endfeels

End-feel is the sensation a clinician perceives at the end of passive joint range of motion, produced by the resisting tissues around a joint. It is assessed during physical examination to help distinguish normal tissue tension from pathological restriction and to guide further testing. End-feel should be evaluated with the joint relaxed, movements performed slowly, and the result compared with the opposite joint when possible.

Normal end-feel is categorized as soft, firm, or hard. Soft end-feel occurs when soft tissue approximation limits movement, such as knee flexion where the thigh and calf come into contact. Firm end-feel results from capsuloligamentous stretch or muscular tension, typical of many joints in late ROM (for example, ankle dorsiflexion or shoulder external rotation). Hard end-feel arises from bony contact between joint surfaces, as seen with elbow extension.

Abnormal end-feels can indicate pathology. A soft end-feel earlier in ROM or lasting longer than expected may reflect edema, effusion, or synovitis. A hard end-feel earlier than normal can suggest osteoarthritis, osteophytes, or intra-articular loose bodies. A springy end-feel, with a rebound after initial resistance, is associated with intra-articular pathology such as a meniscal tear or cartilage damage. An empty end-feel occurs when pain or guarding prevents reaching the ROM limit, often due to acute inflammation, fracture, or significant pain. A spasm or guarding end-feel involves a sudden, involuntary muscle contraction limiting movement.

Interpreting end-feel requires clinical context, including the specific joint, the patient’s age and activity, and bilateral comparison. End-feel is one component of the examination and should be integrated with history, other tests, and imaging as indicated.