Overview of adhesive capsulitis
Adhesive capsulitis (AC), often referred to as frozen shoulder, is characterized by an initially painful and progressively restricted range of motion of the active and passive glenohumeral joint (GH) with spontaneous complete or nearly-complete recovery over a varied period of time.
- Frozen shoulder exam
- Painful stiff shoulder
This provocative condition causes fibrosis of the GH joint capsule, is accompanied by progressive stiffness and an important restriction of range of motion (typically external rotation).
In clinical practice, it can be very difficult to differentiate the early stages of AC from other shoulder pathologies.
Frozen shoulder exam
Currently, frozen shoulder diagnosis is based on the patient’s reported history and physical examination findings of the patient’s shoulder. Range of motion should be evaluated in all available planes and motions, noting any limitations. Patients with adhesive capsulitis will demonstrate a greater limitation in external rotation (ER) compared to internal rotation (IR) and abduction. For example, ER may be limited by 20 degrees, while IR and abduction are limited by 10. Additionally, any compensation or scapular replacement should be documented, as this often accompanies frozen shoulder.
Manual muscle testing (MMT) should include external rotation (ER), internal rotation (IR), and shoulder abduction. Patients with adhesive capsulitis or frozen shoulder show weakness in each of these movements relative to their opposite or unaffected side.
Frozen shoulder generally involves the following:
- A strong component of night pain
- Pain during rapid or unsupervised movements.
- Pain or discomfort when lying on the affected shoulder.
- Pain aggravated by movement.
- Patients experience both active and passive global ROM loss.
- Pain present in all final ranges of motion.
It is also important to assess functional limitations caused by combined movements of the shoulder, such as flexion and ER.
3 tests related to function for the first stage of primary adhesive capsulitis
This is an adapted version of a simple 3-test evaluation for frozen shoulder described by “Yang et al” in 2002 to assess functional limitations in patients with frozen shoulder. Get a free copy of a brochure for these tests here.
- Hand to the neck (shoulder flexion + ER)
- Head to the neck (shoulder flexion + external rotation)
0 – The fingers reach the posterior midline of the neck with the shoulder in total abduction and external rotation without wrist extension.
1 – The fingers reach the midline of the neck but do not have complete abduction and/or external rotation.
2 – The fingers spread the midline of the neck but with compensation for adduction in the horizontal plane or the elevation of the shoulder.
3 – The fingers touch the neck
4- The fingers do not reach the neck.
- From hand to the scapula (shoulder extension + internal rotation)
- Hand to the scapula (shoulder extension + IR)
0 – The hand reaches behind the trunk to the opposite scapula or 5 cm below in complete internal rotation
1- The hand almost reaches the opposite scapula, 6-15 cm below it.
2 – The hand reaches the opposite iliac crest.
3 – The hand reaches the buttock.
4 – The subject cannot move his hand behind the trunk.
- Scapula of the hand to the opposite side (horizontal adduction of the shoulder)
- Shoulder adduction
0 – The hand reaches the spine of the opposite scapula in full adduction without wrist flexion.
1- The hand reaches the column of the opposite scapula in full adduction.
2 – The hand passes through the midline of the trunk.
3 – The hand cannot permit the midline of the trunk.
Adhesive capsulitis measures an essential action for daily activities, such as using the arm to remove an object from a back pocket or tasks related to personal care.
Adhesive capsulitis measures an action important to daily activities, such as using the arm across the body to grasp the car seat belt or using the arm to turn the steering wheel.