What is the medical term for the inability to lift an arm above shoulder length, particularly in individuals over 40 years old?

Medical Terminology for Inability to Lift Arm Above Shoulder Level

The inability to lift the arm above shoulder level is most commonly termed "limited shoulder abduction" or "restricted shoulder elevation," with the two most likely underlying diagnoses being adhesive capsulitis (frozen shoulder) or rotator cuff tendinopathy/tear, particularly in individuals over 40 years old. 1

Primary Diagnostic Considerations

Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis is characterized by painful and limited both active AND passive range of motion, particularly affecting external rotation and abduction. 2, 3

Key distinguishing features include:

• Progressive loss of passive range of motion is the hallmark finding - if you cannot move the patient's arm passively above shoulder level, this strongly suggests adhesive capsulitis rather than rotator cuff pathology 1, 3
• Pain typically precedes the stiffness, progressing through freezing, frozen, and thawing phases over 1-2 years 3, 4
• Coracohumeral ligament thickening on MRI yields high specificity for diagnosis 3
• More common in patients with diabetes mellitus and hypothyroidism 3

Rotator Cuff Tendinopathy/Tear

Rotator cuff pathology presents with painful/weak active abduction but preserved passive motion - this is the critical distinction from adhesive capsulitis. 1

Characteristic features include:

• Pain during overhead activities with weakness, particularly affecting the supraspinatus tendon during abduction between 70-120 degrees 5, 1
• Hawkins' test is 92% sensitive (though only 25% specific) for impingement 5
• Neer's test is 88% sensitive (though only 33% specific) for impingement 5
• Focal weakness with decreased active range of motion during abduction with external or internal rotation 1
• Passive range of motion remains intact, unlike adhesive capsulitis 1

Critical Diagnostic Algorithm

To differentiate between these conditions, assess passive range of motion: 1

1. If passive abduction is limited and painful → suspect adhesive capsulitis 1, 3
2. If passive abduction is preserved but active abduction is painful/weak → suspect rotator cuff tendinopathy 1
3. If both active and passive motion are severely restricted in all planes → advanced adhesive capsulitis 2, 4

Secondary Considerations

Impingement Syndrome

• Repeated impingement of the coracoacromial arch onto the supraspinatus tendon causes pain specifically during the arc of abduction 5, 1
• Hypovascularity in the region proximal to the supraspinatus insertion contributes to pathology 5

Post-Surgical or Post-Cancer Treatment

• Breast cancer survivors may develop decreased range of motion, rotator cuff injury, or adhesive capsulitis after surgery 5
• Up to 50% of patients report limited shoulder range of motion after breast cancer treatment 5

Initial Management Approach

For Suspected Adhesive Capsulitis:

Glenohumeral intra-articular corticosteroid injections have significantly greater 4-6 week beneficial effect compared to other treatments and should be prioritized. 2

• Combined physiotherapy and corticosteroid injections provide greater improvement than physiotherapy alone 3
• Early diagnosis and treatment (phase 1) yields better outcomes than waiting until phase 2 when range of motion is completely reduced 6
• Hydrodilatation (capsular distension) combined with physical therapy shows significant improvement in pain and range of motion 6

For Suspected Rotator Cuff Tendinopathy:

Initial management should include complete rest from aggravating activities, followed by progressive stretching and strengthening. 1

• NSAIDs for acute pain management 1
• Physical therapy focusing on stretching and mobilization 5
• Subacromial corticosteroid injection if pain is related to rotator cuff or bursal inflammation 7
• Progress to rotator cuff and scapular stabilizer strengthening once pain-free motion is achieved 7, 1

Common Pitfalls to Avoid

Do not assume all shoulder stiffness is adhesive capsulitis - always assess passive range of motion to differentiate from rotator cuff pathology where passive motion is preserved. 1

Do not delay corticosteroid injection in true adhesive capsulitis - evidence strongly supports early intervention with intra-articular injections for superior short-term outcomes. 2

In patients over 40, bilateral presentation should raise suspicion for polymyalgia rheumatica - check inflammatory markers (ESR, CRP) and consider trial of low-dose corticosteroids if elevated. 7