Capsular Patterns, ROM, Goniometry, and End Feel

Question 1

Cervical Capsular Pattern

Answer 1

Recognizable pain

Equal limitation of all motions except flexion which is minimally restricted

Question 2

Thoracic Spine Capsular Pattern

Answer 2

Greater limitation of extension, lateral flexion, and rotation than of forward flexion

Question 3

Lumbar Spine Capsular Pattern

Answer 3

Equal restriction of lateral flexion followed by restriction of flexion and extension

Question 4

Atlanto-Occipital Capsular Pattern

Answer 4

Restriction of extension and lateral flexion

Question 5

Thoracolumbar Flexion (tape measure)

Answer 5

Position:
- Feet shoulder width
- Bend forward with knees straight
- Stabilize pelvis to prevent anterior tilt

Tape Measure:
- Tape measure on T1 and S2 vertebrae
- difference before and after is the distance of flexion

Alternative:
- Same position, measure fingertip to floor
- This allows anterior pelvic tilt

Capsular End Feel:
- Firm

Normal ROM:
- 80 degrees +- 5 deg

Question 6

Thoracolumbar Extension (tape measure)

Answer 6

Position:
- Feet shoulder width
- Bend forward with knees straight
- Stabilize pelvis to prevent posterior tilt
- End when pelvis tilts

Tape Measure:
- Tape measure on T1 and S2 vertebrae
- difference before and after is the distance of extension

Prone Pushup:
- Lie on stomach, strap over pelvis
- Press up and measure from surface to sternal notch

Capsular End Feel:
- Firm or Hard

Normal ROM:
- 25 degrees +- 5 deg

Question 7

Thoracolumbar Lateral Flexion (tape measure and goniometer)

Answer 7

Position:
- Stabilize pelvis to prevent lateral tilt
- Stand shoulder width apart
- test is over once heel rises

Goniometer:
- Fulcrum over S2
- Stationary arm perpendicular to floor
- Mobile arm in line with T1
- Remove goniometer and measure when at end range

Tape measure:
- Side bend with feet flat and knees extended
- Mark on leg where tip of middle finger is
- Measure from floor to the tip of the middle finger

Capsular End Feel
- Firm

Normal ROM
- 35 degrees +- 5 degrees

Question 8

Lumbar Flexion (Modified-Modified Schober Test)

Answer 8

Position:
- Standing with feet shoulder width apart

Tape Measure:
- Mark midline of pt’s sacrum that is level with PSIS, this is S2
- 15cm up second mark
- bend forward with straight knees
- ROM = Flexion distance - 15cm

Capsular End Feel
- Firm

Normal ROM
- 80 degrees +- 5 degrees

Question 9

Lumbar Extension (Modified-Modified Schober Test)

Answer 9

Position:
- Standing with feet shoulder width apart

Tape Measure:
- Mark midline of pt’s sacrum that is level with PSIS, this is S2
- 15cm up second mark
- extend back with straight knees
- ROM = extension distance - 15cm

Capsular End Feel
- Firm or Hard

Normal ROM:
- 25 deg +- 5 deg

Question 10

Thoracolumbar Rotation

Answer 10

Position:
- Seated, feet flat.
- Stabilize the pelvis to prevent it from rotating.
- Patient turns to one side as far as possible
- If the pelvis rotates the test is over

Goniometer:
- Fulcrum over the center of cranial aspect
- Stationary arm in line with prominent tubercles on iliac crest
- Mobile arm in line with AC joint

Capsular End Feel
- Firm

Normal ROM:
- 45 deg +- 5 deg