Frozen Shoulder Diagnosis

Frozen Shoulder Diagnosis Questions Answered On This Page...

How is a frozen shoulder diagnosed?

A frozen shoulder is a condition which is termed a "clinical diagnosis". Clinical diagnoses are conditions which are primarily diagnosed by recognising a pattern to the onset or individual it is affecting and which can be confirmed reliably by confirmatory physical examination tests. 

What signs might there be in the clinical history that it is a frozen shoulder?

A frozen shoulder will typically have come on in middle aged individuals (40-60 years) and without any obvious change of activity or trauma. Often sufferer's will have other risk factors such as diabetes, high cholesterol or thyroid problems. Frozen shoulder pain is normally described as an intense pain in the upper arm and if a clinician asks, there will often be significant stiffness of motion as well as significant nocturnal pattern pain. 

Which physical examination tests can confirm a frozen shoulder?

There are two hallmarks of a frozen shoulder when performing a clinical examination. Firstly, the affected shoulder will demonstrate a characteristic pattern of reduced range of motion (stiffness) known as a capsular pattern. A capsular pattern of stiffness is one which affects all planes of movement at the affected shoulder including shoulder external rotation. 

Typically, many shoulder problems result in pain and stiffness in to shoulder internal rotation and shoulder flexion but spare shoulder external rotation. This means that a restriction to shoulder external rotation is very helpful diagnostically in cases of a frozen shoulder. The following videos from onlinephysioexpert.com demonstrate the different movements around the shoulder for learning...

• Shoulder external rotation: Shoulder Rotation Test - Is There a Capsular Restriction?

• Shoulder internal rotation: Shoulder Hand Behind Back (HBB) Flexibility Test 

• Shoulder flexion: Shoulder Raise Test

Many other shoulder conditions will result in some weakness or pain when manually resisting shoulder rotation and abduction strength. However, a frozen shoulder will not significantly affect these tendons. Therefore, the second hallmark of a frozen shoulder during a physical examination, is full or near to full rotator cuff tendon strength. 

Can imaging show a frozen shoulder?

Imaging plays an important role in musculoskeletal and orthopaedic assessment. However, the normal clinical imaging we use for diagnosis in many other conditions plays a limited role in the diagnosis of a frozen shoulder:

• Shoulder xrays do not any signs of a frozen shoulder

• Shoulder MRI scans may demonstrate some signs of a frozen shoulder including increased volume of intra-articular fluid, increased thickness (hypertrophy) and inflammatory signal of the shoulder capsule and in particular increased thickness of the coracohumeral ligament within the rotator interval. 

• Shoulder ultrasound may demonstrate similar findings to that of an MRI scan, in particular increased intensity and thickness of the coracohumeral ligament in the rotator interval.