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The smartphone inclinometer: A new tool to determine elbow range of motion?

  • Frédéric Vauclair
  • Abdulaziz Aljurayyan
  • Fahad H. Abduljabbar
  • Bardia Barimani
  • Patrick Goetti
  • Fiona Houghton
  • Edward J. Harvey
  • Dominique M. Rouleau
Original Article • ELBOW - IMAGING

Abstract

Background

There are easily accessible tools on smartphones (APP) for measuring elbow range of motion (ROM). The purpose of this study is to evaluate the validity of a particular APP in determining elbow ROM in comparison with the commonly used goniometer (GON), surgeon estimation of range (EST) and measurement on X-ray (XR).

Methods

The study included 20 patients (40 elbows). Flexion, extension, pronation and supination were measured using three different methods: EST, GON and APP. Radiographic measurements were taken using the average humeral diaphysis axis and dorsal midthird of ulna in flexion and extension.

Results

The accuracy of the three different methods has been compared to GON using statistical analysis (ANOVA and paired samples test). There was no statistically significant difference for XR flexion measurement (mean of 2.8° ± 1.5°). The APP overestimated flexion (mean of 6.4° ± 1.0°), and EST underestimated it (mean of − 7.9° ± 1.1°). For extension, the mean difference was 2.8° ± 0.7° for EST and − 26.8° ± 3.1° for XR. The APP method did not significantly differ from GON. Supination accuracy was greater with EST (2.7° ± 1.7°) than with APP (5.9° ± 1.9°). There was no difference for pronation measurement with both EST and APP.

Conclusions

This study is the first comparing four measurement techniques of elbow ROM. Our results showed that EST was only accurate for forearm rotation. The XR scored the best for flexion but is less reliable for extension. Surprisingly, compared to GON, APP did not correlate as we expected for flexion and supination, but the other methods were also inaccurate. We found APP to be very useful to measure complete arc of motion (difference between maximal flexion and maximal extension).

Level of Evidence

III, Retrospective review of a prospective cohort of elbow fracture patients: Diagnostic Study.

Keywords

Elbow range of motion Smartphone application Inclinometer Goniometer Accuracy X-ray measurement 

Notes

Compliance with ethical standards

Conflict of interest

Dominique M. Rouleau is a consultant for Bioventus, and Wright. The institution (HSCM) of one or more of the authors (DMR) has received funding from: Arthrex, Conmed, Depuy, Linvatec, Smith and Nephew, Stryker, Synthes, Tornier, Wright and Zimmer. Frédéric Vauclair has received funding from two nonprofit foundations (SICPA foundation and Swiss Orthopedics) for his orthopedic trauma fellowship at McGill University Health Centre. For all remaining authors, none declared.

