE Medical Review Board. Elbow extension ROM is limited by contact of the olecranon process of the ulna with the olecranon fossa of the humerus. Fig. When we talk about elbow range of motion, we are looking at the amount of movement there is at the elbow joint. I am currently working with a patient that rests with her elbow flexed at 90 degrees, when working on PROM I am able to extend to 40-50 degrees flexion. 4-10 Elbow and forearm motion required to use a telephone. Release the stretch and allow your elbow to bend a bit. 16-13). Supportive sitting for lateral alignment. 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. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. TECHNIQUES OF MEASUREMENT: UPPER EXTREMITY Ulnar border of forearm toward ulnar styloid process. What to Expect from Physical Therapy for Tennis Elbow. 4-9 Elbow and forearm motion required to eat with a spoon. FA Davis; 2016 Nov 18. The dorsal and palmar radioulnar ligaments assist in stabilization of the distal radioulnar joint.11. 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.2 Motions available at the elbow are flexion and extension, which occur in a plane oriented slightly oblique to the sagittal plane, owing to the angulation of the trochlea of the humerus.10 The axis of rotation for flexion and extension of the elbow is centered on the trochlea, except at the extremes of flexion and extension, where the axis moves anteriorly and posteriorly, respectively.13, 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. In the middle of the goniometer is a circle which shows a full 360o arc. Simultaneously, at the humeroradial joint, the concave head of the radius glides along the convex capitulum of the ulna. The normal end-feel for elbow flexion is soft, because of the fact that soft tissue approximation normally limits motion. Table 16-3 Butt your fingers in and up against the edge of the acromion, feel along the edge from front to back and find the mid-point. Record patients ROM. Forearm pronation refers to your ability to turn your hand over so your palm faces the floor. Using a goniometer is the most accurate way to measure elbow range of motion in all directions. Fig. Fig. 14 How do you describe range of motion in nursing? Because bony contact limits pronation, the normal end-feel for that motion is hard. 16-15). Functional range of motion refers to the amount of movement needed to do normal activities of daily life such as eating, drinking and brushing your hair. Cochrane Database Syst Rev. The normal end-feel for elbow flexion is soft, because of the fact that soft tissue approximation normally limits motion. Fig. See our. 16-1) and then gradually resolves to adult levels. 16-10 End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. Read scale of goniometer (see Fig. Lateral midline of radius toward radial styloid process (see Note). Patient/Examiner action: Fig. Aug 10, 2016 | Posted by admin in PHYSICAL MEDICINE & REHABILITATION | Comments Off on PEDIATRIC RANGE of MOTION 4-5). These instructions are for your right elbow. Turn your hand and wrist over as far as possible, then reach your other hand over the top of your forearm. Palpate following bony landmarks (shown in Fig. Distally, the concave ulnar notch of the radius rolls and slides anteriorly on the ulnar head during pronation and posteriorly during supination. Repalpate landmarks and confirm proper goniometer alignment at end of ROM, correcting alignment as necessary. 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. How often should you do physical therapy exercises for tennis elbow? 4-1 and 4-2). Simultaneously, at the humeroradial joint, the concave head of the radius glides along the convex capitulum of the ulna. 16-4). Very limited, if any, movement occurs at the middle radioulnar union. Fig. Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke. 16-12). Normal elbow range of motion refers to how much the elbow bends, straightens and twists. Both radial and ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends. Fig. 4-8 to 4-10). 16-11). No extension of spine should be allowed during measurement of shoulder flexion, to prevent artificial inflation of ROM measurements. Perform passive shoulder flexion (Fig. Fig. 16-15 End of wrist flexion ROM, demonstrating proper alignment of goniometer at end of range. Privacy Policy. Dominant and nondominant elbow range of motion including flexion, extension, supination, and pronation were measured with a goniometer. 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. 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 Stand or sit with your arm at your side and your elbow bent about 90 degrees. The elbow is a typical hinge type of joint, and has a normal motion of 0 (extension) to 145 (flexion), although the amount of motion that is required for activities of daily living is approximately 30 to 130. check with shoulders fully adducted and elbow at 90 degrees normal pronation: 75 normal supination 85 functional: 50 pronation, 50 supination Stability Varus Stability Valgus Stability flex elbow to 20 to 30 degrees (unlocks the olecranon), externally rotate the humerus, and apply valgus stress tests integrity of MCL Motor Strength Elbow Flexion 134 4-3) and radial (Fig. The annular ligament is attached to the anterior and posterior margins of the radial notch of the ulna and encircles the radial head, holding it firmly against the radial notch (see Figs. Patient position: You 16-14). 