Physical Examination Findings in Adhesive Capsulitis
The hallmark physical examination finding in adhesive capsulitis is equal restriction of both active and passive range of motion in all planes, with external rotation being the most severely affected, followed by abduction, and then internal rotation—this capsular pattern distinguishes it from rotator cuff pathology where passive motion remains relatively preserved. 1, 2
Key Range of Motion Findings
External (lateral) rotation is the most significantly restricted movement and correlates most strongly with the onset of shoulder pain in adhesive capsulitis. 1, 3 This is the single most important finding to assess during examination.
- Abduction is severely restricted, particularly in the frozen stage of the condition 3
- Internal rotation is also limited but typically less severely than external rotation and abduction 1
- The restriction is present equally in both active and passive motion—this is critical for diagnosis 1, 2
Distinguishing Features from Other Shoulder Pathology
Patients with adhesive capsulitis do not demonstrate focal weakness with specific resistance testing, which distinguishes it from rotator cuff pathology. 1, 2 This is a crucial differentiating feature that prevents misdiagnosis.
- No swelling or muscle atrophy is observed on inspection 1
- Passive range of motion is equally restricted as active range of motion—unlike rotator cuff tears where passive motion may be preserved despite active motion limitations 1, 2
- Strength testing does not reveal focal weakness when resistance is applied, contrasting with rotator cuff dysfunction 1
Additional Examination Considerations
In post-stroke patients with adhesive capsulitis, capsular stiffness and altered resting position of the scapula in lateral rotation may be present. 4
- Tenderness to palpation may be present but is not a defining feature 4
- The metacarpophalangeal and proximal interphalangeal joints can show pain, tenderness, and edema when shoulder-hand syndrome develops in post-stroke patients 3
Critical Differential Diagnosis Points
Degenerative joint disease, crystal arthropathies, septic arthritis, calcific tendinitis, acromioclavicular joint disease, and subacromial/subdeltoid bursitis must be excluded, as these can produce overlapping clinical pictures. 3, 2 The key distinguishing feature remains the equal restriction of both active and passive motion in all planes, particularly external rotation.
Rotator cuff pathology shows focal weakness and may have preserved passive motion, making it the most important condition to differentiate from adhesive capsulitis during physical examination. 1, 2