The Capsule of the Shoulder Joint

Joint Capsular Patterns

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.

What is a capsular pattern?

A capsular pattern is the reproducible limitation of joint movements when the joint capsule is the limiting structure.

What is a non-capsular pattern?

A non-capsular pattern is a pattern of limitation of joint movement that is not the result of the joint capsule.

The chart on this page presents those patterns and was adapted from Magee, DJ: Orthopedic Physical Assessment, 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

Paper: Validity of Cyriax’s Concept Capsular Pattern for the Diagnosis of Osteoarthritis of Hip and/or Knee

You may also be interested in: Tissue Healing Times/Phases

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