How to check End feel during examination?
It has always been a query regarding the end feel for a particular joint and its movement. In order to solve this query here is a bit of overview on it. Hope it clarifies the doubts and solves the issue with better ease for judging the particular type of end feel.
Defining the End Feel in easier terms is the feel that is perceived by the assessor at the end of any movement. The movement that the patient performs actively is repeated passively and when the end of the available range is reached over pressure is applied to get a feel of resistance of tissue. This feel of barrier at the end of a passive range of motion is called end feel.
Steps to be noted while assessing End Feel
- Movement & end pressure should be done slowly and carefully
- Detect the end of available range of motion
- Distinguish between normal & abnormal end feel
- Caution to be taken not to be too forceful and injure the tissue
- Always compare it with the contra lateral side
Significance of taking End feel
- It helps the assessor to differentiate between limiting structures
- It guides in measuring range of motion and compare with the contra lateral side and thereby detect the pathology
- It determines if the limitation is due to articular or peri-articular problem
- Proper evaluations of end feel help determine a prognosis for the condition & learn severity or stage of problem.
- The quality of resistance at end range
- Each joint has a normal end feel at a normal point in Range of Motion (ROM)
- Incorrect end feel, or correct end feel at incorrect ROM indicate pathology
NORMAL OR PHYSIOLOGICAL END FEEL
| 1. | Soft tissue approximation | Subcutaneous tissues (muscle bulk, fat) are pushing against each other e.g.- Knee Flexion, Elbow Flexion |
| 2. | Tissue stretch (Muscle stretch) | Passive elastic stretch (Tension) Feels like stretching a bicycle tire inner tube e.g.- Hip Flexion with Knee Extension |
| 3. | Tissue stretch (Capsular stretch) | Tension in joint capsule Feels like stretching a leather belt; more resistance than ligament e.g.- Extension of MCP Joint of Fingers |
| 4. | Tissue stretch (Ligamentous stretch) | Tension in ligaments surrounding the joint Feels like stretching a leather belt e.g.- Forearm Supination |
| 5. | Hard (Bony) | Bone contacting bone (painless) Feels like pushing 2 wooden surfaces together e.g.- Elbow Extension |
ABNORMAL OR PATHOLOGICAL END FEEL
| 1. | Soft Capsular | Related to compressing & stretching of soft tissues Similar to Normal but with restricted ROM. Is often found in acute conditions with stiffness occurring early in range & increases until end of range Soft boggy end feel e.g.- Synovitis, Soft Tissue Oedema |
| 2. | Hard Capsular | Similar limitation comes abruptly after smooth, friction free movement e.g.- Frozen Shoulder, Chronic Conditions |
| 3. | Early Muscle Spasm | Invoked with movement, with a sudden arrest of movement often accompanied by pain End feel is sudden e.g.– Acute protective spasm associated with Inflammation |
| 4. | Late Muscle Spasm | Restriction occurs at or near end of ROM Caused by instability & the resulting irritability caused by movement e.g.- Chronic condition, spasm caused by instability |
| 5. | Springy | When passive movement performed rebound phenomenon occurs e.g.- Meniscal Tear or spasm |
| 6. | Empty | Sensation is painful at certain limit. Range is not restricted but patient is not willing to allow motion to end of range because of anticipated pain and so assessor did not reach end feel Feels like the joint has more range available, but patient is purposefully preventing movement through full ROM. e.g.- Acute Joint Inflammation, Bursitis, Abscess, Fractures, Psychogenic disorders |
| 7. | Bone to Bone | Similar to normal end feel but range is not complete e.g.- Osteophyte formation, Myositis Ossificans |
References
- Magee DJ. “Orthopaedic Physical Assessment.” 5th Philadelphia: WB Saunders. 2012.
- Image courtsey : bostonbodyworker.com
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