Does adhesive capsulitis always mean a complete loss of passive shoulder movement?

Adhesive Capsulitis and Passive Range of Motion

No, adhesive capsulitis does not always mean you absolutely cannot passively move your shoulder—it means you have significantly reduced passive range of motion, not complete absence of movement. 1

Key Diagnostic Features

The defining characteristic of adhesive capsulitis is significant reduction in both active and passive range of motion, not complete immobility 2, 3. The condition is characterized by:

• Restricted passive motion in multiple planes, particularly external rotation and abduction 1, 4
• Progressive loss of movement rather than sudden complete immobility 2
• Pain accompanying the restricted motion, with severity varying by stage 4, 2

Clinical Presentation by Stage

The degree of passive motion restriction varies significantly depending on disease stage 2:

Stage 1 ("Freezing" Phase)

• Shoulder continuously loses passive motion over 4-6 months 2
• Movement is reduced but not absent 2
• Worsening pain accompanies progressive stiffness 2

Stage 2 ("Frozen" Phase)

• Continuing stiffness with maximal restriction of passive ROM 2
• This is when passive motion is most limited, but still present to some degree 2
• Pain and inflammation begin improving 2

Stage 3 ("Thawing" Phase)

• Restriction of shoulder motion decreases 2
• Passive ROM gradually increases 2

Important Clinical Distinctions

Reduced passive shoulder abduction and external rotation of the glenohumeral joint are predictors of shoulder pain in adhesive capsulitis, not indicators of complete immobility 1. The American Heart Association specifically notes that patients demonstrate "reduced passive shoulder abduction and external rotation" rather than absent motion 1.

Common Pitfall to Avoid

Do not confuse "significantly restricted" with "completely absent" passive motion 4, 3. The diagnosis requires demonstrable limitation in passive ROM, but patients retain some degree of passive movement throughout the disease course 2, 3.

Treatment Implications

The fact that passive motion is reduced but not absent is clinically relevant because 4, 2:

• Stretching exercises and joint mobilization remain viable treatment options since some passive motion exists 4
• Physical therapy focusing on improving ROM is recommended, which would be impossible if no passive motion existed 1, 4
• Manipulation under anesthesia or arthroscopic release are reserved for recalcitrant cases, not as first-line treatments 4, 2