End Feel Shoulder Flexion

Decoding the End Feel of Shoulder Flexion: A Guide for Clinicians and Students

Understanding the end feel of shoulder flexion is crucial for accurate diagnosis and effective treatment planning in musculoskeletal physiotherapy and medicine. The "end feel" refers to the quality of resistance felt by the examiner at the end range of a joint's passive movement. A correctly identified end feel provides valuable insights into the underlying joint structures and helps differentiate between various pathologies. Misinterpreting the end feel can lead to inaccurate diagnoses and inappropriate treatment, potentially delaying recovery and even causing harm. This article addresses common questions and challenges encountered when assessing the end feel of shoulder flexion.

1. Anatomy and Biomechanics of Shoulder Flexion:

Shoulder flexion is a complex movement involving the glenohumeral (GH) joint, the acromioclavicular (AC) joint, and the scapulothoracic articulation. The primary motion occurs at the GH joint, where the humerus moves anteriorly and superiorly on the glenoid fossa. However, scapulothoracic rhythm plays a vital role, contributing approximately 1:2 ratio of scapular upward rotation to humeral elevation. Several muscles contribute to this movement, primarily the anterior deltoid, pectoralis major (clavicular head), coracobrachialis, and biceps brachii. Understanding these anatomical components is essential for interpreting the end feel.

2. Normal End Feel of Shoulder Flexion:

A normal end feel for shoulder flexion is typically described as firm. This signifies a combination of capsular stretch and muscle stretch. The feeling is a gradual increase in resistance as the joint approaches the end of its range of motion. This is a result of the stretching of the anterior joint capsule, the anterior deltoid, and the pectoralis major. It’s important to note that slight variations in the normal end feel exist between individuals due to differences in muscle mass, joint laxity, and overall flexibility.

3. Abnormal End Feels in Shoulder Flexion:

Several abnormal end feels can be encountered during shoulder flexion assessment, each indicating a different potential pathology:

Empty End Feel: This signifies pain that prevents the patient from reaching the full range of motion. It's often associated with acute inflammatory conditions such as bursitis, tendinitis, or rotator cuff tears. The examiner feels no real tissue resistance before the patient experiences pain.

Spasmodic End Feel: This is characterized by a sudden, involuntary muscle contraction that limits the range of motion. It's often associated with muscle guarding or spasm secondary to pain or injury. The resistance is abrupt and can be accompanied by muscle twitching.

Bony End Feel: A bony end feel occurs when bone contacts bone, indicating a pathological condition. This is often associated with osteophytes (bone spurs), fracture, or dislocation. The feeling is hard and abrupt, unlike the gradual firm resistance of a normal end feel.

Springy End Feel: This uncommon end feel in shoulder flexion suggests the presence of a loose body (e.g., cartilage fragment) within the joint. It gives a sensation of rebounding when the joint is passively moved.

4. Differential Diagnosis based on End Feel:

The table below summarizes the possible diagnoses based on different end feels in shoulder flexion:

| End Feel | Possible Diagnosis | Associated Symptoms |
|-----------------|---------------------------------------------------|-------------------------------------------------------|
| Firm | Normal, mild capsular tightness | None or mild discomfort at end range |
| Empty | Rotator cuff tear, bursitis, subacromial impingement | Significant pain, limited active and passive ROM |
| Spasmodic | Muscle strain, pain, guarding | Pain, muscle spasm, limited ROM |
| Bony | Osteoarthritis, fracture, dislocation | Pain, limited ROM, possible deformity |
| Springy | Loose body within the joint | Clicking or catching sensation, pain, limited ROM |

5. Step-by-Step Assessment of Shoulder Flexion End Feel:

1. Patient Positioning: The patient should be sitting or supine, with the arm relaxed at their side.
2. Stabilization: Stabilize the scapula to isolate the GH joint movement.
3. Passive Movement: Passively move the patient's arm through shoulder flexion, gently but firmly. Observe their comfort level.
4. Palpation: Feel for muscle tension and joint resistance during the movement.
5. End Range Assessment: Note the quality of the resistance felt at the end range of motion. Record the type of end feel (firm, empty, etc.) and any associated pain.
6. Comparison: Compare the end feel of the affected side with the unaffected side.

6. Examples:

Patient A: Presents with an empty end feel during shoulder flexion. They report severe pain, and active range of motion is severely limited. This suggests a possible rotator cuff tear or severe bursitis.
Patient B: Shows a firm end feel, but slightly tighter than the contralateral side. This may indicate mild capsular tightness, potentially requiring stretching exercises.
Patient C: Experiences a spasmodic end feel. This might be due to muscle guarding related to previous injury or pain. Treatment should focus on pain management and muscle relaxation techniques.

Conclusion:

Accurate assessment of the end feel during shoulder flexion is a critical skill for clinicians. Understanding the normal and abnormal end feels, coupled with a comprehensive assessment of the patient's history and clinical presentation, allows for a more precise diagnosis and the development of an effective treatment plan. Remember that this assessment should always be conducted within a holistic examination, considering other factors such as patient history, observation, palpation, and special tests.

FAQs:

1. Can a single assessment of end feel provide a definitive diagnosis? No, end feel is just one piece of the puzzle. It needs to be combined with other clinical findings for an accurate diagnosis.

2. How do I differentiate between a firm and a bony end feel? A firm end feel is gradual, while a bony end feel is abrupt and hard. The feeling is very different.

