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.