A 45-year-old man enters the outpatient physical therapy department with a compl

Question

A 45-year-old man enters the outpatient physical therapy department with a complaint of rightshoulder pain of 1 week’s duration. The pain began Monday morning following a weekend of scrapingand painting his house. The patient describes his pain as aching and troublesome; his pain is a 6on a pain scale of 0 to 10. He reports that he is married, and having difficulty in home maintenanceactivities such as lawn mowing. He is able to perform only 30% of his normal home and recreationalactivities. The therapist decides to conduct a musculoskeletal examination.While palpating the shoulder region, increased tenderness and skin temperature in the region ofthe bicipital groove of the right anterior shoulder is noted. Active ROM of the right shoulder revealsincreased pain and some limitations during shoulder flexion, abduction, and extension; all other activemotions are pain free and within normal ROM limits. Passive shoulder motions are pain free withnormal ROM, except for shoulder extension, which is limited and causes an increase in pain towardthe end of motion. QUESTIONS1. What is a capsular pattern of limitation? Does this patient have a capsular pattern of limitation for the glenohumeral joint

Explanation / Answer

capsular pattern

a series of limitations of joint movement when the joint capsule is a limiting structure.

When inflammation of a joint is present (known as synovitis or capsulitis), not only does passive stretching of the capsule cause pain but a limitation of range of motion of the involved joint is always found to be in a specific pattern; this pattern is always similar for that particular joint, although each joint has a different and instantly recognizable capsular pattern.

yes, patients have a capsular pattern in glenohumeral joints,from flexion as the least limited movement to externalrotation as the most limited movement. It occurs only in synovial joints that are controlled bymuscles and not in joints that depend primarily on ligamentous stability, such as the sacroiliac.

In a joint, the proportional loss or limitation of passive range of motion that suggests inflammation inthat joint (e.g., the capsular pattern of the glenohumeral joint, in order of most restriction, is lateralrotation, abduction, and medial rotation).

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