8-12 months (n = 45) 16-1 Lateral view of passive hyperextension of the elbow demonstrated by a 3-year-old female. As the forearm pronates, the radius crosses anteriorly over the surface of the ulna. Fig. Verywell Health's content is for informational and educational purposes only. The normal end feel of elbow flexion range of motion is soft and springy as the movement is limited by your biceps muscles. Lateral midline of radius toward radial styloid process (see Note). 2018;34(7):505-528. doi:10.1080/09593985.2017.1422206. 1 year (n = 64) 116. 16-10 End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. Perform passive lateral rotation of the shoulder, stopping at the point of elevation of the scapula off the table. 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. 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. Lateral view of passive hyperextension of the elbow demonstrated by a 3-year-old female. Only gold members can continue reading. Of 50 subjects examined, 49 were able to perform all 12 functional activities included in the study, with elbow motion limited to a range of 75 degrees to 120 degrees of flexion. endstream
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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. Read scale of goniometer (see Fig. If you haveelbow painor an injury to your elbow, wrist, or shoulder, you may benefit from physicaltherapy (PT)to help improve your ability to use your arm normally without pain.
Fig. 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. 16-1 Lateral view of passive hyperextension of the elbow demonstrated by a 3-year-old female. Fig. 16-6). Premium Wordpress Themes by UFO Themes Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Related * 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 lateral condylar fracture group needed 30.2, 35.6, 2.3, and 8.9 days, respectively, in 4 directions. Having a range of 30o-130o of flexion allows for around 80% of normal forearm and hand function but outside this range, losing more flexion has a greater impact than losing more extension, at a ratio of around 2:1. The humeroradial and humeroulnar joints make up the joint complex known as the elbow (Figs. Forearm pronation refers to your ability to turn your hand over so your palm faces the floor. 16-1) and then gradually resolves to adult levels. Extension of the elbow is the curvilinear movement by which the biceps brachii located at the front of the upper arm relaxes while the triceps brachii and its concomitant muscles located at the back contract by pulling the arm down from a flexed position straightening the elbow and increasing the angular range of motion until the elbow locks . 16-3 End of shoulder flexion ROM, showing proper hand placement for stabilizing and flexing shoulder. Stand or sit with your elbow bent 90 degrees and tucked in at your side. The ability to turn your wrist over so your hand faces up is called supination, and this motion occurs at both your elbow and at your wrist joint. Patient is supine with the hand supinated. 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. Elbow pain can limit your ability to perform basic functional tasks. Related At infants elbow to maintain alignment (Fig. Read scale of goniometer (see Fig. A typical PT exercise program for an elbow injury includesgaining ROM first and then building strength in that new ROM. 5 Table 4-1 Read scale of goniometer. You 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. A recent study by van Andel and colleagues31 reported that all functional tasks examined in their study required a minimum of 85 degrees of elbow flexion. This can help you to identify and areas of stiffness or limitation and allow you to see what progress you are making with rehab. Fig. This disc binds the distal ulna and radius together and is the primary reinforcement for the joint. Stabilization: As in the adult, follow standard procedures for measuring range of motion that have been outlined in Chapter 1. That is usually the journal article where the information was first stated. Patients may also have hyperextension beyond 0 of extension in hyperlaxity or other soft tissue disorders. Failure to exercise such care will result in errors in measurement. Elbow flexion and extension may be measured with the patient in the upright (standing or sitting), supine, or side-lying position. Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated (Fig. Bony anatomy of the joints of the elbowposterior view. Confirmation of alignment: We are constantly using our arms and moving our elbows throughout the day, whether we are typing, having a cup of coffee, eating, picking things up, carrying things or even just talking on the phone. The American Academy of Orthopaedic Surgeons, MEASUREMENT of RANGE of MOTION of the ANKLE and FOOT, MEASUREMENT of RANGE of MOTION of the KNEE, MEASUREMENT of RANGE of MOTION of the WRIST and HAND, MEASUREMENT of RANGE of MOTION of the HIP, RELIABILITY and VALIDITY of MEASUREMENTS of RANGE of MOTION and MUSCLE LENGTH TESTING of the LOWER EXTREMITY, MEASUREMENT of RANGE of MOTION of the CERVICAL SPINE and TEMPOROMANDIBULAR JOINT, MEASUREMENT of RANGE of MOTION of the THORACIC and LUMBAR SPINE, RELIABILITY and VALIDITY of MEASUREMENT of RANGE of MOTION for the SPINE and TEMPOROMANDIBULAR JOINT, Joint Range of Motion and Muscle Length Testing. 16-14 Starting position for measurement of wrist flexion, demonstrating proper initial alignment of goniometer. End of wrist flexion ROM, demonstrating proper alignment of goniometer at end of range. 16-4 End of shoulder flexion ROM, demonstrating proper alignment of goniometer at end of range. Documentation: Read scale of goniometer (see Fig. The normal end-feel for elbow flexion is soft, because of the fact that soft tissue approximation normally limits motion. 0
Elbow extension. Lateral midline of humerus toward acromion process. Hold the bent position of your elbow for five to 10 seconds, and then release the stretch by straightening your elbow. 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. 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. When you reach a dip, you have reached the edge of the acromion process and dropped down onto the humeral head. Fig. Laterally rotate patients shoulder through available ROM. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Karen, The material on this website is intended for educational information purposes only. Baseball records were reviewed for arm dominance, age, years of professional pitching, professional innings pitched, and history .
Read scale of goniometer. Release the stretch and allow your elbow to bend a bit. Neck 4. Keep your hand relaxed. In most cases Physiopedia articles are a secondary source and so should not be used as references. Palpate following bony landmarks (see Fig. Of 50 subjects examined, 49 were able to perform all 12 functional activities included in the study, with elbow motion limited to a range of 75 degrees to 120 degrees of flexion. Fig. Stationary arm: Lateral midline of thorax. By Brett Sears, PT You may need a pillow under the upper arm in cases of hyperextension (>0) Goniometer Placement Expected Findings Expected range of motion is 0 degrees in males and 10-15 degrees in females (hyperextension) [1] References Norkin CC, White DJ. 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). Anatomical position of forearm defined as 0 pronation. Very limited, if any, movement occurs at the middle radioulnar union. Hold your end position for 2-3 seconds. Most functional activities require a fairly large amount of elbow flexion ROM (Figs. See Chapter 5. 4-8 to. 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. Palpate following bony landmarks (shown in Fig. 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. AGE Neck (lateral bending) Extension 60O Flexion 50O Left 45O Right 45O . . Return limb to starting position. 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. Biomed Res Int. 16-5). As the forearm pronates, the radius crosses anteriorly over the surface of the ulna. Because of greater stability provided to the humerus, the supine position is preferred for measurement of ROM. MEASUREMENT of RANGE of MOTION of the ELBOW and FOREARM 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. Caution should be used in extrapolating these data to the general population because sample sizes for all studies were small. Distally, the concave ulnar notch of the radius rolls and slides anteriorly on the ulnar head during pronation and posteriorly during supination.21 16-11 Goniometer alignment for measurement of elbow extension. Fig. 4-6 Anatomy of the distal radioulnar joint. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process) indicated by red dots. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Range of motion of many upper extremity joints appears to differ in infants and young children compared with adults (Table 16-1). Everyone documents it a little differently. 4-5 Anatomy of the proximal radioulnar joint. Elbow and forearm motion required to eat with a spoon. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. May be compromised owing to apparent lack of elbow extension. hb``b``g`e`X8f0>P ]` A4@:"A&^oB`l>+"-p33p.0uR!x 3#K
