Physical Therapy ROM Chart

This document contains an upper extremity range of motion chart to record measurements for the shoulders, elbows, forearms, wrists, and thumbs. It includes spaces to record the patient's name, date of birth, dates of measurements, and comments. Normal ranges of motion are listed for each joint to compare the patient's measurements against.

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Natasya Setyamarta

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Physical Therapy ROM Chart

Uploaded by

Natasya Setyamarta

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as DOCX, PDF, TXT or read online on Scribd

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Upper Extremity Range of Motion Chart

Name: DOB: School Years:

Left Right
Dates
Normal Normal
180 Shoulder Flexion 180

180 Shoulder Abduction 180

70 Shoulder internal rotation 70

90 Shoulder external rotation 90

145 Elbow flexion 145

(0) Elbow extension (0)

80-90 Forearm neutral position 80-90

Supination (elbow bent)
80-90 Pronation (elbow bent) 80-90

80 Wrist flexion 80

70 Wrist extension 70

20 Wrist radial deviation 20

30 Wrist ulnar deviation 30

70 Thumb abduction 70
Note: All measurements are PROM, unless specified by A for Active Range of Motion.
WFL= Within Functional Limits
WNL= Within Normal Limits
Student Name:________________________ DOB:_______________________
Date Comments
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Please note position, medication, surgeries or anything that might effect ROM measurements.

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Physical Therapy ROM Chart

Uploaded by

Physical Therapy ROM Chart

Uploaded by

Upper Extremity Range of Motion Chart

Name: DOB: School Years:

180 Shoulder Abduction 180

70 Shoulder internal rotation 70

90 Shoulder external rotation 90

145 Elbow flexion 145

80-90 Forearm neutral position 80-90

20 Wrist radial deviation 20

30 Wrist ulnar deviation 30

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