Comprehensive Guide to Joint Positions and Capsular Patterns

Temporomandibular and Craniovertebral Joint Characteristics

• Temporomandibular Joint (TMJ):     - Open Packed Position (OPP): The joint is slightly ajar ($Mouth\ slightly\ open$).     - Closed Packed Position (CPP): The position of maximum occlusion, identified as clenched teeth.     - Capsular Pattern: A primary limitation of mouth opening.

• Atlanto-Occipital (AO) Joint:     - Open Packed Position (OPP): Positioned midway between flexion and extension.     - Closed Packed Position (CPP): Achieved at full extension of the joint.     - Capsular Pattern: Restriction is noted with extension and side flexion being equally limited.

Shoulder Girdle and Spinal Column Arthrology

• Acromioclavicular Joint:     - Open Packed Position (OPP): Positioned with the arms resting naturally by the side.     - Closed Packed Position (CPP): Occurs at $90^\circ$ of abduction.     - Capsular Pattern: Characterized by pain at the extremes of the end-range of movement.

• Sternoclavicular Joint:     - Open Packed Position (OPP): Positioned with the arms resting naturally by the side.     - Closed Packed Position (CPP): Occurs at full elevation of the joint.     - Capsular Pattern: Pain is present at the extremes of the end-range of movement.

• Spinal Column (Cervical, Thoracic, and Lumbar Spine):     - Open Packed Position (OPP): Positioned midway between flexion and extension.     - Closed Packed Position (CPP): Occurs at full extension of the spine.     - Capsular Pattern: Lateral flexion (side flexion) and rotation are equally limited, along with a limitation in extension.

Glenohumeral and Elbow Joint Complexes

• Glenohumeral Joint:     - Open Packed Position (OPP): $55^\circ$ of abduction and $30^\circ$ of horizontal adduction.     - Closed Packed Position (CPP): Position of abduction and external rotation, commonly abbreviated as ABER ($Abduction,\ External\ Rotation$).     - Capsular Pattern: External Rotation is more limited than Abduction, which is more limited than Internal Rotation (\text{ER} > \text{AB} > \text{IR}).

• Ulnohumeral (Elbow) Joint:     - Open Packed Position (OPP): $70^\circ$ of flexion and $10^\circ$ of supination.     - Closed Packed Position (CPP): Full extension of the elbow.     - Capsular Pattern: Flexion is more limited than extension (\text{Flexion} > \text{Extension}).

• Radiohumeral Joint:     - Open Packed Position (OPP): Full extension combined with full supination.     - Closed Packed Position (CPP): $90^\circ$ of flexion and $5^\circ$ of supination.     - Capsular Pattern: Limitations across the range of flexion, extension, supination, and pronation.

Forearm and Radiocarpal Joint Mechanics

• Proximal Radioulnar Joint:     - Open Packed Position (OPP): $70^\circ$ of flexion and $35^\circ$ of supination.     - Closed Packed Position (CPP): $5^\circ$ of supination.     - Capsular Pattern: Limitations in both supination and pronation.

• Distal Radioulnar Joint:     - Open Packed Position (OPP): $10^\circ$ of supination.     - Closed Packed Position (CPP): $5^\circ$ of supination.     - Capsular Pattern: Remains in the full range of movement ($ROM$), but significant pain is felt at the extremes of motion.

• Radiocarpal Joint (Wrist):     - Open Packed Position (OPP): Neutral position accompanied by slight ulnar deviation.     - Closed Packed Position (CPP): Full extension.     - Capsular Pattern: Flexion and extension are equally limited.

Hip and Knee Joint Positions

• Acetabulofemoral (Hip) Joint:     - Open Packed Position (OPP): $30^\circ$ of flexion, $30^\circ$ of abduction, and slight external rotation (ER).     - Closed Packed Position (CPP): Full extension and internal rotation (IR), or the position described as EXABIR ($Extension, Abduction,\ and\ Internal\ Rotation$).     - Capsular Pattern: Internal rotation is most limited, followed by flexion and abduction (\text{IR} > \text{F} > \text{AB}).

• Tibiofemoral (Knee) Joint:     - Open Packed Position (OPP): $25^\circ$ of knee flexion.     - Closed Packed Position (CPP): Full knee extension and external rotation (ER) of the tibia.     - Capsular Pattern: Flexion is more limited than extension (\text{Flexion} > \text{Extension}).

Ankle and Foot Articulations

• Talocrural Joint (Ankle):     - Open Packed Position (OPP): $10^\circ$ of plantarflexion (PF).     - Closed Packed Position (CPP): Full dorsiflexion (DF).     - Capsular Pattern: Plantarflexion is more limited than dorsiflexion (\text{PF} > \text{DF}).

• Subtalar Joint:     - Open Packed Position (OPP): Midway between the extremes of the range of motion ($ROM$).     - Closed Packed Position (CPP): Supination.     - Capsular Pattern: Limitation of the varus range of movement.

• Midtarsal Joint:     - Open Packed Position (OPP): Midway between the extremes of the range of motion ($ROM$).     - Closed Packed Position (CPP): Supination.     - Capsular Pattern: Limitations in dorsiflexion (DF), plantarflexion (PF), adduction, and internal rotation (IR).

Digits of the Hand and Foot

• Metatarsophalangeal (MTP) Joint:     - Open Packed Position (OPP): Neutral position.     - Closed Packed Position (CPP): Full extension.     - Capsular Pattern:         - $1\text{st}$ MTP: Limitation in extension and flexion.         - $2\text{nd}$ through $5\text{th}$ MTP: Variable limitations.

• Interphalangeal (IP) Joint:     - Open Packed Position (OPP): Slight flexion.     - Closed Packed Position (CPP): Full extension.     - Capsular Pattern: Limitations in both flexion and extension.

• Metacarpophalangeal (MCP) Joint:     - Open Packed Position (OPP): Slight flexion.     - Closed Packed Position (CPP):         - Finger: Full extension.         - Thumb: Full opposition.     - Capsular Pattern: Flexion and extension are equally limited.