A capsular pattern ROM in the shoulder is best described as which?

• A. External rotation is most limited, followed by abduction, then internal rotation
• B. Internal rotation is most limited, followed by abduction, then external rotation
• C. Abduction is most limited, followed by external rotation, then internal rotation
• D. External rotation is least limited

Answer: (A)

A shoulder capsular pattern arises when the joint capsule itself limits motion in a characteristic order. For the glenohumeral joint, the most restricted movement is external rotation, followed by abduction, then internal rotation. This pattern is typical of a capsular involvement such as adhesive capsulitis (frozen shoulder), where inflammation and fibrosis reduce the capsule’s elasticity and produce a uniform, progressive loss of ROM.

If ROM losses don’t follow this order, it suggests a noncapsular problem (for example, a rotator cuff injury or AC joint issue) rather than a capsular restriction.