Elbow Range of Motion

Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board

Elbow range of motion (ROM) often becomes restricted following an injury.

This can impact day to day activities, and left untreated, may get progressively worse.

When we talk about elbow range of motion, we are looking at the amount of movement there is at the elbow joint.

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).

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. So having good flexibility and mobility is the elbow is really important.

What Is Elbow Range Of Motion?

There are three different types of elbow range of motion:

Active Elbow ROM: how far the elbow can move in one direction on its own i.e. movement it caused by muscle contraction without any external help
Passive Elbow ROM: how far the elbow can move in one direction when moved by an external force i.e. someone else moves the elbow while the muscles are completely relaxed
Active Assisted Elbow ROM: how far the elbow can move in one direction when it is weak or in pain with some assistance i.e. the muscles are partially contracting to move the elbow but with some help e.g. from a physical therapist

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.

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. If you want help working out what is wrong visit the elbow pain diagnosis section.

What Is Normal Elbow Range Of Motion?

Normal Elbow Range Of Motion: Flexion, Extension, Pronation & Supination

Normal elbow range of motion refers to how much the elbow bends, straightens and twists.

The twisting movements actually occur between the forearm bones, radius and ulna, but are usually considered to be part of elbow motion.

Normal active elbow range of motion is:

Flexion ROM: normal active elbow flexion range of motion is 140^o-150^o i.e. fully bent
Extension ROM: normal active elbow extension range of motion is 0^o i.e. fully straight
Pronation ROM: normal active pronation range of motion is 75^o-85^o i.e. palm facing down
Supination ROM: normal active supination range of motion is 80^o-90^o i.e. palm facing up

Normal passive elbow ROM is:

Passive Elbow Flexion: up to 155^o, depending on the size of the upper arm – the limit is the forearm pushing onto the biceps muscles
Passive Elbow Extension: up to 10^o hyperextension is considered normal
Passive Pronation: up to 90^o
Passive Supination: up to 95^o

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.

Functional range of motion at the elbow is 30-130 degrees of flexion.

At the elbow joint, most functional activities require around 100 degrees of flexion/extension and rotation:

Elbow Flexion/Extension: 30-130^oi.e. from 30^o off extension to 130^oflexion
Pronation/Supination: 50^o-50^o i.e. 50^o pronation and 50^o supination from neutral

This means you can still perform most daily activities even if you have lost 20^o-30^o of motion in any direction.

Normal elbow range of motion required for common activities of daily living are:

Elbow range of movement required for various activities of daily living

Losing end range flexion has more of a functional impact than losing end range extension in the elbow.

Having a range of 30^o-130^o 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.

This means that every degree of flexion lost is roughly equivalent to 2 degrees further extension loss in terms of functional impact.

Anything that interferes with normal elbow movement can cause pain. There may be:

Medial Elbow Pain: pain on the inner side of the elbow
Lateral Elbow Pain: pain on the outer side of the elbow
Posterior Elbow Pain: pain at the back of the elbow
Forearm Pain: pain in the forearm region

How To Measure Elbow ROM

Using a goniometer is the most accurate way to measure elbow range of motion in all directions. A goniometer is a simple device that measures angles – it looks like a circular protractor with two arms!

In the middle of the goniometer is a circle which shows a full 360^o arc. Out of this comes two arms, a stationary arm that extends out of the circle and a moveable arm.

When using a goniometer to measure elbow motion, it is much easier to get someone else to do the measuring for you – it’s hard to try and line everything up and get an accurate yourself.

How To Measure Flexion/Extension

When measuring elbow flexion and extension range of motion, you must first identify three landmarks on the arm

Elbow - Lateral Epicondyle: bony lump on the outer side of the elbow
Shoulder – Acromion Process: bony lump on the outer side of the shoulder
Wrist - Radial Styloid: bony lump on the outer side of the wrist

To find the acromion, place one hand on top of your opposite shoulder. Walk your fingers out to the edge of your shoulder across a flat ledge. When you reach a dip, you have reached the edge of the acromion process and dropped down onto the humeral head. Butt your fingers in and up against the edge of the acromion, feel along the edge from front to back and find the mid-point. Line the stationary arm of the goniometer up to that point.

The lateral epicondyle is the slightly lower of the two lumps on the outer side of the elbow. It sits just below the joint line (the small dip between the upper arm bone and forearm bone). Line the centre of the goniometer circle up with this point.

The radial styloid is the bony lump on the outer side of your wrist directly below the base of the thumb. Line the moveable arm of the goniometer up with that point.

Either lie down on your back with a pillow or rolled up towel underneath your upper arm (making sure the elbow hangs freely), or sit with the arm down by your side, elbow against your waist.
Place the axis of the goniometer over the lateral epicondyle
Line the stationary arm of the goniometer with the middle of the acromion process
Line the moveable arm of the goniometer up with the radial styloid

Measuring Elbow Flexion

How To Measure Elbow Flexion Range Of Motion

To measure active elbow flexion, bend the elbow as far as you can with your palm facing up, without moving the upper arm
To measure passive range have someone gently push through the back of your forearm near your wrist to see if there is any extra movement

The normal end feel of elbow flexion range of motion is soft and springy as the movement is limited by your biceps muscles.

Measuring Elbow Extension

How To Measure Elbow Extension Range Of Motion

To measure active elbow extension, bring the arm down straight and the forearm back as far as you can, keeping the upper arm in line with your body
To measure passive range of motion support the back of the upper arm and gently push back through the front of the forearm

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.

Hyperextension injuries occur when the elbow is forced backwards and bends back to far - you can find out all about the common causes, symptoms, diagnosis and treatment in the hyperextended elbow section.

How To Measure Pronation / Supination

To measure pronation and supination range of motion you are going to be lining the goniometer up with the:

Ulna Styloid: the bony lump just below the inner side of the wrist (little finger side)
Humerus: the upper arm bone
Distal Radius: the forearm bone

Measuring Supination

How To Measure Supination Range Of Motion

Sit or stand with your elbow bent 90 degrees, and turn your palm up
Line the axis of the goniometer up just below the ulna styloid as shown and have the stationary arm parallel to the humerus (upper arm bone)
Bring the moveable arm of the goniometer down so it rests across the front of the forearm, just below the wrist
To measure active range of motion, bring your wrist and thumb back as far as you can to get full rotation and measure the angle.

From here you can measure passive supination by grasping the back of the forearm and gently twisting it as far round as possible.

The normal end feel of supination range of motion is firm / elastic as movement is limited by tension in the ligaments

Measuring Pronation

This is very similar to measuring supination, but this time you turn the palm down and measure from the other side of your wrist.

How To Measure Pronation Range Of Motion

Sit or stand with your elbow bent 90 and turn your palm to face down
Line the axis of the goniometer up just below the ulna styloid on the outer side of the wrist as shown and have the stationary arm parallel to the humerus
Rest the moveable arm of the goniometer across the back of the forearm, just below the wrist
To measure active pronation range of motion, twist your palm and thumb down as far as you can to get full rotation.

From here you can measure passive pronation by grasping the back of the forearm just below the wrist and gently twist it as far round as possible.

As with supination, the normal end feel of pronation is firm/elastic as movement is limited by ligament tension.

How To Measure Elbow ROM Without A Goniometer

If you don’t have a goniometer, you can still assess your elbow range of motion. This can help you to identify and areas of stiffness or limitation and allow you to see what progress you are making with rehab. It’s not as accurate as using a goniometer but it can still give useful feedback.