capsular patterns

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Capsular patterns at different joints:

A) Joints spanned by muscles:
1. TM joint: increasing limitation of opening the mouth.
2. Shoulder joint: limitation in the following order from maximum to minimum, lateral rotation (most limited)- abduction- medial rotation (least limited).
3. Elbow joint: flexion more limited than extension. Rotations free and painless. For each 90-degree limitation of flexion there is 10-degree limitation of extension.
4. DRU joint: full range of motion with pain only at the limits of motion.
5. Wrist joint: equal degree of limitation of flexion and extension.
6. Trapezium-first-metacarpal joint (1st CM joint): more limitation of abduction than extension, flexion is full.
7. 2nd to 5th CM joint: limited motion in all directions.
8. IP joints of all the fingers: more limitation of flexion than extension.
9. Hip joint: limitation in the following order from maximum to minimum,
Medial rotation and flexion (most)- abduction- adduction and lateral rotation (little or no)- by Dr. cyriax
Medial rotation-extension-abduction-lateral rotation- by Kaltenborn.
10. Knee joint: extension is more limited than flexion. For each 3-degree limitation of flexion there is 50-degree limitation of extension.
11. Tibiofibular joint: a) Upper- pain on contraction of biceps femoris.
b) Lower- pain when the mortice is sprung.
12. Ankle joint: more limitation of plantiflexion than dorsiflexion.
13. Talocalcanial/Subtalar joint: limitation of varus (supination) till the joint fixes in valgus (pronation).
14. Mid-tarsal joint: limitation in the following order from maximum to minimum,
Dorsiflexion- plantiflexion-adduction-medial rotation (inversion). Abduction and lateral rotation (eversion) are full.
15. 1st MTP joint: more limitation of extension than flexion. For 10 to 20-degree limitation of flexion there are 60 to 80-degree limitation of extension.
16. 2nd to 5th MTP joint: tend to fix in extension, its obvious that there is more limitation of flexion.
17. IP joints of all the toes: tends to fix in flexion, its obvious that there is more limitation of extension.

B) Joints not spanned by muscles:
1. SC/AC joints: pain at the extreme range.
2. Sacroiliac, symphysis pubis & sacrococcygeal joint: pain when stress falls on the joint.


C) Joints of the spinal column:
1. Cervical joints: side flexion and rotation are equally limited towards both the sides. Extension is limited but flexion is full.
2. Thoracic joints: limitation in the following order from maximum to minimum,
Extension- side flexions & rotations (equal to both sides)- flexion.
3. Lumbar joints: limitation in the following order from maximum to minimum, equal limitation of side flexions-flexion-extension.

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