Goniometric Measurement of Burn Scar Contracture: A Paradigm Shift Challenging the Standard

Abstract

Standard goniometry is the most commonly used method of assessing the range of motion (ROM) in patients with burn scar contracture. However, standard goniometry was founded on arthrokinematic principles and doesn’t consider the cutaneous biomechanical influence between adjacent joint positions and skin pliability to accommodate motion. Therefore, the use of standard goniometry to measure burn scar contracture is called into question. This prospective, multicenter, comparative study investigated the difference between standard goniometry, based on arthrokinematics and a revised goniometry protocol, based on principles of cutaneokinematics and functional positions to measure ROM outcome in burn survivors. Data were collected for 174 joints from 66 subjects at seven burn centers totaling 1044 measurements for comparison. ROM findings using the revised protocol demonstrated significantly more limitation in motion 38.8 ± 15.2% than the standard protocol 32.1 ± 13.4% (p < .0001). Individual analyses of the motions likewise showed significantly more limitation with revised goniometry compared with standard goniometry for 9/11 joint motions. Pearson’s correlation showed a significant positive correlation between the percentage of cutaneous functional units scarred and ROM outcome for the revised protocol (R2 = .05, p = .0008) and the Δ between the revised and standard protocols (R2 = .04, p = .0025) but no correlation was found with the standard goniometric protocol (R2 = .015, p = .065). The results of this study support the hypothesis that standard goniometry underestimates the ROM impairment for individuals whose motion is limited by burn scars. Having measurement methods that consider the unique characteristics of skin impairment and the impact on functional positions is an important priority for both clinical reporting and future research in burn rehabilitation.

The degree of joint range of motion limitations after burn injuries during recovery

“…However, with today's wisdom concerning the cutaneokinimatic (CKM) influence of adjacent cutaneous functional units (CFU's) [36,37] and the position of adjacent joints on the ROM, future studies evaluating ROM limitations after burn injuries should definitely consider the concept of the revised goniometric protocol of Parry et al [38].…”

3D Mesh Releasing Method: A Retrospective Analysis of Fractional CO2 Treatment on Contracture Scars

“…A photograph‐based measurement of ROM tended to have error if the following details were not noticed: (i) the consistency of the placement of the involved limb. It has been reported that position of the limb and way of flexion would cause difference in the measurement of ROM, especially in burn patients due to the lack of compliance in the skin [44,45]. (ii) The relative position of the camera to the joint in question, a measurement error could occur if the camera was not perpendicular to the joint studied.…”

The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries

“…In accordance with earlier studies, our study showed that ROM using lateral goniometry is a feasible outcome measure to evaluate burn scar contractures. 31 , 32 , 44 , 45 However, we developed a new strategy to assess the effectiveness of contracture release surgery. The change in ROM was analyzed on 3 levels: planes of motion, joints, and patient level.…”

“…However, Parry et al recently questioned this method in burn survivors. 31 , 44 Standard goniometry does not take into account the influence of adjacent joint positions and pliability of the skin when measuring motions. Future studies should consider using the method proposed by Parry et al 44 …”