Capsular and Non-Capsular Patterns

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Description

That was James Cyriax who along with other authors developed the idea of the scanning examination. That was the origin of the concepts of “contractile” and “inert” tissue, “end feel,” and “capsular patterns” and this contributed greatly to development of a comprehensive and systematic physical examination of the moving parts of the body.

Broadly speaking, there are two patterns of range of motion used in the interpretation of joint motion:

~ A capsular pattern of restriction is a limitation of pain and movement in a joint specific ratio, which is usually present with arthritis, or following prolonged immobilization.

~ A noncapsular pattern of restriction is a limitation in a joint in any pattern other than a capsular one, and may indicate the presence of either a derangement, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion.

Mechanism of Injury / Pathological Process

How to examine Capsular Pattern? With passive movement, a full ROM must be carried out in all possible directions. A midrange movement will not elicit potential findings. While evaluating the end feel, the examiner must look at the pattern of limitation or restriction.

According to Dutton, capsular patterns are based on clinical findings rather than research; perhaps that's why the capsular patterns may be different or inconsistent.

There will be a presence of a typical pattern in the joint, if the capsule of the joint is affected. This pattern could be a resultant of joint reaction with muscle spasm that leads to capsular constriction. There could be osteophyte formation too as a possible factor for restriction. Each joint has a characteristic pattern of limitation. Capsular pattern cannot judge the endfeel. Only the joints controlled by muscles exhibit capsular pattern. E.g. The distal tibiofibular joint and the sacroiliac joint does not have any capsular pattern. A study done by Hayes et al explained the usefulness of pattern of limitation, but they also pointed that the proportion of limitation should not be used.

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