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Non capsular pattern
This specific clinical image of a non capsular pattern points in the direction of a lesion of an inert structure, with exclusion of arthrosis and arthritis (here we find a capsular pattern).
We don't think of a lesion of a contractile structure.
E.g. a ligamentous lesion, a disc lesion, a bursitis,...
Non capsular pattern (2)
Clinical examples of a non capsular pattern :
Ligamentous adhesions
After an injury, adhesions may limit the normal range of movement. We then expect a very typical history, together with a precise clinical picture :
History : the patient has been injured and received immobilization or rest only without active treatment. After some time, the structure functions well with daily life but the repair and remodeling phase did not occur in optimal conditions. After higher stress activities (sport) there is pain for several days since the structure does not function well.
Clinical picture :
ONE movement is SLIGHTLY limited by LOCALIZED pain
Example : adhesions in the MCL of the knee : flexion is +/- 10° limited, with local medial pain.
Internal derangement
A joint partially blocked and partially free.
Example : meniscus subluxation at the knee, acute
Torticollis, acute lumbago. In those cases the joint is partly free in one direction (but painful) and totally blocked in another direction.
Extra-articular limitation
GROSS limitation in ONE direction, with normal movement in all other directions.
Example : passive knee flexion markedly limited in case of a lesion in the quadriceps muscle belly (because of muscle spasm). The lesion, and the reason for this limitation, lies clearly outside the joint.
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