Joint Capsular Patterns - Chart
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.
The chart on this page presents those patterns and was
adapted from Magee, DJ: "Musculoskeletal Conditions",
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 |
