End Feel




End Feel: A physical therapy term applied to the passive end range of motion of a joint. Normal movement is limited by any of a number of factors, such as articular surface contact, the extensibility of ligaments, tendons, or muscles associated with a joint; or the opposition of soft tissue. When a therapists performs a passive range of motion check of a particular joint, there will be some type of limitation of motion based on one of these factors. The factor that is most responsible for this limitation of motion will cause a particular "feel" which can help the therapist diagnose the problem in the joint. For instance, the barrier may be caused by the joint capsule itself, tight muscle tissue, soft tissue approximation, or contact of different joint surfaces. This barrier, which can be assessed by its particular feel, is called the end feel. An abnormal end feel will be markedly different from a normal one.

The basic normal end-feels are classified according to two basic systems, Cyriax and Kaltenborn.

Kaltenborn

  • Hard - (bony) Abrupt hard stop where bone contacts bone, as in elbow extension when the olecranon process moving against the olecranon fossa.
  • Firm - (soft tissue stretches) A firm or springy feeling stop where there is some give as soft tissue, as in a muscle, stretches when a joint is moved.
  • Soft - (soft tissue opposition) When two soft tissue surfaces come together producing a soft compression, as when the back of the thigh and the calf muscles come together during knee flexion.

Cyriax

  • Tissue Stretch - Movement with a bit of give as the soft tissues stretch, yielding a firm, but not hard, leathery sensation, such as when ligaments or the joint capsule stretches, causing a hard to arrest movement with some give, as in passive external rotation of the shoulder. At the end of this movement there is a feeling of rising tension or resitance, and there may be a slight feeling of springiness. Some sources also subdivide this into two other categories:
    • Capsular (Hard) - This is when the joint capsule is the primary limitation of the movement continuing, as it would be in the example of external shoulder rotation, above. According to Palmer, et al. this feels like two pieces of rubber being pressed together.3
    • Elastic (Soft) - This is when the end of the movement is caused by a muscle or other soft tissue stretching and then reaching the end of its range of motion. This is similar to capsular, although not all sources refer to it as separate to the capsular end feel and some replace the capsular end feel with this designation. This is a firm yet slightly forgiving stop to movement, with perhaps a bit of springy resistance. This end feel is caused by other tissue stretching at the end of their range of motion, such as muscles. The example most often given is the end of ankle dorsiflexion where the movement is arrested by the stretching of the soleus.4,3
  • Bone-to-bone (bony) - Same as Hard, above, where there is a sudden stop or hard end feel.
  • Soft Tissue Approximation - when two muscle bellies meet, like Soft, above. Another example is the distal part of upper arm meeting the forearm in elbow flexion.

These end feels can be normal for many joints, but can also be abnormal in others, where the end feel is different than what the feel normally is for that joint. There are also addtional types of end feels which are never normal, such as:

  • Springy (springy block) - This is a feeling of the joint stopping and then rebounding, and it is normally not found in the human body.
  • Muscle Spasm - A sudden stop of movement accompanied by pain, caused by the muscle spasming near the normal end, or at the end, of a movement. This can be caused by active inflammation or joint instability.
  • Empty - This is the feeling that there is nothing to stop the movement except the great pain the patient is feeling, which stops the movement prematurely even though no physical mechanism exists to stop it. Examples that cause this are an acute subacromial bursitis or a tumor. Patients have a hard time explaining this feeling.4

The following table describes the normal end-feel of the wrist, elbow, and knee joints, as well as the tissues responsible for producing this end-feel.1

Joint Motion End-Feel Tissues Responsible
Wrist Flexion Firm Dorsal Radiocarpal ligament and the joint capsule
Extension Firm Palmar Radiocarpal ligament and the joint capsule
Radial deviation Hard scaphoid meets the styloid process of radius
Elbow Flexion Soft Compression of distal muscle mass of biceps with forearm muscles
Extension Hard Olecranon process moving against the olecranon fossa
Knee Flexion Soft Compression of hamstrings and calf muscles
Extension Firm End-range of motion of hamstrings and gastrocnemius

Probably the most common normal end feel in the body is a firm end feel, caused by tension in soft tissues, such as during movements of the wrist.

For more information see Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength by Hazel M. Clarkson or Orthopedic Physical Assessment by David Magee

References
1. Starkey, Chad, and Jeffrey L. Ryan. Evaluation of Orthopedic and Athletic Injuries. Philadelphia: F.A. Davis, 1996. 411.
2. Clarkson, Hazel M. Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength. Philadelphia: Lippincott Williams & Wilkins, 2000.
3. Palmer, M. Lynn., and Marcia E. Epler. Fundamentals of Musculoskeletal Assessment Techniques. Philadelphia, Penn: Lippincott, 1998.
4. Magee, David J. Orthopedic Physical Assessment. St. Louis, MO: Saunders Elsevier, 2008.

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This page created 30 Aug 2012 01:16
Last updated 27 Feb 2016 22:21

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