3. What are the implications of missing an abnormal end feel? Missing an abnormal end feel can lead to misdiagnosis, inappropriate treatment, and delayed recovery.

4. Are there any specific tests that can help to confirm the suspected diagnosis based on end feel? Yes, various imaging techniques (X-ray, MRI, Ultrasound) and special orthopedic tests can help confirm the diagnosis.

5. How can I improve my skill in assessing end feel? Practice on healthy individuals first to establish a baseline understanding of normal end feels. Then, practice on patients with various conditions under the supervision of an experienced clinician.

Search Results:

Passive Range of Motion: Shoulder flexion - Physiopedia Shoulder flexion can be accomplished in one of two ways, through glenohumeral joint flexion, or through glenohumeral joint, scapular, and clavicular motion. [1] The patient can be in a supine …

Passive Movement Evaluation - Massage Today The sensation often described is a "leathery" feel to the end of the motion, such as in external rotation of the shoulder. A true capsular end feel occurs when the joint capsule is the primary …

End feel | PPT - SlideShare 14 Nov 2019 · This document discusses end feel and range of motion measurements. It defines end feel as the quality of movement perceived by the practitioner at the end of available range …

End feel Flashcards - Quizlet A firm capsular end feel for elbow flexion may be due to capsular shortening after wearing a long arm cast. A hard end feel can result from abnormal bony structures (e.g., osteophyte) limiting …

What Is the “End Feel”? - The Boston Bodyworker The sensation often described is a “leathery” feel to the end of the motion, such as in external rotation of the shoulder. A true capsular end feel occurs when the joint capsule is the primary …

The Sleeper Stretch - Technique and Tips for Shoulder Health I’ve observed significant improvements in shoulder flexion range of motion simply by targeting posterior tightness, even without directly focusing on flexion. ... reducing the amount of internal …

Anatomy for Physios - 2c. Joint End Feels - Google Sites Tissue stretch is the most common type of normal end feel; it is found when the capsule and ligaments are the primary restraints to movement. Examples are lateral rotation of the …

Types of End Feels Explained | Ablison 5 Sep 2024 · End feels are categorized into distinct types based on the quality of resistance felt when the joint is moved to its limit. Clinicians often use these sensations as diagnostic tools to …

Normal End Feel Abnormal End Feel: ST ND | PDF - Scribd Abnormal end feels include capsular thickening, muscle spasm, or empty sensation. Grades of strength from 0 to 5 are defined for resisted shoulder motions. The strength and presence of …

End Feel Examples (Normal End Feels vs Abnormal End Feels) End feel occurs when the joint capsule is stretched at the end of its normal range, such as with external rotation of the shoulder joint. for the therapist, normal capsular stretch feels like …

Post-Op Shoulder: Using End Feel to Gauge Progression Speed 9 Aug 2016 · Use End Feel as Your Gauge. So, what is the one factor that I think is the most important in rehabilitating a patient safely and gradually after a surgery? In my opinion, end …

How I Got Through the Terrible Menopause Symptom No One … 22 Jan 2025 · Shoulder flexion stretch. Standing in a doorway, raise your arm and rest it against the door frame. Slowly move your body forward slightly until you feel the stretch in the front of …

What are the different type of joint-end feels? 14 Dec 2020 · There are multiple types of joint end-feels all of which are different for each individual! Bone on Bone. When the end of range is encountered, the SMT will feel the bone …

Table 3-1 End-Feel Categorization Scheme - Healio Table 3-1 End-Feel Categorization Scheme Normal End-Feels Soft-tissue approximation Soft and spongy, a gradual painless stop (eg, elbow flexion) Capsular An abrupt, hard, firm end point...

Upper Extremity - ROM, End Feel, Muscle Action & Innervations ... Study Upper Extremity - ROM, End Feel, Muscle Action & Innervations flashcards from Kayla Keckeisen's class online, or in Brainscape's iPhone or Android app. Learn faster with spaced …

End-Feel - Physiopedia "End Feel" is a type of sensation or feeling that the examiner experienced when the joint is at the end of its available passive range of motion in assessment. There are multiple types of joint …

Passive Range of Motion (PROM) of the Shoulder The normal end-feel for different movements is as follows: Abduction: Bone to bone or tissue stretch. Horizontal adduction: Tissue stretch. Flexion: Tissue stretch. Extension: Tissue …

End Feel Flashcards by Kelsy Schoen - Brainscape Study End Feel flashcards from Kelsy Schoen's University of Kansas Medical Center class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition.

How to Know When to Push a Stiff and Painful Shoulder - Mike … 19 Oct 2015 · Every joint has a normal end feel. Some common examples are: Boney: Hard end feel of two bones approximating. Elbow extension is a good example. Capsular or …

Functional Anatomy of the Shoulder - Physiopedia In the absence of pathology, the end feel will be firm; Normal range: around 100 degrees from the anatomic position; An alternative testing position for internal and external glenohumeral joint …

End-Feels for Shoulder Flashcards - Quizlet Study with Quizlet and memorize flashcards containing terms like Glenohumeral Flexion, Shoulder Complex Flexion, Glenohumeral Extension and more.

SHOULDER - Musculoskeletal Key 7 Jun 2016 · The examiner assesses for scapular compensations that occur during passive motion, end feels at the end of shoulder motion, and the ROM available with each motion. …

End Feel Shoulder Flexion

Decoding the End Feel of Shoulder Flexion: A Guide for Clinicians and Students

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