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Physical Findings of Adhesive Capsulitis

The physical examination of patients with adhesive capsulitis reveals a global reduction in range of motion with a marked decrease in glenohumeral translation also present. Examination of the opposite shoulder (if normal) is performed to identify the patient’s expected normal range of motion for comparison. Evaluation for limitation of pure glenohumeral motion (best measured in the supine position with the scapula immobilized) is often more demonstrative of the extent of contracture present than the measurement of total shoulder girdle range of motion (glenohumeral plus scapulothoracic motion). The latter, however, is more closely linked to the patient’s clinical perception of their ability to function, so frequently both types of shoulder motion are measured and followed. Patients with adhesive capsulitis will demonstrate at least a 20% reduction in range of motion, and findings of 50% or greater loss of motion are not uncommon.

Some degree of weakness is often noted when examining for shoulder girdle strength in patients with adhesive capsulitis. The magnitude of this finding may be misleading however if the patient is experiencing an inflammatory component to their disease. When this is present, strength testing can produce substantial pain and result in a limited resistive effort. To obtain the most representative assessment of the patient’s true shoulder strength, resistive strength testing should be performed within the patient’s comfortable arc of motion, often testing elevation strength at approximately 30 to 45 degrees of elevation, and rotational strength with the arm at the side.

Pain is often reported to be present diffusely throughout the shoulder girdle; however tenderness with palpation is often greatest over the anterior subacromial bursa, the proximal biceps tendon, the rotator interval area and the anterior capsule. The posterior capsule, the lateral subdeltoid recess, and rotator cuff area often have less tenderness with the acromioclavicular joint often spared. Depending upon the phase of the disease process tenderness can be quite severe, so palpation is often best performed at the end of the exam to avoid patient guarding while examining for range of motion and strength.

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