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RggHLdefrr\Y. Supine with upper extremity in anatomical position (see Note), with elbow extended as far as possible, folded towel under distal humerus, proximal to humeral condyles (optional) (Fig. Supination of the forearm is limited by tension in ligamentous structures (anterior radioulnar ligament and oblique cord).25 Limitation of forearm pronation occurs as the result of contact between the bones of the forearm (radius crossing over ulna) and tension in the medial collateral ligament of the elbow and the dorsal radioulnar ligament of the distal radioulnar joint.7,21 Information regarding normal ranges of motion for forearm supination and pronation is located in Appendix B. 16-4). 16-2 Starting position for measurement of shoulder flexion. Because bony contact limits pronation, the normal end-feel for that motion is hard. 4-3 through 4-5).16 A second ligament, the quadrate ligament, runs from the inferior aspect of the radial notch to the neck of the radius, reinforces the joint capsule, and has been attributed with stabilization of the proximal radioulnar joint during the extremes of pronation and supination.29 The distal radioulnar joint is reinforced by a triangular articular disc that is positioned on the distal end of the ulna. 4-9 Elbow and forearm motion required to eat with a spoon. Tags: Joint Range of Motion and Muscle Length Testing
The chapter is organized so that upper extremity range of motion is discussed, followed by techniques associated with the upper extremity. Biplanar (AP in full elbow extension, Lateral in 90 elbow flexion) views are sufficient in adults, while oblique views may be needed in children, especially to document lateral condyle fracture. I worked in hand therapy and documented it as 40. 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). At the extremes of flexion and extension, rolling motions of the ulna and radius replace the gliding motion. 16-4). *Source: Watanabe et al.19 The best way to improve elbow range of motion is usually through a combination of: If your elbow range of motion is restricted, it is really important to understand why in order to get the best treatment, so make sure you get checked out by your doctor and have a look at the elbow pain diagnosis section. 1 year (n = 64) The distal radioulnar joint is located anatomically at the wrist, although inside a separate joint capsule. 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. 4-3) and radial (. Althoughtherapeutic modalitieslike electrical stimulation and ultrasound may be used during your elbow rehab, exercise should be the mainstay of your physical therapy program. CAPSULAR PATTERN The radial head spins anteriorly during pronation and posteriorly during supination. It takes times for elbow range of motion to improve so stick with it, and only measure your range once or twice a week theres no need to do it more often. Fig. LIMITATIONS OF MOTION Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process) indicated by red dots. Fig. End of shoulder flexion ROM, showing proper hand placement for stabilizing and flexing shoulder. 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. Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. 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. Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated, and folded towel under humerus (optional) (Fig. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 1. Lateral epicondyle of humerus. General posture of the upper quarter: Proximal factors should be considered which could predispose the patient to elbow symptoms. Midpoint of lateral aspect of acromion process. Using your "good" hand, grasp the wrist of your of your.
What affects your elbows range of motion? Over dorsal surface of hand and proximal to the elbow (Fig. Bony anatomy of the joints of the elbowanterior view. Range of motion of many upper extremity joints appears to differ in infants and young children compared with adults (Table 16-1). Turn your hand and wrist over as far as possible, then reach your other hand over the top of your forearm. Stand with your back against a wall, elbows bent right angles, back of your arm against the wall, Straighten your elbow bringing the back of your hand towards the wall, If your hand touches the wall, you have full extension (0. 16-2), and align goniometer accordingly. Fig. Stabilization: Carrying angle: The carrying angle has a mean value of 10 degrees for men and 13 degrees for women. The main movements of the elbow are flexion and extension (bending and straightening the elbow) and pronation and supination (rotating the palm up and down). End of shoulder lateral rotation ROM, demonstrating proper alignment of goniometer at end of range. 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, Grays Anatomy2 describes three articulations that interconnect the bones of the forearm: the proximal and distal radioulnar joints and the middle radioulnar union. Depending on your injury, you should continue the exercises for six to 12 weeks. 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.
