What is a capsular pattern?
What is a capsular pattern?
The capsular pattern is a combination of pain and/or limitation, which points in the direction of a joint problem.
Each joint, under muscular control, has a specific capsular pattern. Example :
- Capsular pattern in the shoulder is a limitation of certain passive movements : lateral rotation > elevation > medial rotation.
- Capsular pattern of the elbow : flexion is more limited than extension.
When a capsular pattern has been found on examination, then this had very clear clinical implications :
- or the patient suffers from osteoarthrosis or
from some sort of arthritis.
The arthritis might be minor or severe, the limitation therefore could be slight or considerable ; the proportions, however, remain always the same.
If the end feel on passive movement is harder, we first think of osteoarthrosis.
When we find a muscle spasm end feel, we think of an arthritis i.e. an active inflammatory lesion.
The various capsular patterns
Keep in mind that the discovery of the different capsular patterns was mainly the result of trial an error. More recent scientific evolutions will confirm some patterns, but will also adapt or even reject some patterns.
- Jaw: Increasing limitation of mouth opening.
- Cervical spine: Equal limitation of extension, both side flexions and both rotations. Flexion is the best movement.
- Shoulder: Limitation of abduction, more limitation of lateral rotation, less limitation of medial rotation.
- Elbow: Limitation of extension, more limitation of flexion.
- Lower radio-ulnar joint: Pain on passive pro- and supination, no limitation.
- Wrist: Equal limitation of flexion and extension.
- Trapezio-first metacarpal joint: Limitation of abduction and extension, no limitation of flexion.
- Thumb and finger joints: Flexion more limited than extension.
- Thoracic spine: Equal limitation of both rotations.
- Lumbar spine: Equal limitation of extension and both side flexions.
- Hip: Gross limitation of medial rotation and abduction ; flexion more limited than extension. Controversy : in case of minor arthrosis sometimes there is just a limitation of flexion and medial rotation.
- Knee: Limitation of extension, more limitation of flexion. Controversy : if the patient has a minor arthrosis, then it is possible that we don’t find the capsular pattern, but we only find a slight limitation of flexion. If the patient suffers from an acute arthritis, then we certainly will find the capsular pattern as described above.
- Ankle joint: Limitation of dorsiflexion, more limitation of plantiflexion.
- Talocalcanean joint: Increasing limitation of varus, in the end fixation in full valgus.
- Midtarsal joints: Limitation of dorsiflexion, plantiflexion, adduction and medial rotation ; no limitation of abduction and lateral rotation.
- First metatarsophalangeal joint: Limitation of plantiflexion with more limitation of dorsiflexion.
- II-V metatarsophalangeal joints: Variable. Fixation in extension with flexed IP joints.