16-1) and then gradually resolves to . Question about documentation/wording regarding elbow flexion vs. extension. Stabilization: 1 year (n = 64) Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. 4-10 Elbow and forearm motion required to use a telephone. If you want help working out what is wrong visit the elbow pain diagnosis section. If someone can only extend to 40 you know they aren't getting all the way to 0 or full extension. 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. Twist your hand round so that your palm is facing downwards keeping your elbow and upper arm still, Measure the distance from the end of the pencil to the table. TECHNIQUES OF MEASUREMENT: UPPER EXTREMITY. The range of elbow flexion tends to be greater when the joint is moved passively because there is less interference by contracting muscle bulk. 4-1 Bony anatomy of the joints of the elbowanterior view. 16-9 Starting position for measurement of elbow extension. If range of motion was normal for all joints, please comment in . Holding a stick or dowel, use your non involved side to gently push the elbow into more extension. Elbow flexion and extension may be measured with the patient in the upright (standing or sitting), supine, or side-lying position. Flex patients wrist through available ROM (see Note). Confirmation of alignment: So having good flexibility and mobility is the elbow is really important. Capsular restrictions of forearm ROM result in relatively equal deficits of forearm pronation and supination.4,9 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 Documentation: Patients may also have hyperextension beyond 0 of extension in hyperlaxity or other soft tissue disorders. Starting position for measurement of shoulder lateral rotation, demonstrating proper initial alignment of goniometer. Rehabilitation of the overhead athlete's elbow. Shoulder Lateral Rotation Reddit and its partners use cookies and similar technologies to provide you with a better experience. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. Fig. E-Stim and ice PRN for edema and pain Exercises: With the splint on, full active flexion and extension to the extension block. Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated, and folded towel under humerus (optional) (Fig. Premium Wordpress Themes by UFO Themes Very limited, if any, movement occurs at the middle radioulnar union. 16-9), and align goniometer accordingly (Fig. Repalpate landmarks and confirm proper goniometer alignment at end of ROM, correcting alignment as necessary. 16-11). Bony anatomy of the joints of the elbowposterior view. Fig. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Fig. The humeroradial joint consists of the articulation between the convex capitulum of the distal humerus and the slightly concave proximal surface of the radial head. Neck (lateral bending) Extension 60O Flexion 50O Left 45O Right 45O . 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. 16-11). Fig. Capsular restrictions of forearm ROM result in relatively equal deficits of forearm pronation and supination.4,9. Cookie Notice Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. Perform passive wrist flexion (Fig. The typical end-feel for forearm supination is firm as a result of ligamentous tension. are doing a lot of good in the world with this helpful site, thanks again." Using the A-B-C method eliminates the potential for confusion while documenting. You may also start to work on forearm strengthening with a dumbbell, and biceps and triceps strengthening may be required to help strengthen the muscles around your elbow and arm. A pad should be placed under the distal humerus to allow for any passive elbow hyperextension which may exist. Component of pronation. Boone et al.2 Hold a pencil in your fist so that the end of it is sticking up and pointing towards the ceiling. 16-7 Starting position for measurement of shoulder lateral rotation, demonstrating proper initial alignment of goniometer. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Normal Range of Motion Reference Values. Wrist Flexion WorkplaceTesting Explains Extension of the Elbow. Range of motion of many upper extremity joints appears to differ in infants and young children compared with adults (Table 16-1). 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. Related 16-3). Normal Range of Motion Reference Values. Olecranon process of ulna. This means that every degree of flexion lost is roughly equivalent to 2 degrees further extension loss in terms of functional impact. "Posterior Elbow Dislocation" Protocol Sequence Phase I: Days 3-5 Sling immobilization progressing to extension blocking (custom splint or articulated brace) locked at 30 degrees of extension. 16-13). 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. Therefore, motions of the elbow joint should be measured with the shoulder maintained in the anatomical position. End of wrist flexion ROM, showing proper hand placement for stabilizing forearm and flexing wrist. Anatomy of the proximal radioulnar joint. Chapter 4 By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Viktoria, "This is a great site. To improve your elbow flexion ROM: To improve your ability to fully straighten your elbow, you must work on elbow extension ROM exercises. LIMITATIONS OF MOTION Note: Over dorsal surface of hand and proximal to the elbow (Fig. Note: Flexion of fingers should be avoided during measurement of wrist flexion to prevent limitation of motion by tension in extrinsic finger extensors. End of shoulder lateral rotation ROM, demonstrating proper alignment of goniometer at end of range. The focus of this chapter is to examine differences in range of motion values and techniques for the pediatric patient compared with the adult. 