Endfeel and It's type. How to assess Endfeel?

When assessing passive movement, the examiner should apply overpressure at the end of the Range of motion to determine the quality of end feel. it is known as endfeel. or you can simply say that it is sensation the examiner “feels” in the joint as it reaches the end of the Range of Motion.


A proper evaluation of end feel can help the examiner to assess the type of pathology present, indirectly it is a lot helpful.


endfeel classify into two:
1) Normal Endfeel
2)Abnormal Endfeel

It can be helpful to determine a prognosis severity or stage of the problem Normal endfeel is classified into three types.
1) Bone-to-Bone
2) Soft-Tissue Approximation
3) Tissue Stretch

Tissue stretch is the most common type of normal end feel. it is found when the capsule and ligaments are the primary restraints to movement, Know about Abnormal Endfeel

End-feel is the end-of-range resistance quality of the joint. Each joint has a normal end sensation at a normal point in the motion range (ROM) or a correct end sensation at an incorrect ROM indicates a pathology. limited ROM? why? there are so many reasons which can affect on Range of motion. Intra-articular lesions, tightening of joint capsules, shortening of ligaments, pain, swelling, and trauma sometimes in or near the joint may be included. How can we distinguish these? Here, physical therapists are using' end feelings.' The sensation or feeling that the therapist detects when the joint is at the end of its available PROM is defined as an end feeling.

Several end-feelings are being used.it feels Hard. it will be painless. no patient response while movement. An example of bone to bone endfeel is elbow extension. In this type of end feel, there is a yielding compression (mushy feel) that stops further movement. Examples: elbow and knee flexion, in which movement is stopped by compression of the soft tissues, primarily the muscles. In a particularly slim person with little muscle bulk, the end feel of elbow flexion may be bone-to-bone.
There is a hard or firm (springy) type of movement with a slight give. At the end of the Range of Motion, there is a feeling of springy or elastic resistance.
The normal tissue stretch end feel has a feeling of “rising tension or stiffness.” so it can be divided into two types:
Examples: lateral rotation of the shoulder, and knee and metacarpophalangeal joint extension.



The abnormal end feels, 

several of which have subdivisions and each of which is commonly associated with some degree of pain or restricted movement. classified in Five :

1) Muscle Spasm : 

This end feel is invoked by movement, with a sudden dramatic arrest of movement often accompanied by pain. The end feel is sudden and hard.

An early muscle spasm occurs early in the ROM, almost as soon as movement starts; this type of muscle spasm is associated with inflammation and is seen in more acute conditions.

A late muscle spasm occurs at or near the end of the ROM. It is usually caused by instability and the resulting irritability caused by movement.

2) Capsular:

this ending feel is similar to tissue stretch. present earliest in ROM. ROM is reduced. 
this ending feel can be classified into
hard capsular, in which the end feel has a thicker stretching quality to it, and
soft capsular (boggy), which is similar to normal tissue stretch end feel but with a restricted ROM.


3) Bone-to-Bone

This abnormal end feel is similar to the normal bone-to-bone type, but the restriction occurs before the end of ROM.
An example is a bone-to-bone end feel in the cervical spine resulting from osteophyte formation.

4) Empty:

The empty end feel is detected when movement produces considerable pain. The movement cannot be performed or stops because of the pain.

5) Springy Block:

Similar to a tissue stretch, most commonly found in joints with menisci. There is a rebound effect with a thick stretching feel still it is not as stretchy as a hard capsular end feel.
it usually indicates an internal derangement within the joint.
Example: A springy block end feel may be found with a torn meniscus of a knee when it is locked or unable to go into full extension.

Significance of Endfeel
An appropriate assessment of end feel can support the examiner
  • To assess the type of pathology present
  • To identify the limiting structures and choose a focused and effective treatment
  • Determine a prognosis for the condition
  • And learn the severity or stage of the problem
  • By determining if the pain or restriction is the main problem, the examiner can determine if a more gentle treatment should be given (pain predominating) or a more vigorous treatment (restriction predominantly).

Examination Of Endfeel? How to Document?

  1. It takes practice and sensitivity to build the capacity to decide the kind of end-feel.
  2. When assessing passive movement, the examiner should apply overpressure of each passive movement at the end of the ROM to determine the quality of the end feel (the feeling the examiner "feels" in the joint as it reaches the end of the ROM).
  3. Passive ROMs, especially towards the end of the motion, have to be carried out slowly and carefully when testing the feeling of the end.
  4. Secure stabilization of the proximal bone to the joint being tested is critical to preventing multiple joints and structures from moving and interfering with the final feeling determination.
To be sure it is not causing severe symptoms. If the patient is able to hold a position without causing symptoms at the end of the physiological ROM (end range of active movement), or if the symptoms quickly ease after returning to the resting position, then the end feeling can be tested. Pain with a pathological final feeling is common (if the patient has severe pain at the end, the end feeling should be tested with extreme care only).

References
Susan B.O'Sullivan, Thomas J. Schmitz, George D. Fulk. Physical Rehabilitation. 6th edition. F. A. Davis Company. 2014.
David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.

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