Orthopedic Testing (Joint End-Feel)

Question 1

What are the different types of joint end-feels?

Answer 1

Soft-tissue approximation
Bone-to-bone
Capsular
Tissue stretch
Empty
Muscle spasm
Springy block

Question 2

What joint end-feels are considered normal?

Answer 2

Soft-tissue approximation
Bone-to-bone
Tissue Stretch

Question 3

What joint end-feels are considered abnormal?

Answer 3

Muscle spasm
Capsular
Empty
Springy block

Question 4

Describe what muscle spasm at the beginning- vs end-range of a movement generally indicates

Answer 4

Start of ROM: Inflammation and/or acute case/injury

End or close to end of ROM: joint instability problem

Question 5

What differentiates tissue stretch from capsular feel?

Answer 5

Tissue stretch is considered normal, and has a consistent elastic + recoil feel to it, with normal ROM, as a result of joint-capsule (including capsular/instrinsic ligament) stretch
Capsular feel has a “thicker” feel to it with restricted ROM - it can be differentiated into hard capsular (restricted ROM via less elasticity at some premature point in the ROM, like pulling leather), which is seen in chronic conditions, and soft capsular (normal elastic feel at end of ROM, but noticeably and abnormally restricted ROM), which is seen in acute conditions (edama, synovities, etc.)

Question 6

What are capsular patterns?

Answer 6

Restrictions and/or pain due to generalized joint reaction (muscle spasm, generalized osteophyte formation, capsulitis, and capsular contraction being most common, etc.) with a particular pattern of restriction dependent on the joint (e.g. glenohumeral showing most in external rotation -> abduction -> medial rotation)

Question 7

What joints can exhibit capsular patterns? Give examples of joints that cannot.

Answer 7

Joints that are acted upon by muscles - sacroiliac and distal tibiofibular joints being examples of not being able to show capsular patterns

Question 8

What are non-capsular patterns?

Answer 8

Restrictions and/or pain that discriminate in direction of movement (e.g. restriction of glenohumeral abduction only due to subacromial bursitis, but not external rotation, etc.), and do not show generalized capsular restriction by showing the typical capsular pattern