Capsular and Non-capsular Patterns Flashcards
What is a capsular pattern?
A restriction in available ROM in a set pattern:
- Greatest lost of extension
- Equal loss of both side flexion and rotation
- Least loss of flexion
When does a capsular pattern occur?
- When joints become inflamed
- Trauma
- Infection
- Degeneration
Injuries that cause a capsular pattern:
- Osteoarthritis (OA)
- Spondylosis
- Stenosis
- Spondylolithesis
- Rheumatoid Arthritis (RA)
- Traumatic Arthritis (TA)
- Whiplash
- Ankylosing Spondylitis
Injuries classed as non-capsular conditions:
- Disc lesion
- Facet Joint syndrome
- Thoracic outlet syndrome
What is Osteoarthritis?
- Degenerative condition
- Commonly affects 50+ year olds
- Wear and tear to the joint
- May be primary or possibly secondary due to previous lesion (Whiplash)
Key clinical features of Osteoarthritis:
- Capsular Pattern
- Affects bilateral facet joints
- Pain is movement and posture dependant
- Central, unilateral or bilateral pain
- Occasional paraesthesia if severe
Treatment for Osteoarthritis:
- Warm area using electrotherapy
- Grade B Maitland Mobilisation
- Address any postural concerns
What is Rheumatoid Arthritis?
- Systematic auto-immune Disease
- Degenerating and possible joint disruption
- Often severe capsulitis
- May lead to joint laxity and deformity
Key clinical features of Rheumatoid Arthritis:
- Capsular pattern
- Often ages between 30-70
- Mainly complains of intermittent pain
- Other joints can be affected
- Large amount of joint degeneration
- May have loose ligaments
Treatment for Rheumatoid Arthritis:
- If not acute flare up refer to GP (Rheumatology opinion)
- Grade A Maitland’s then progress to Grade B
What is Traumatic Arthritis?
Typically occurs due to trauma:
- Whiplash
Key clinical features of Traumatic Arthritis:
- Capsular pattern
- Affects bilateral facet joints
- Pain is movement and posture dependant
- Pain may be severe enough to radiate
- Central, unilateral or bilateral pain
Treatment for Traumatic Arthritis:
- Grade A-B Maitland’s as pain allows
- Electrotherapy
- May require manipulation at later stage if it has underlying non-capsular pattern elements.
What is Ankylosing Spondylitis?
- Gradual fusing of Intervertebral joints
Key clinical features of Ankylosing Spondylitis:
- Capsular pattern
- Young men 20/30s
- Always insidious onset
- Severe morning stiffness
- Possible history of back pain
- May have had hip/shoulder stiffness first
- Chance of having problems with eyes (iritis factor and blood)
Treatment for Ankylosing Spondylitis:
- Regular exercise
- Grade B Mobilisations
What is a Herniated Disc and what are the Symptoms?
Nucleus Pulposus leaks through Annulus Fibrosus:
- Compressed Spinal Nerve
- 30 - 50 year olds
- Possible Past history of LBP
- Onset when bending, twisting, lifting
- L4-L5, L5-S1
- LBP + Leg pain
- Worse when flexion or sitting
- Relieved by standing or lying
- SLR, Valsalva
- Antalagic Gait
What is Ankylosing Spondylitis and what are the Symptoms?
Vertebrae fuses together
- 20-40 years old mostly males
- Insidious onset
- Diffused pain and stiffness >3months
- Possible radiation to buttocks and thighs
- > Stiffness in morning
- -Lordosis +Kyphosis
- Capsular Pattern
- 50% of cases other joints involved
How does a Disc Lesion occur?
- Initiated following fracture to vertebral end plate (in young)
- Fracture causes bleeding and change in material and integrity of Disc
- Changes mean Disc is unable to distribute loads evenly (more strain on annulus)
- Older conditions involve annulus more than nucleus
- Annulus becomes weak and unable to withstand pressure pressure and strain
Treatment for Disc Lesion:
- Address posture/muscle imbalance
- Mobilise for pain and stiffness as presented
- Manipulation or traction if articular signs are present
What is Facet Joint Syndrome and what are the Symptoms?
Trapped Synovial Fold
- Pain in extension, lateral Flexion and rotation (compression in joint)
- Positive Kemp Manoeuvre
- Lateral Sharp/catchy localised pain
- Possible deep dull radiation to buttocks and thighs
What is The difference between Spondylolytic Spondylolithesis and Non-spondylolytic Spondylolithesis?
Spondylolytic: - L5 - Adolescent Athletes - Causes by repetitive extension exercises Non-spondylolytic: - L4 - Older Population - Caused by Degenerative elongation
What is Spondylolisthesis and what are the Symptoms?
Forward Slippage of one Vertebrae:
- Visible/palpable step deformation
- Aggravated by extension and activity
- Relieved by rest
- Possible Nerve Entrapment