References

  1. 1.
    Aurich M, Anders J, Trommer T, Liesaus E, Wagner A, Venbrocks R (2007) Autologous chondrocyte transplantation by the sandwich technique. A salvage procedure for osteochondritis dissecans of the knee. Unfallchirurg 110:176–179. doi: 10.1007/s00113-006-1174-6 CrossRefPubMedGoogle Scholar
  2. 2.
    Clar C, Cummins E, McIntyre L, Thomas S, Lamb J, Bain L, Jobanputra P, Waugh N (2005) Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation. Health Technol Assess 9(iii–iv, ix–x):1–82. doi: 10.3310/hta9470 Google Scholar
  3. 3.
    Armstrong AD, MacDermid JC, Chinchalkar S, Stevens RS, King GJ (1998) Reliability of range-of-motion measurement in the elbow and forearm. J Shoulder Elbow Surg 7:573–580CrossRefPubMedGoogle Scholar
  4. 4.
    Flowers KR, Stephens-Chisar J, LaStayo P, Galante BL (2001) Intrarater reliability of a new method and instrumentation for measuring passive supination and pronation: a preliminary study. J Hand Ther 14:30–35CrossRefPubMedGoogle Scholar
  5. 5.
    Rothstein JM, Miller PJ, Roettger RF (1983) Goniometric reliability in a clinical setting. Elbow and knee measurements. Phys Ther 63:1611–1615CrossRefPubMedGoogle Scholar
  6. 6.
    Chapleau J, Canet F, Petit Y, Laflamme GY, Rouleau DM (2011) Validity of goniometric elbow measurements: comparative study with a radiographic method. Clin Orthop Relat Res 469:3134–3140. doi: 10.1007/s11999-011-1986-8 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hafeez K, Kaim Khani GM, Jawaid M, Bux M (2014) Is smartphone a necessity or luxury among orthopedic specialty? J Pak Med Assoc 64:S27–S29PubMedGoogle Scholar
  8. 8.
    Ferriero G, Vercelli S, Sartorio F, Muñoz-Lasa S, Ilieva E, Brigatti E et al (2013) Reliability of a smartphone-based goniometer for knee joint goniometry. Int J Rehabil Res 36:146–151. doi: 10.1097/MRR.0b013e32835b8269 CrossRefPubMedGoogle Scholar
  9. 9.
    Jenny JY, Bureggah A, Diesinger Y (2016) Measurement of the knee flexion angle with smartphone applications: which technology is better? Knee Surg Sports Traumatol Arthrosc 24(9):2874–2877. doi: 10.1007/s00167-015-3537-4 CrossRefPubMedGoogle Scholar
  10. 10.
    Ockendon M, Gilbert RE (2012) Validation of a novel smartphone accelerometer-based knee goniometer. J Knee Surg 25:341–345. doi: 10.1055/s-0031-1299669 CrossRefPubMedGoogle Scholar
  11. 11.
    Wellmon RH, Gulick DT, Paterson ML, Gulick CN (2016) Validity and reliability of two goniometric mobile apps: device, application and examiner factors. J Sport Rehabil 24:1–25. doi: 10.1123/jsr.2015-0041 (Epub ahead of print) Google Scholar
  12. 12.
    Boone DC, Azen SP (1979) Normal range of motion of joints in male subjects. J Bone Joint Surg Am 61:756–759CrossRefPubMedGoogle Scholar
  13. 13.
    Gajdosik RL, Bohannon RW (1987) Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther 67:1867–1872CrossRefPubMedGoogle Scholar
  14. 14.
    Blinded for Review Pruposes Chapleau J, Balg F, Harvey EJ, Ménard J, Vauclair F, Laflamme GY, Hebert-Davies J, Rouleau DM (2016) Impact of olecranon fracture malunion: study on the importance of PUDA (Proximal Ulna Dorsal Angulation). Injury 30 pii: S0020-1383(16)30429-6. doi: 10.1016/j.injury.2016.08.029 (Epub ahead of print)
  15. 15.
    Milanese S, Gordon S, Buettner P, Flavell C, Ruston S, Coe D et al (2014) Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther 19:569–574. doi: 10.1016/j.math.2014.05.009 CrossRefPubMedGoogle Scholar
  16. 16.
    Fish DR, Wingate L (1985) Sources of goniometric error at the elbow. Phys Ther 65:1666–1670CrossRefPubMedGoogle Scholar
  17. 17.
    Gunal I, Kose N, Erdogan O, Gokturk E, Seber S (1996) Normal range of motion of the joints of the upper extremity in male subjects, with special reference to side. J Bone Joint Surg Am 78:1401–1404CrossRefPubMedGoogle Scholar
  18. 18.
    Meislin MA, Wagner ER, Shin AY (2016) A comparison of elbow range of motion measurements: smartphone-based digital photography versus goniometric measurements. J Hand Surg Am 41(4):510–515.e1. doi: 10.1016/j.jhsa.2016.01.006 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  • Frédéric Vauclair
    • 1
  • Abdulaziz Aljurayyan
    • 2
    • 4
  • Fahad H. Abduljabbar
    • 3
    • 4
  • Bardia Barimani
    • 4
    • 5
  • Patrick Goetti
    • 1
  • Fiona Houghton
    • 4
  • Edward J. Harvey
    • 4
  • Dominique M. Rouleau
    • 6
  1. 1.Department of Orthopedic and Trauma SurgeryLausanne University HospitalLausanneSwitzerland
  2. 2.Department of Orthopedic SurgeryKing Saud UniversityRiyadhSaudi Arabia
  3. 3.Department of Orthopedic SurgeryKing Abdulaziz UniversityJeddahSaudi Arabia
  4. 4.Department of Orthopedic SurgeryMcGill University Health CentreMontrealCanada
  5. 5.Faculty of MedicineImperial College LondonLondonUK
  6. 6.Department of Orthopedic SurgeryHôpital du Sacré-Cœur de MontréalMontrealCanada

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