Capsular and Non-capsular Patterns

Question 1

What is a capsular pattern?

Answer 1

A restriction in available ROM in a set pattern:

• Greatest lost of extension
• Equal loss of both side flexion and rotation
• Least loss of flexion

Question 2

When does a capsular pattern occur?

Answer 2

• When joints become inflamed
• Trauma
• Infection
• Degeneration

Question 3

Injuries that cause a capsular pattern:

Answer 3

• Osteoarthritis (OA)
  
  • Spondylosis
  • Stenosis
  • Spondylolithesis
• Rheumatoid Arthritis (RA)
• Traumatic Arthritis (TA)
  
  • Whiplash
• Ankylosing Spondylitis

Question 4

Injuries classed as non-capsular conditions:

Answer 4

• Disc lesion
• Facet Joint syndrome
• Thoracic outlet syndrome

Question 5

What is Osteoarthritis?

Answer 5

• Degenerative condition
• Commonly affects 50+ year olds
• Wear and tear to the joint
• May be primary or possibly secondary due to previous lesion (Whiplash)

Question 6

Key clinical features of Osteoarthritis:

Answer 6

• Capsular Pattern
• Affects bilateral facet joints
• Pain is movement and posture dependant
• Central, unilateral or bilateral pain
• Occasional paraesthesia if severe

Question 7

Treatment for Osteoarthritis:

Answer 7

• Warm area using electrotherapy
• Grade B Maitland Mobilisation
• Address any postural concerns

Question 8

What is Rheumatoid Arthritis?

Answer 8

• Systematic auto-immune Disease
• Degenerating and possible joint disruption
• Often severe capsulitis
• May lead to joint laxity and deformity

Question 9

Key clinical features of Rheumatoid Arthritis:

Answer 9

• Capsular pattern
• Often ages between 30-70
• Mainly complains of intermittent pain
• Other joints can be affected
• Large amount of joint degeneration
• May have loose ligaments

Question 10

Treatment for Rheumatoid Arthritis:

Answer 10

• If not acute flare up refer to GP (Rheumatology opinion)

- Grade A Maitland’s then progress to Grade B

Question 11

What is Traumatic Arthritis?

Answer 11

Typically occurs due to trauma:

- Whiplash

Question 12

Key clinical features of Traumatic Arthritis:

Answer 12

• Capsular pattern
• Affects bilateral facet joints
• Pain is movement and posture dependant
• Pain may be severe enough to radiate
• Central, unilateral or bilateral pain

Question 13

Treatment for Traumatic Arthritis:

Answer 13

• Grade A-B Maitland’s as pain allows
• Electrotherapy
• May require manipulation at later stage if it has underlying non-capsular pattern elements.

Question 14

What is Ankylosing Spondylitis?

Answer 14

• Gradual fusing of Intervertebral joints

Question 15

Key clinical features of Ankylosing Spondylitis:

Answer 15

• Capsular pattern
• Young men 20/30s
• Always insidious onset
• Severe morning stiffness
• Possible history of back pain
• May have had hip/shoulder stiffness first
• Chance of having problems with eyes (iritis factor and blood)

Question 16

Treatment for Ankylosing Spondylitis:

Answer 16

• Regular exercise

- Grade B Mobilisations

Question 17

What is a Herniated Disc and what are the Symptoms?

Answer 17

Nucleus Pulposus leaks through Annulus Fibrosus:

• Compressed Spinal Nerve
• 30 - 50 year olds
• Possible Past history of LBP
• Onset when bending, twisting, lifting
• L4-L5, L5-S1
• LBP + Leg pain
• Worse when flexion or sitting
• Relieved by standing or lying
• • SLR, Valsalva
• Antalagic Gait

Question 18

What is Ankylosing Spondylitis and what are the Symptoms?

Answer 18

Vertebrae fuses together

• 20-40 years old mostly males
• Insidious onset
• Diffused pain and stiffness >3months
• Possible radiation to buttocks and thighs
• > Stiffness in morning
• -Lordosis +Kyphosis
• Capsular Pattern
• 50% of cases other joints involved

Question 19

How does a Disc Lesion occur?

Answer 19

• Initiated following fracture to vertebral end plate (in young)
• Fracture causes bleeding and change in material and integrity of Disc
• Changes mean Disc is unable to distribute loads evenly (more strain on annulus)
• Older conditions involve annulus more than nucleus
• Annulus becomes weak and unable to withstand pressure pressure and strain

Question 20

Treatment for Disc Lesion:

Answer 20

• Address posture/muscle imbalance
• Mobilise for pain and stiffness as presented
• Manipulation or traction if articular signs are present

Question 21

What is Facet Joint Syndrome and what are the Symptoms?

Answer 21

Trapped Synovial Fold

• Pain in extension, lateral Flexion and rotation (compression in joint)
• Positive Kemp Manoeuvre
• Lateral Sharp/catchy localised pain
• Possible deep dull radiation to buttocks and thighs

Question 22

What is The difference between Spondylolytic Spondylolithesis and Non-spondylolytic Spondylolithesis?

Answer 22

Spondylolytic:
- L5 
- Adolescent Athletes
- Causes by repetitive extension exercises 
Non-spondylolytic: 
- L4
- Older Population 
- Caused by Degenerative elongation

Question 23

What is Spondylolisthesis and what are the Symptoms?

Answer 23

Forward Slippage of one Vertebrae:

• Visible/palpable step deformation
• Aggravated by extension and activity
• Relieved by rest
• Possible Nerve Entrapment