Adhesive Capsulitis (Frozen Shoulder) Clinical Presentation

Updated: May 17, 2017
  • Author: Jefferson R Roberts, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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Patients in the initial (freezing) stage of frozen shoulder syndrome (FSS) will describe the following:

  • Insidious onset of vague, dull pain at the deltoid insertion
  • Pain with shoulder movement
  • Nagging pain at night, with sleep deprivation and the inability to sleep on the affected side
  • Marked limitation of active and passive shoulder rotation, particularly external rotation

The pain of FSS can be described as dull or aching.  The pain leads to significant disability, affecting the activities of daily living, work, and leisure. [30]

During the second (frozen) stage, patients will complain of stiffness and severe loss of shoulder motion. The pain will be less pronounced. Patients will endorse the inability to reach over their head, to their side, and across their chest with the affected arm, or to scratch their back or put on a coat. The contralateral shoulder often becomes symptomatic years after FSS develops in the first shoulder. [11]


Physical Examination

On examination, the patient will have tenderness at the deltoid insertion and over the anterior capsule and posterior capsule with deep palpation. Compensatory scapulothroacic motion can create pain around the medial scapula. Foward flexion, abduction, and internal and external rotation of the shoulder should be assessed. Reduction in active and passive range of motion at the glenohumeral joint compared with the unaffected shoulder will be present. Limitation of external rotation and abduction will be the most prominent findings.