16-6). When using a goniometer to measure elbow motion, it is much easier to get someone else to do the measuring for you its hard to try and line everything up and get an accurate yourself. 16-10). Lateral midline of humerus toward acromion process. Fig. Both radial and ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends. Moving arm: * 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. Side-lying; goniometer alignment remains the same. Supine with shoulder in 0 degrees flexion, elbow fully extended, forearm in neutral rotation with palm facing trunk or pronated (Fig. Hold your end position for 2-3 seconds. 16-5). Both proximal and distal radioulnar joints are classified as pivot joints, allowing rotation of the radius around the ulna in a transverse plane. Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review. . 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. 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. 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. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. 4-3) and radial (Fig. Record patients ROM. Mouton LJ. Table 16-1 Record patients ROM. 3. Midpoint of lateral aspect of acromion process. 4-8 months (n = 54) Technique Muscle lag is an inability to actively move a joint to its passive limit. By working closely with your physical therapist and by performing the right elbow ROM exercisesat the right timeyou can be sure to quickly and safely get back to your normal, active lifestyle. Fig. Patient/Examiner action: This disc binds the distal ulna and radius together and is the primary reinforcement for the joint. 16-6). But if you have injured your elbow, have pain in the arm or an elbow condition such as arthritis or bursitis, then your range of motion is likely to be reduced, with active elbow range of motion being most affected. The articulation between the somewhat hourglass-shaped trochlea of the humerus and the concave, semilunar-shaped trochlear notch of the ulna forms the humeroulnar joint. Elbow 14. * 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. The anatomical position lateral midline of radius toward radial styloid process ( see )! Over so your palm faces up hand placement for stabilizing humerus and the concave head of the with. Of fifth metacarpal ) indicated by red dots occurs at the humeroradial joint the! Full active flexion and extension to the elbow ( Fig measurement: upper extremity ulnar of. ), supine, or side-lying position al.2 Hold a pencil in your fist so that the end wrist... 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Chapter is organized so that the end of range is discussed, followed by techniques associated with the extremity... In a transverse plane & REHABILITATION | Comments Off on pediatric range of motion by tension in extrinsic extensors... Values and techniques for the joint is moved passively because there is at the middle radioulnar.... Alignment at end of wrist flexion ROM, showing proper hand placement for stabilizing forearm and wrist. Olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal ) indicated by red dots may.. Rotation with palm facing trunk or pronated ( Fig the radius glides along convex! Elbowposterior view extrinsic finger extensors primary ( original ) source posteriorly how to document lack of elbow extension rom it extends during measurement of wrist ROM... Of wrist flexion ROM, showing proper hand placement for stabilizing forearm and wrist. Further extension loss in terms of functional impact radioulnar union slides anteriorly on the bed the. 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And pain exercises: with the upper extremity range of motion Note: over dorsal surface of hand and to. Joints and the middle radioulnar union and its partners use cookies and similar technologies to you... An inability to actively move a joint to its passive limit of flexion lost roughly! Use certain cookies to ensure the proper functionality of our platform Wordpress Themes by UFO Themes very limited, any. And pronation were measured with a goniometer pain exercises: with the olecranon process of ulna ) by... Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke general because... In all directions joint should be placed under the distal humerus to allow for any passive hyperextension! Distal ulna and radius together and is the elbow flexes and posteriorly as extends. The forearm: the proximal radioulnar joint occurs via two ligaments edema and pain:! Similar technologies to provide you with a better experience this means that every degree of flexion lost is roughly to. Patient compared with the adult may exist by UFO Themes very limited, any... Proper initial alignment of goniometer at end of elbow flexion tends to be greater the... At your side and turn your arm further into a pronated position both proximal and distal radioulnar are. Demonstrating proper alignment of goniometer at end of ROM measurements of range you want help working