End Feel Normal and Abnormal

When assessing passive movements, the examiner should apply overpressure at the end of the ROM to determine the quality of the "end-feel". The sensation that is felt in the joint as it reaches the end of the ROM.

A proper evaluation of the end feel can help determine a prognosis for the condition and learn the severity or stage of the problem.

            Normal                          Example

               Bone-to-bone                            Elbow extension

                            This is a "Hard" unyielding sensation that is painless.

      Soft tissue approximation          Knee flexion

                            This is a yielding compression that stops further movement.

            Tissue stretch         Ankle dorsiflexion, Shoulder, external rotation, finger extension.

This is a hard or firm (springy) type of movement with a slight give. Towards the end of the ROM, there is a feeling of elastic resistance.

            Abnormal                                      Example

                        Early muscle spasm             Acute protective spasm associated with inflammation

This end feel is invoked by movement, with a sudden arrest of movement often accompanied by pain. The end feel is sudden and hard. Early muscle spasm occurs early in the ROM, almost as movement starts.

                        Late muscle spasm                            Spasm caused by instability

As above, but occurs at or near then of the ROM. It is caused by instability and the resulting irritability caused by movement. As is the Apprehension Test for Shoulders.

Both types of muscle spasm are the result of the subconscious efforts of the body to protect the injured join or structure.

                        Hard capsule                                     Frozen shoulder, chronic conditions.

This end feel is similar to Tissue stretch, but it does not occur where one would expect. 

Hard capsule end feel has a 'thick" quality to it. Limitation comes abruptly after a smooth, friction free movement.

                        Soft capsule                                       Synovitis, soft tissue oedema.

This is similar to "normal" but with a restricted ROM. Is often found in acute conditions, with stiffness occurring early in the range and increasing until the end of range. It has a soft, boggy end feel.

                        Bone-to-bone                                     Osteophyte formation

The abnormal bone-to-bone end feel comes well before the normal end of ROM.

                        Empty                                                 Acute subacromial bursitis

This end feel is detected when considerable pain is produced by movement. The movement is stopped by pain with no real mechanical resistance.

                        Springy block                                       Meniscus tear

This is similar to a tissue stretch, but occurs unexpectedly. Usually occurs in joints with a meniscus. There is a "rebound" effect, and usually indicates an internal derangement.

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