Adhesive Capsulitis (Frozen Shoulder) Clinical Presentation

Updated: Jul 21, 2022
  • Author: Jefferson R Roberts, MD; Chief Editor: Herbert S Diamond, MD  more...
  • Print


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. [31]

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. [12]


Physical Examination

The patient's posture should be observed while he or she is wearing a gown and sitting on a stool. The examiner should note whether the patient is listing to one side because of pain, or holding the neck to one side because of spasm or pain. Such initial observations help determine whether a cervical condition may be contributing to the patient's symptomatology.

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. Forward flexion, abduction, and internal and external rotation of the shoulder should be assessed. Active and passive range of motion at the glenohumeral joint will be reduced, compared with the unaffected shoulder. Limitation of external rotation and abduction will be the most prominent findings.