Physical therapy students learning orthopedic assessment should be familiar with the concept of capsular patterns of the joints to effectively differentially diagnose joint pain and dysfunction. Dr. James Cyriax was the first to extensively study soft tissue lesions. When inflammation of a joint is present (known as synovitis or capsulitis), not only does passive stretching of the capsule cause pain but a limitation of range of motion of the involved joint is always found to be in a specific pattern; this pattern is always similar for that particular joint, although each joint has a different and instantly recognizable capsular pattern.

The chart on this page presents those patterns and was adapted from Magee, DJ: “Musculoskeletal Conditions”, University of Alberta, 1993.

Joint	Capsular Pattern
Temporomandibular	Opening
Occipitoatlanto	Extension & side flexion equally limited
Cervical Spine	Side flexion & rotations equally limited, extension
Glenohumeral	Lateral rotation, abduction, medial rotation
Sternoclavicular	Pain at extreme range of movement
Acromioclavicular	Pain at extreme range of movement
Humeroulnar	Flexion, extension
Radiohumeral	Flexion, extension, supination, pronation
Proximal Radioulnar	Supination, pronation
Distal Radioulnar	Pain at extremes of rotation
Wrist	Flexion & extension equally limited
Trapeziometacarpal	Abduction, extension
MCP and IP	Flexion, extension
Thoracic Spine	Side flexion & rotation equally limited, extension
Lumbar Spine	Side flexion & rotation equally limited, extension
SI, Symphysis Pubis, & Sacrococcygeal	Pain when joints stressed
Hip	Flexion, Abduction, medial rotation (order varies)
Knee	Flexion, extension
Tibiofibular	Pain when joint stressed
Talocrural	Plantar flexion, dorsiflexion
Subtalar (Talocalcaneal)	Limitation of varus range of movement
Midtarsal	Dorsiflexion, plantar flexion, adduction, medial rotation
First MTP	Extension, flexion
Second to Fifth MTP	Variable
IP	Flexion, extension

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