I was reviewing a chart the other day and saw the phrase ‘capsular pattern.’ Most joints in the body have a capsular pattern. Here’s what that means……Most joints in your body are surrounded by what’s called a capsule. The capsule is a thin, fibrous sac that surrounds the joint and has a bunch of fluid in it that helps lubricate the joint and decreases friction. The capsule also has a bunch of nerves and stuff that help with sensation and proprioception. When you lose motion in a joint, there are certain patterns of motion loss to look for that will tell your super, duper, incredibly smart therapist if it’s a problem with the joint itself or if something more sinister is going on. Like, perhaps, a stroke???? No, just kidding. I mean it could still be a problem with the joint and not have a capsular pattern but anyway, if you go to a health care provider and they mistake a stroke for a joint problem or vice versa, get a new health care provider ASAP!
Take the shoulder for example. If the shoulder joint is messed up… you’ve heard of frozen shoulder right? What happens with a frozen shoulder is that the capsule thing I talked about – when your arm is down at your side the underside of the capsule folds up like an accordion. When you raise your arm, all those folds flatten out. That’s what should happen, but when your shoulder freezes for whatever reason those folds become sticky and adhere to each other and no longer unfold when you raise your arm. Hence, range of motion is lost and your therapist has to get in there and stretch that shit back out. You most likely should lose motion in this pattern…….First external rotation goes. Put your arm by your side, keep your upper arm still and move your hand out to the side – that’s external rotation. Then you probably will have lost a little less abduction (lifting your entire arm out to the side) than normal than loss of normal external rotation. And lastly, you’ll probably lose some internal rotation,(same as external rotation description but move the hand toward the belly instead of out.) But less percentage of normal internal rotation motion is lost than with external rotation or abduction. This is just a guideline, your motion loss might be different but this is pretty accurate for orthopedic injuries like this. Most joints have this guideline.