From the Guidelines
Adhesive capsulitis is diagnosed through a combination of clinical evaluation and imaging studies, with a focus on assessing range of motion limitations and pain with movement, as well as excluding other potential causes of shoulder pain and stiffness. The diagnosis begins with a thorough medical history and physical examination, where the healthcare provider assesses range of motion limitations in the shoulder, particularly external rotation, abduction, and internal rotation, as noted in studies on poststroke shoulder pain 1. Pain with movement is typically present, especially at the extremes of motion. Imaging studies such as X-rays are often ordered first to rule out other conditions like arthritis or fractures, though they typically appear normal in adhesive capsulitis.
Key Diagnostic Factors
- Range of motion limitations, especially in external rotation, abduction, and internal rotation
- Pain with movement, particularly at the extremes of motion
- Exclusion of other potential causes of shoulder pain and stiffness, such as traction/compression neuropathy, complex regional pain syndrome, shoulder trauma, bursitis/tendonitis, rotator cuff tear, and heterotrophic ossification, as listed in the management of adult stroke rehabilitation care guideline 1
- Clinical presentation following the typical pattern of adhesive capsulitis: a painful phase, followed by a freezing phase, and finally a thawing phase, which can inform the diagnosis and treatment approach 1
Importance of Early Diagnosis
Early diagnosis is crucial as treatment initiated in the early stages may help prevent progression to more severe restriction and prolonged recovery time, highlighting the need for prompt and accurate diagnosis in clinical practice, as emphasized in the veterans affairs/department of defense clinical practice guideline for the management of adult stroke rehabilitation care 1.
From the Research
Diagnosis of Adhesive Capsulitis
The diagnosis of adhesive capsulitis, also known as "frozen shoulder," is typically made based on a combination of clinical evaluation and diagnostic imaging. The key characteristics of adhesive capsulitis include:
- Pain and decreased range of motion, especially in external rotation 2, 3, 4
- Idiopathic condition with increased prevalence in patients with diabetes mellitus and hypothyroidism 2, 3, 4
- Clinical findings may be rather unspecific and may overlap with other diseases, such as calcific tendinitis, rotator cuff pathology, and autoimmune disorders 5
Diagnostic Imaging
Imaging studies, such as magnetic resonance imaging (MRI), magnetic resonance arthrography, and high-resolution ultrasound, can help confirm the diagnosis and exclude other causes of shoulder pain. These imaging modalities can demonstrate specific pathological findings, including:
- Thickening of the joint capsule and of the coracohumeral ligament 2, 5
- Fibrosis of the subcoracoid fat triangle 5
- Extravasation of gadolinium outside the joint recesses 5
Differential Diagnosis
The differential diagnosis for adhesive capsulitis includes:
- Acromioclavicular arthropathy 3
- Autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis) 3
- Biceps tendinopathy 3
- Glenohumeral osteoarthritis 3
- Neoplasm 3
- Rotator cuff tendinopathy or tear (with or without impingement) 3
- Subacromial and subdeltoid bursitis 3
Clinical Evaluation
A thorough clinical evaluation is essential for diagnosing adhesive capsulitis. This includes: