Validity of Goniometric Elbow Measurements: Comparative Study with a Radiographic Method

A universal goniometer is commonly used to measure the elbow's ROM and carrying angle; however, some authors question its poor intertester reliability. We (1) assessed the validity of goniometric measurements as compared with radiographic measurements in the evaluation of ROM of the elbow and (2) determined the reliability of both. The ROM and carrying angle of 51 healthy subjects (102 elbows) were measured using two methods: with a universal goniometer by one observer three times and on radiographs by two independent examiners. Paired t-test and Pearson's correlation were used to compare and detect the relationship between mean ROM. The maximal error was calculated according to the Bland and Altman method. The intraclass correlation coefficients (ICC) ranged from 0.945 to 0.973 for the goniometric measurements and from 0.980 to 0.991 for the radiographic measurements. The two methods correlated when measuring the total ROM in flexion and extension. The maximal errors of the goniometric measurement were 10.3A degrees for extension, 7.0A degrees for flexion, and 6.5A degrees for carrying angle 95% of the time. We observed differences for maximum flexion, maximal extension, and carrying angle between the methods. Both measurement methods differ but they correlate. When measured with a goniometer, the elbow ROM shows a maximal error of approximately 10A degrees. The goniometer is a reasonable and simple clinical tool, but for research protocols, we suggest using the radiographic method because of the higher level of precision required.