What is the normal capsular pattern for the sternoclavicular joint?

• A. No true capsular pattern; possible loss of horizontal adduction and pain (and sometimes slight loss of end range) with each motion
• B. Flexion before extension
• C. External rotation is limited first
• D. Equal limitation of pronation and supination

Answer: (A)

The sternoclavicular joint doesn’t have a definite capsular pattern. Its capsule is relatively lax and the joint moves in multiple directions (elevation/depression, protraction/retraction, and a rotational component during protraction). Because of this multi-planar mobility, there isn’t a single, consistent sequence of restriction that characterizes its capsular pattern. The typical description is that there is no true capsular pattern, though some patients may show a loss of horizontal adduction (protraction) and pain, with only possible slight end-range limitation in various directions.

Think of it this way: unlike some joints that consistently restrict one direction first, the SC joint’s complex three-dimensional motion doesn’t produce a uniform pattern. The other options imply a specific ordered limitation (like flexion before extension or external rotation being limited first) or movements from joints outside its range (pronation/supination), which don’t apply to the normal capsular pattern of the SC joint.