Browse > Article
http://dx.doi.org/10.12674/ptk.2021.28.1.13

Clinical Application and Limitations of the Capsular Pattern  

Lim, Wootaek (Department of Physical Therapy, College of Health and Welfare, Woosong University)
Publication Information
Physical Therapy Korea / v.28, no.1, 2021 , pp. 13-17 More about this Journal
Abstract
A normal range of motion is essential for performing activities of daily living. The capsular pattern is the proportional motion restriction in range of motion during passive exercises due to tightness of the joint capsule. Although the capsular pattern is widely referred to in clinical practice, there is no scientific evidence to support the concept. In this review, the appropriateness of the capsular pattern for evaluation of joint pathology was assessed. In the Textbook of Orthopaedic Medicine written by Cyriax, the capsular pattern did not specify how much reduction in angular motion is considered motion restriction. As the definition proposed initially was unclear, different methods have been used in previous studies investigating capsular pattern. In addition, the capsular pattern described all the major joints of the human body, but only the hip joint, knee joint, and shoulder joint were studied in experimental studies. Sensitivity and specificity were reported in one study and were meaningful in specific pathologies (loss of extension to loss of flexion). There was no consensus on the reliability and validity. In summary, the capsular pattern suggested by Cyriax or Kaltenborn is not supported or applies only to certain conditions. Various components around a joint complement each other and provide stability to the joint. It is recommended that the therapist perform multiple assessments rather than rely on a single assessment when evaluating joints.
Keywords
Joint capsule; Joint range of motion; Soft tissue injury;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Khurana N, Sharma A, Kalra S. Comparison of Cyriax capsular stretch versus posterior glide in treating adhesive capsulitis of shoulder. Physiother Occup Ther J 2011;4(1):5-10.
2 Joseph MF. Clinical evaluation and rehabilitation prescription for knee motion loss. Phys Ther Sport 2012;13(2):57-66.   DOI
3 Kirby K, Showalter C, Cook C. Assessment of the importance of glenohumeral peripheral mechanics by practicing physiotherapists. Physiother Res Int 2007;12(3):136-46.   DOI
4 Ramey K, Fothergill L, Hadley D, Merryman A, Salazar D, Cook C. Variables associated with abandoning the manual therapy approach learned in physical therapy school. J Man Manip Ther 2006;14(2):108-17.   DOI
5 Cyriax JH. Text-book of orthopaedic medicine. Vol. 1. Diagnosis of soft tissue lesions. 3rd ed. London: Cassell; 1957;711.
6 Cyriax JH. Text-book of orthopaedic medicine. Vol. 1. Diagnosis of soft tissue lesions. 6th ed. London: Bailliere Tindall; 1975;768.
7 Cyriax JH. Text-book of orthopaedic medicine. Vol. 1. Diagnosis of soft tissue lesions. 8th ed. London: Bailliere Tindall; 1982;512.
8 Kaltenborn FM, Evjenth O, Kaltenborn TB, Morgan M, Vollowitz E. Manual mobilization of the joints: joint examination and basic treatment. Vol. 1. The extremities. 8th ed. Oslo: Orthopedic Physical Therapy Products; 2014;368.
9 Bijl D, Dekker J, van Baar ME, Oostendorp RA, Lemmens AM, Bijlsma JW, et al. Validity of Cyriax's concept capsular pattern for the diagnosis of osteoarthritis of hip and/or knee. Scand J Rheumatol 1998;27(5):347-51.   DOI
10 Hayes KW, Petersen C, Falconer J. An examination of Cyriax's passive motion tests with patients having osteoarthritis of the knee. Phys Ther 1994;74(8):697-707; discussion 707-9.   DOI
11 Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991;34(5):505-14.   DOI
12 Lim W. Influence of tibial rotation on EMG activities of medial and lateral hamstrings during maximal isometric knee flexion. Phys Ther Korea 2018;25(4):46-52.   DOI
13 Lim W. Appropriateness of tibial rotation for isolation of the medial and lateral hamstrings. Ann Appl Sport Sci 2020;8(S2):e907.
