Clinical identifiers for early-stage primary/idiopathic adhesive capsulitis

Adhesive capsulitis is frequently challenging to diagnose in its early stage and to differentiate from other common shoulder disorders. This study aimed to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study. Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in this cross-sectional study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately after an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of ≥70% for passive external rotation was deemed a positive anesthetic response (PAR). Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR]=0.26, P=.03), pain at the end of range of all measured active movements (OR=0.06, P=.02), and global loss of passive glenohumeral movements (OR=0.23, P=.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR.

This study did not validate any of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus.. Clinicians should be mindful that commonly used clinical identifiers may not be applicable to this stage.