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July, 2005, Vol. 05, Issue 07

The Capsular Pattern of the Shoulder

By Ben Benjamin, PhD

Question: What is the most limited and painful movement in cases of arthritis of the shoulder?

Answer: When any type of arthritis is present in the glenohumeral joint of the shoulder, lateral rotation is the most limited and painful movement.

Dr. James Cyriax discovered that limitation of movement in an arthritic joint follows a unique pattern, which he called the "capsular pattern" for that joint.

Passive lateral rotation. - Copyright – Stock Photo / Register Mark
Passive lateral rotation.

For example, the shoulder's capsular pattern is as follows: most limitation in passive lateral rotation, some limitation in passive scapulohumeral abduction, and least limitation in passive medial rotation.

Joint capsule of the shoulder and synovial lining within the joint. - Copyright – Stock Photo / Register Mark
Joint capsule of the shoulder (A) and synovial lining within the joint (B).

Other joints exhibit different patterns. For instance, arthritis in the knee causes more limitation of movement in flexion than in extension, and arthritis in the hip causes more limitation in medial rotation, flexion and abduction, with slight limitation in extension and almost no limitation in lateral rotation.

Passive scapulohumeral abduction. - Copyright – Stock Photo / Register Mark
Passive scapulohumeral abduction.

Passive medial rotation. - Copyright – Stock Photo / Register Mark
Passive medial rotation.

Arthritis pain often develops when the shoulder suffers a slight trauma or series of traumas (such as a bump into a solid object or multiple tendon injuries) and begins to stiffen up. In many cases, the specific cause of the trauma is unknown. This condition is referred to as traumatic arthritis, capsulitis or frozen shoulder. It is very painful and usually lasts for at least a year without any therapeutic intervention. Skillfully performed injection therapy combined with special shoulder stretching techniques can dramatically improve this shoulder condition within several weeks.


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