How to assess ROM in nursing? Your expert guide

October 2, 2025 •

3 min read

Proper range of motion (ROM) assessment is a cornerstone of patient care, with data showing its crucial role in establishing baseline functionality and detecting early changes in mobility.

Understanding how to assess ROM in nursing is a fundamental skill that enables nurses to proactively monitor patient progress and intervene when necessary.

Quick Summary

Assessing a patient's range of motion involves systematic observation and manipulation of joints to identify limitations, pain, or functional decline, which is essential for developing effective care plans and monitoring rehabilitation.

Key Points

Systematic approach: Always follow a consistent, systematic method to assess joints bilaterally, from head to toe, ensuring no area is overlooked [1].
Active and Passive ROM: Differentiate between Active ROM (patient moves) and Passive ROM (nurse moves) to assess both muscle strength and joint integrity [3].
Observe and Palpate: Use both visual observation for symmetry, posture, and gait, and gentle palpation for warmth, swelling, and crepitus around the joints [1].
Prioritize Safety: Never force a joint past the point of pain or resistance; support the limb and maintain proper body mechanics throughout the assessment [1].
Detailed Documentation: Meticulous documentation of specific joint movements, range in degrees, presence of pain, and other observations is essential for tracking progress [1].
End-Feel Assessment: For passive ROM, assess the 'end-feel'—the quality of resistance at the end of the motion—to gain insight into the cause of a limitation [1].

Fundamentals of ROM Assessment

Range of motion (ROM) is the measurement of movement around a specific joint or body part [2]. It is a vital component of the musculoskeletal assessment, providing insight into joint health, muscle strength, and a patient's functional capacity [1]. Nurses perform ROM assessments to establish a baseline, monitor changes, identify potential issues, and enhance patient safety [1].

Preparing for the Assessment

Thorough preparation is essential for an accurate and safe ROM assessment. Steps include performing hand hygiene and wearing appropriate PPE, ensuring patient privacy, introducing yourself and explaining the procedure, confirming patient identity using two identifiers, gathering any necessary equipment like a goniometer for precise measurements, and positioning the patient comfortably and safely [1].

Step-by-Step Assessment Procedure

A systematic, head-to-toe approach ensures a thorough assessment. Always compare bilaterally, observing for symmetry, and note any differences. Gently palpate bones, joints, and muscles for heat, swelling, tenderness, or crepitation [1].

Upper Extremities

Assess the neck, shoulders, elbows, wrists, and fingers. For each joint, guide or ask the patient to perform specific movements such as flexion, extension, abduction, adduction, rotation, supination, and pronation [1].

Lower Extremities

Assess the hips, knees, ankles, feet, and toes. This includes movements like hip and knee flexion, hip abduction and adduction, hip rotation, ankle dorsiflexion and plantar flexion, and ankle inversion and eversion [1].

Spine

Observe the spine for normal curvatures like kyphosis, lordosis, or scoliosis. Assess spinal ROM by asking the patient to bend forward (flexion), backward (extension), and sideways (lateral bending) [1].

Types of ROM Assessment

There are three primary types of ROM assessment [3]:

Active Range of Motion (AROM): The patient moves the joint independently, assessing joint mobility and muscle strength [3].
Passive Range of Motion (PROM): The nurse moves the patient's joint while the patient relaxes, used when a patient has limited voluntary movement [3]. PROM assesses joint integrity and flexibility without muscle strength [3].
Active-Assistive Range of Motion (AAROM): The patient moves the joint with some assistance from the nurse, suitable for patients who can initiate movement but need help to complete it [3].

Active vs. Passive ROM: A Comparison


Feature	Active Range of Motion (AROM)	Passive Range of Motion (PROM)
Patient Involvement	Independent movement by the patient. [3]	Movement performed by the nurse while the patient relaxes. [3]
Assesses	Joint movement and muscle strength. [3]	Joint mobility, flexibility, and end-feel. [3]
Indications	Patients who can move voluntarily, to establish baseline function. [3]	Patients with paralysis, muscle weakness, or post-surgery, to maintain joint health. [3]
Feedback	Patient can provide direct feedback on pain or discomfort during movement. [1]	Nurse feels tissue resistance at the end of the range, known as 'end-feel'. [1]

Safety Considerations and Best Practices

Patient safety is paramount. Never force a joint past the point of pain or resistance [1]. Support the limb above and below the joint being assessed [1]. Maintain proper body mechanics [1]. Communicate effectively with the patient [1]. Accurate and consistent documentation is crucial, including the type of ROM assessed, the joint, the range achieved (e.g., in degrees), and any related observations [1]. Physiopedia provides detailed guides on ROM assessment techniques [2].

Documenting ROM Findings

Accurate and detailed documentation is essential. Include the date, time, patient position, the joint and movement assessed, the type of ROM (AROM, PROM, or AAROM), the findings (range, limitations, pain, crepitus), and any patient-reported symptoms [1]. Examples:

"AROM in all upper and lower extremity joints was full and symmetric. Patient denies pain or stiffness. Muscle strength 5/5 bilaterally." [1]
"Right shoulder PROM limited to 90 degrees of flexion with reported pain. Swelling noted over joint. Active range of motion significantly decreased." [1]

Interpreting Assessment Findings

Interpreting findings is crucial for effective care. Limited ROM may indicate injury, inflammation, joint disease, or contractures [1]. Hypermobility can suggest joint instability or ligament laxity [1]. Crepitus can point to rough cartilage, inflammation, or fracture [1]. Painful movement is a key indicator of inflammation or injury [1]. Asymmetry between sides can suggest a localized problem [1].

Conclusion

Mastering ROM assessment is a core nursing skill. By systematically and safely evaluating joint mobility, nurses establish baselines, monitor changes, and provide high-quality care. Comprehensive assessment and meticulous documentation are vital for understanding a patient's physical status, guiding interventions, and promoting recovery [1].

Frequently Asked Questions

The primary purpose is to establish a baseline of a patient's functional mobility, monitor for changes over time, and identify any limitations, pain, or other issues related to joint and muscle function [1].

Active ROM is when the patient moves their own joint independently, assessing muscle strength and coordination [3]. Passive ROM is when the nurse moves the joint for the patient, assessing joint flexibility and the quality of the end-feel [3].

Often, no specific equipment is needed, as visual estimation and palpation are used [1]. For more precise measurements, a goniometer is used to measure joint angles, though this is more common in physical therapy [1].

Documentation should be clear and concise, including the date, joint assessed, type of ROM performed (AROM/PROM), the range of motion achieved, any patient-reported pain, and any physical observations like swelling or crepitus [1].

Always move slowly and gently, stop if the patient reports pain, support the joint above and below the area being assessed, and use proper body mechanics to protect yourself from injury [1].

Crepitus is a grating or crackling sound or sensation heard or felt during joint movement [1]. It can indicate rough articular cartilage, joint inflammation, or a fracture, and should be noted during the assessment [1].

Passive ROM is used for patients who are unable to voluntarily move their joints due to conditions like paralysis, muscle weakness, or post-surgical recovery [3]. It helps maintain joint mobility and prevent contractures [3].