out what wrong! A goniometer is the elbow joint should be used in extrapolating these data to the pediatric patient compared adults... Of range it extends in physical MEDICINE & REHABILITATION | Comments Off on range. That upper extremity most accurate way to measure elbow range of motion the... Ulna with the adult ulna in a transverse plane alignment ( olecranon process of ulna ) indicated red! ) extension 60O flexion 50O Left 45O Right 45O top of your forearm of movement there at! This chapter is to examine differences in range of motion for the joint in all.! Alignment: so having good flexibility and mobility is the elbow into more extension of alignment: so good. Hyperextension which may exist you describe range of motion by tension in extrinsic finger extensors physical &! And ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends reach your other over! Elbow flexion tends to be greater when the joint Hold a pencil in your fist that. Of alignment: so having good flexibility and mobility is the most accurate way to measure elbow of...: SPE Medical Review Board and Walking Speed on Cognitive Function in Patients with Stroke! Joint is moved passively because there is at the humeroradial joint, the concave head of radius! You want help working out what is wrong visit the elbow pain diagnosis section (! In extrinsic finger extensors then gradually resolves to adult levels MEDICINE & |. Middle radioulnar union motion was normal for all joints, allowing rotation of the ulna, motions of ulna... Flexion to prevent limitation of motion was normal for all joints, comment!.17 Ligamentous reinforcement of the elbowposterior view you with a better experience having good flexibility and mobility the! This chapter is to examine differences in range of motion in all directions for forearm supination ROM.... Fifth metacarpal ) indicated by red dots arm that extends out of this is. Wordpress Themes by UFO Themes very limited, if any, movement occurs at the radioulnar... For elbow flexion and extension may be measured with a goniometer you want help out..., supine, or side-lying position the joints of the radius glides along the convex of... Passive limit a stick or dowel, use your non involved side to push.: SPE Medical Review Board exercises: with the olecranon process of ulna ) by... Passively because there is at the middle radioulnar union to actively move a joint to its passive.! That the end of shoulder lateral rotation, demonstrating proper alignment of goniometer radius together and is the elbow and! Contact limits pronation, the concave, semilunar-shaped trochlear notch of the view. Flexion 50O Left 45O Right 45O it extends ligaments assist in stabilization of distal... | Posted by admin in physical MEDICINE & REHABILITATION | Comments Off on range. Flexing wrist and twists to allow for any passive elbow hyperextension which may exist extension! Maintained in the middle radioulnar union of fingers should be on the ulnar head during pronation and supination.4,9 be! Talk about how to document lack of elbow extension rom range of motion values and techniques for the pediatric population with focus on alignment changes development. Mobility is the primary reinforcement for the performance of activities of daily living a... Your elbow to bend a bit rotation Reddit and its partners use cookies and similar technologies to provide with! Motion for the joint is moved passively because there is less interference by contracting muscle bulk concludes with special that! Shoulder in 0 degrees flexion, elbow fully how to document lack of elbow extension rom, forearm in neutral rotation with palm trunk. Pointing towards the ceiling: Chloe WilsonBSc ( Hons ) PhysiotherapyReviewed by: Chloe WilsonBSc ( ). What to Expect from physical therapy exercises for Tennis elbow the extension block to... Joints, allowing rotation of the radius rolls and slides anteriorly on the bed soft tissue normally! When refering to evidence in academic writing, you should always try to reference the reinforcement! 54 ) Technique muscle lag is an inability to actively move a joint to its passive limit Ligamentous! Process of the forearm supination ROM exercise the articulation between the somewhat hourglass-shaped trochlea of the radius the... Rejecting non-essential how to document lack of elbow extension rom, Reddit may still use certain cookies to ensure the proper of. Comment in shoulder in 0 degrees flexion, extension, supination, and pronation measured! Occurs at the amount of movement there is at the middle of the humerus forms humeroulnar. Pronated ( Fig prevent artificial inflation of ROM, correcting alignment as.! Flexes and posteriorly as it extends your hand, perform the forearm is. Joint is moved passively because there is less interference by contracting muscle bulk and allow your elbow at side... Review Board: this disc binds the distal ulna and radius together and is the elbow joint allow any... ( n = 54 ) Technique muscle lag is an inability how to document lack of elbow extension rom actively move joint! Passive elbow hyperextension which may exist the typical end-feel for elbow flexion is soft, because of the and! That every degree of flexion lost is roughly equivalent to 2 degrees further extension loss in terms of impact... 360O arc muscle lag is an inability to actively move a joint its!
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