Scapula. Ulnar border of forearm toward ulnar styloid process. If you want to learn more about how I treat ACL's or the knee in general, then you can check out our all online knee seminar at www.onlinekneeseminar.com and let me know what you think. End of shoulder flexion ROM, demonstrating proper alignment of goniometer at end of range. Palpate following bony landmarks (see Fig. Passive Forearm Rotations. The range of elbow flexion tends to be greater when the joint is moved passively because there is less interference by contracting muscle bulk. Changes in Upper Extremity Range of Motion: Birth to 19 Years of Age, Upper Extremity Motions Demonstrating Significant Change In Amplitude During The First 2 Years*. Palpate following bony landmarks (see Fig. Fig. Measurement of joint motion: a guide to goniometry. In patients with tightness of the long head of the triceps, such positioning may limit flexion of the elbow. TECHNIQUES OF MEASUREMENT: UPPER EXTREMITY During pronation and supination of the forearm, motion occurs at the proximal and distal radioulnar joints simultaneously. Starting position for measurement of elbow extension. Even offers many rehab exercises. These results were similar to those reported by Vasen et al,32 who used a motion-restricting brace to determine the functional ROM of the elbow. Abduction: 25 degrees Adduction: 20 degrees Fig. May be compromised owing to apparent lack of elbow extension. FA Davis; 2016 Nov 18. "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. 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. 16-11). 4-8 Elbow and forearm motion required to comb ones hair. Lower extremity range of motion then is discussed, followed by techniques associated with the lower extremity. The lateral epicondyle is the slightly lower of the two lumps on the outer side of the elbow. Fig.
If a person has a 10 degree contracture and loss of full knee extension with 130 degrees of knee flexion, it would be documented as -10-130. 16-9). The exercises can be done daily as part of an elbow rehabilitation program. The American Academy of Orthopaedic Surgeons5 recommends that the patient be in the upright position with the shoulder flexed to 90 degrees when measurements of elbow flexion and extension are taken. 2018 Jun; 2018(6): CD013042. 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. Br J Gen Pract. Terms & Conditions apply shoulder-pain-explained.com 2015-23 Last updated 11th January 2023, Contact Us About Us Blog Privacy Policy Advertising Policy Sitemap, The material on this website is intended for educational information purposes only. Lateral (flexion) Extension 25O Flexion 90O Left 25O Right 25O Degrees Degrees Degrees Degrees 3. 116 Goniometer alignment for measurement of elbow extension. Elbow flexion refers to your ability to bend your elbow. End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. The normal end-feel for elbow extension is hard as the olecranon process of the ulna becomes wedged in the olecranon fossa of the humerus. Grays Anatomy2 describes three articulations that interconnect the bones of the forearm: the proximal and distal radioulnar joints and the middle radioulnar union. Grab your wrist and gently add overpressure by turning your hand further into supination. Its not as accurate as using a goniometer but it can still give useful feedback. 16-12). Fig. 4-3 Ligamentous reinforcement of the elbow and proximal radioulnar jointmedial view. 4-3) and radial (Fig. Observation. Elbow flexion and extension may be measured with the patient in the upright (standing or sitting), supine, or side-lying position. Same starting position as for pronation but this time twist the hand the other way so the palm is facing up (still gripping the pencil in a fist). . 1 The chapter concludes with special tests that are specific to the pediatric population with focus on alignment changes through development. *Watanabe et al.19 In patients with tightness of the long head of the triceps, such positioning may limit flexion of the elbow. The normal end feel of elbow extension range of motion is hard as the bones (olecranon process of the ulna and olecranon fossa of the humerus) interlock and prevent further movement. So for example elbow extension/flexion range is 0-145 (or somewhere around there). Repalpate landmarks and confirm proper goniometer alignment at end of ROM, correcting alignment as necessary. 4-10 Elbow and forearm motion required to use a telephone. Supine with shoulder in 0 degrees flexion, elbow fully extended, forearm in neutral rotation with palm facing trunk or pronated (Fig. There are established ranges that doctors consider normal for various joints in the body. Ulnar border of forearm toward ulnar styloid process.
