Causes of

Restriction of joint
Range of motion
DR. RONAK PATEL(PT)
RANGE OF MOTION:
 Itis arc of motion that occurs at a joint
or series of joints.
 The starting position for measuring all
ROM is anatomical position, except
rotation is transverse plane.
ROM
Restricted ROM
ACTIVE RANGE OF MOTION:
 AROM is arc of motion attained by a
subject during unassisted voluntary
motion.

PASSIVE RANGE OF MOTION:

 PROM is the arc of motion attained by
an examiner without assistance from
the subject.
 Thesubject remains relaxed and plays
no active role in producing the motion.
HYPERMOBILITY:
 Refers to an increase in passive ROM
that exceeds normal values for that
joint, given the subject’s age and
gender.
HYPOMOBILITY:
 Refers to a decrease in PROM that is
substantially less than normal values for that
joint, given the subject’s age and gender.
The limitation of PROM may be due to a
variety of causes:
 Abnormalities of the joint surface
 Passive
shorting of joint capsule,
ligament, muscles, fascia and skin
 Inflammation of these structures
 Associated with many orthopaedic
conditions such as osteoarthritis,
rheumatoid arthritis, adhesive capsulitis
and spinal disorders
 Itis common consequences of
immobilization after fractures and scar
development after burns.
 Neurological conditions such as stroke,
head trauma, cerebral palsy, complex
regional pain syndrome can also result
in hypomobility owing to loss of
voluntary movement, increased muscle
tone, immobilization and pain.
 Metaboliccondition such as diabetes
have been associated with limited
ROM.
Capsular pattern of restricted motion:
 Cyriax has proposed that pathological
conditions involving the entire joint
capsule cause a particular pattern of
restriction involving all or most of the
passive motion of joint. This pattern of
restriction is called a capsular pattern.

 Capsular pattern vary from joint to joint.

Noncapsular pattern of restricted motion:
 A limitation of motion that is not proportioned
similarity to a capsular pattern is called a
noncapsular pattern of restricted motion.
 A noncapsular pattern is usually caused by a
condition involving structures other then the
entire joint capsule.
 Internal joint derangement ,adhesion of a part
of a joint, ligament shorting, muscle strains and
muscle contractures are examples of
conditions that typically result in noncapsular
pattern of restriction
 Injury/disease may affect each or all
of the structural components of a joint
& lead to a reduction in normal R.O.M.
 COMMON CAUSES:-
1) Tightness of skin, superficial Fascia or
scar tissue-limit the active& passive
ROM.
2) MUSCULAR WEAKNESS OR
INEFFICIENCY:-
 Weakness or flaccidity of muscle limits
active range if the power of Muscle is
insufficient to overcome the resistance
offered by the weight of part moved.

 Tightnessor spasticity – limits both active

or passive movement as muscle
antagonistic to the movement are
unable to relax & allow it to take place.
SPASTICITY
FLACCIDITY
 3)ADHESION FORMATION:-
 It limit both active /passive movement.
 Itoccurs following the output of a sero-
fibrous exudate into the region of the
joint or joint itself.
 Joint structures become soaked in this
exudate and if it is not speedily removed
the fibrinous constituents of the exudate
‘glue’ the collagenous fibres of the
ligaments & tendons together.
 The fibrous ‘glue’ constitutes the adhesion
,which is relatively soft and easily broken
,but later when the adhesions are
consolidated, they contract to form scars.

 In the case of shoulder joint , for example

,adhesion formation may limit movement
considerably, the capsule being glued in
folds, if the joint is allowed to remain in the
same position for too long.
4) Displacement or tearing of an intra-
capsular fibrocartilage or the presence
of foreign body in the joint.

 Itlimits both active & passive R.O.M.

and accompanied by intense pain as
the result of which the joint becomes
locked by muscular spasm.
5) CARTILAGENOUS OR BONY
DESTRUCTION:-
 It
limits both active/passive movement
And articular surfaces will not slide easily
upon one another.
 Bony or fibrous ankylosis limits movement
Together.
 Bony obstructions such as in myositis-
ossificans, limits the range in the direction
of the obstruction.
6) sometimes no organic cause can be
found when the patient is unable to
move a joint.
Factors affecting ROM
 ROM varies among individuals and is
influenced by factors such as age,
gender, and whether the motion is
performed actively or passively.
 Otherfactors relating to subjects
characteristics such as body mass
index(BMI), occupational activities and
recreational activities may affect ROM
but have not been as extensively
researched as age and gender.
1) Age:
The youngest age group has more
effective ROM than adults.
2)GENDER:
 The effects of gender on the ROM of
extremities and spine also appear to be
joint and motion specific.
 Females have more ROM compared to
male.
 Extra fat or muscle mass may inhibit a
joint’s normal ROM by physically
blocking its path of movement.
a protruding abdomen can limit how
high you can flex your hip and pull your
knee to chest.
3) Prolonged immobilization:
 Extrinsic- cast and splints, skeletal traction
 Intrinsic- pain and inflammation
- Muscle ,tendon and fascia
disorders
- Skin disorders
- vascular disorders
- Bony block
4) Sedentary lifestyle and habitual faulty or
asymmetrical postures:
 Confinement to bed or wheelchair, prolonged
positioning associated with occupation or work
environment.

5) Paralysis ,tonal abnormalities and muscle

imbalance

6)Postural malalignment : congenital or acquired

 Scoliosis
 kyphosis
Distinguish between skin, muscular and
capsular contracture
Contracture:
 It is defined as the adaptive shortening of
muscle tendon unit and other soft tissues that
cross or surround a joint that result in
significant resistance to passive or active
stretch and limitation of ROM and it may
compromise functional abilities.

 Restricted motion can range from mild

muscle shortening to irreversible contracture.
SKIN CONTRACTURE
 It can occur because of burn , skin grafting
due to any major scar caused by incision or
accidents, any skin diseases.
 Fibrous changes in the connective tissues of
skin and subcutaneous tissues can cause
adherence of these tissues and subsequent
development of fibrotic contracture.
 Although it is possible to stretch a fibrotic
contracture and eventually increase ROM,
the fibrotic skin contracture are easily visible
over the joint affected by them.
CAPSULAR CONTRACTURE
 It occurs when the collagen fiber capsule
shrinks, tightens or compresses.
 A particular contracture develops when
connective tissues that cross or attach to a
joint or joint capsule.
 MUSCULAR CONTRACTURE
 It can occur for many reasons, such as
paralysis , muscular atrophy and forms of
muscular dystrophy.
 Fundamentally the muscle and its tendon
shorter, resulting in reduced flexibility.
 Causes are:
Immobilization
Spasticity- increase muscle tone.
Flaccidity – decrease muscle tone.
Agonist and antagonist.
Muscular atrophy/dystrophy
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