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 (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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Patterns adapted from:
Orthopedic Physical Assessment
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Thank you for the article..it help every physiotherapy students…