are doing a lot of good in the world with this helpful site, thanks again." Thank you, {{form.email}}, for signing up. 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. 4-8 to 4-10). Wrist exercises may be repeated up to four times a day. Chapter 16 Fig. Read scale of goniometer. Component of pronation. Lie on your back on a bed, next to the edge. What to Expect from Physical Therapy for Tennis Elbow. Axis: Wrist: Extension/Flexion: 70/75: Radial\Ulnar : 20/35: Thumb basal joint: Palmar Adduction/Abduction: Contact/45: Radial Adduction/Abduction: Contact/60: Thumb . Fig. 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. Examiner action: and thanks so much, great site! OSTEOKINEMATICS Alternative patient position: Elbow/Forearm Rom Requirements For Functional Activities Typical Range of Motion: Elbow: Extension/Flexion: 0/145: Forearm: Pronation/Supination: 70/85 . Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated (Fig. Fig. Patients forearm should be completely supinated at beginning of ROM, or beginning reading of goniometer. Patient position: Perform passive shoulder flexion (Fig. Supination of the forearm is limited by tension in ligamentous structures (anterior radioulnar ligament and oblique cord).25 Limitation of forearm pronation occurs as the result of contact between the bones of the forearm (radius crossing over ulna) and tension in the medial collateral ligament of the elbow and the dorsal radioulnar ligament of the distal radioulnar joint.7,21 Information regarding normal ranges of motion for forearm supination and pronation is located in Appendix B. Feedback can be delivered many ways. OSTEOKINEMATICS Elbow extension ROM is limited by contact of the olecranon process of the ulna with the olecranon fossa of the humerus. When measuring elbow flexion and extension range of motion, you must first identify three landmarks on the arm. Yourphysical therapistwill work with you to develop a plan of care to help you return to your previous level of function. 4-1 and. *Watanabe et al.19 Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. Note: 16-14). Range of motion measures from the dominant and nondominant sides were compared. Sit in a chair with your elbow resting on a table. Reach your opposite hand over the top of your forearm, and grabbing your wrist, turn your arm as far as possible without pain. 4-8 Elbow and forearm motion required to comb ones hair. Flex patients wrist through available ROM (see Note).
When the forearm is fully supinated, the radius and the ulna lie parallel to each other. Wrist Flexion Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Line the centre of the goniometer circle up with this point. Perform passive lateral rotation of the shoulder, stopping at the point of elevation of the scapula off the table. Mouton LJ. ROM Measurement Procedures: Elbow Flexion and Extension Centers for Disease Control and Prevention (CDC) 608K subscribers Subscribe 65 Share Save 30K views 6 years ago Universal Data Collection. 16-9). 16-4). Viktoria, "This is a great site. Repalpate landmarks and confirm proper goniometric alignment at end of ROM, correcting alignment as necessary. Clear, easy understand. Perform passive wrist flexion (Fig. 16-11). Read scale of goniometer (Fig. Stand or sit with your arm at your side and your elbow bent about 90 degrees. To perform the forearm pronation ROM stretch: Once you improve your elbow ROM with these exercises, your physical therapist may then prescribe strengthening exercises. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. 16-5 Starting position for measurement of shoulder lateral rotation. We cover the anatomy, rehab prescription, ACL, meniscal injuries knee replacements and patellofemoral issues. To add overpressure to the stretch, use your opposite hand and reach underneath the forearm of your supinated arm. Patient position: Please reference the adult chapters for alternative positioning or joints or movements that have not been included. Laterally rotate patients shoulder through available ROM. There are three different types of elbow range of motion: In a normal, healthy elbow joint, these three range of motions will be fairly similar with passive elbow range of motion being slightly greater than active range of motion.