14 Oosterwijk AM, Nieuwenhuis MK, van der Schans CP, Mouton LJ. Shoulder and elbow range of motion for the performance of activities of daily living: a systematic review. Physiother Theory Pract 2018;34(7):505-28.   DOI
15 Mine T, Ihara K, Kawamura H, Kuriyama R, Date R. Gait parameters in women with bilateral osteoarthritis after unilateral versus sequential bilateral total knee arthroplasty. J Orthop Surg (Hong Kong) 2015;23(1):76-9.   DOI
16 Smith SL, Woodburn J, Steultjens MPM. Sex- and osteoarthritis-related differences in muscle co-activation during weightbearing tasks. Gait Posture 2020;79:117-25.   DOI
17 Abbate LM, Jeffreys AS, Coffman CJ, Schwartz TA, Arbeeva L, Callahan LF, et al. Demographic and clinical factors associated with nonsurgical osteoarthritis treatment among patients in outpatient clinics. Arthritis Care Res (Hoboken) 2018;70(8):1141-9.   DOI
18 Damen J, van Rijn RM, Emans PJ, Hilberdink WKHA, Wesseling J, Oei EHG, et al. Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort. Arthritis Res Ther 2019;21(1):4.   DOI
19 Petersen CM, Hayes KW. Construct validity of Cyriax's selective tension examination: association of end-feels with pain at the knee and shoulder. J Orthop Sports Phys Ther 2000;30(9):512-21; discussion 522-7.   DOI
20 Hayes KW, Petersen CM. Reliability of assessing end-feel and pain and resistance sequence in subjects with painful shoulders and knees. J Orthop Sports Phys Ther 2001;31(8):432-45.   DOI
21 Fritz JM, Delitto A, Erhard RE, Roman M. An examination of the selective tissue tension scheme, with evidence for the concept of a capsular pattern of the knee. Phys Ther 1998;78(10):1046-56; discussion 1057-61.   DOI
22 Chauhan V, Saxena S, Grover S. Effect of deep transverse friction massage and capsular stretching in idiopathic adhesive capsulitis. Indian J Physiother Occup Ther 2011;5(4):185-8.
23 Pellecchia GL, Paolino J, Connell J. Intertester reliability of the cyriax evaluation in assessing patients with shoulder pain. J Orthop Sports Phys Ther 1996;23(1):34-8.   DOI
24 Sandler RD, Dunkley L. Osteoarthritis and the inflammatory arthritides. Surgery (Oxford) 2018;36(1):21-6.   DOI
25 Trevethan R. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health 2017;5:307.   DOI
26 Watson R. Quantitative research. Nurs Stand 2015;29(31):44-8.   DOI
27 Greenwood MJ, Erhard RE, Jones DL. Differential diagnosis of the hip vs. lumbar spine: five case reports. J Orthop Sports Phys Ther 1998;27(4):308-15.   DOI
28 Creaby MW, Bennell KL, Hunt MA. Gait differs between unilateral and bilateral knee osteoarthritis. Arch Phys Med Rehabil 2012;93(5):822-7.   DOI
29 Klassbo M, Harms-Ringdahl K, Larsson G. Examination of passive ROM and capsular patterns in the hip. Physiother Res Int 2003;8(1):1-12.   DOI
30 Rundquist PJ, Ludewig PM. Patterns of motion loss in subjects with idiopathic loss of shoulder range of motion. Clin Biomech (Bristol, Avon) 2004;19(8):810-8.   DOI
31 McClelland JA, Feller JA, Menz HB, Webster KE. Patients with total knee arthroplasty do not use all of their available range of knee flexion during functional activities. Clin Biomech (Bristol, Avon) 2017;43:74-8.   DOI
32 Dabadghav R, Potdar A, Patil V, Sancheti P, Shyam A. Additional effect of neuromuscular electrical stimulation on knee extension lag, pain and knee range of motion in immediate postsurgical phase (0-2 weeks) in primary total knee arthroplasty patient. Ann Transl Med 2019;7(Suppl 7):S253.   DOI
33 Hirata K, Yamadera R, Akagi R. Associations between range of motion and tissue stiffness in young and older people. Med Sci Sports Exerc 2020;52(10):2179-88.   DOI
34 Oh D, Lim W, Lee N. Concurrent validity and intra-trial reliability of a Bluetooth-embedded inertial measurement unit for real-time joint range of motion. Int J Comput Sci Sport 2019;18(3):1-11.   DOI
35 Ombregt L. A system of orthopaedic medicine. 3rd ed. Edinburgh: Churchill Livingstone; 2013;844.
36 Hindle KB, Whitcomb TJ, Briggs WO, Hong J. Proprioceptive neuromuscular facilitation (PNF): its mechanisms and effects on range of motion and muscular function. J Hum Kinet 2012;31:105-13.   DOI
37 Metcalfe AJ, Andersson ML, Goodfellow R, Thorstensson CA. Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study. BMC Musculoskelet Disord 2012;13:153.   DOI