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.

JointCapsular Pattern
TemporomandibularOpening
OccipitoatlantoExtension & side flexion equally limited
Cervical SpineSide flexion & rotations equally limited,
extension
GlenohumeralLateral rotation, abduction, medial rotation
SternoclavicularPain at extreme range of movement
AcromioclavicularPain at extreme range of movement
HumeroulnarFlexion, extension
RadiohumeralFlexion, extension, supination, pronation
Proximal RadioulnarSupination, pronation
Distal RadioulnarPain at extremes of rotation
WristFlexion & extension equally limited
TrapeziometacarpalAbduction, extension
MCP and IPFlexion, extension
Thoracic SpineSide flexion & rotation equally limited,
extension
Lumbar SpineSide flexion & rotation equally limited,
extension
SI, Symphysis Pubis, & SacrococcygealPain when joints stressed
HipFlexion, Abduction, medial rotation (order varies)
KneeFlexion, extension
TibiofibularPain when joint stressed
TalocruralPlantar flexion, dorsiflexion
Subtalar (Talocalcaneal)Limitation of varus range of movement
MidtarsalDorsiflexion, plantar flexion, adduction, medial
rotation
First MTPExtension, flexion
Second to Fifth MTPVariable
IP (Interphalangeal)Flexion, extension

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

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