February 2015

Adhesive Capsulitis Diagnostic Tip
Passive Loss of External Rotation > 20°

Slough_Feb 15Greater than 20° loss of passive external rotation compared to the uninvolved side (as measured with the patient’s elbow at his or her side with the examiner controlling for trunk rotation and humeral extension), should alert the examiner to a component of anterior capsular restriction and adhesive capsulitis in the absence of significant arthritis.

Anterior shoulder pain and lateral arm and deltoid insertional pain are common with altered scapular mechanics secondary to decreased glenohumeral joint motion.  Thickening of the rotator interval and anterior capsule restricts external rotation of the arm when it is at the side of the body.  Inferior capsular pouch involvement inhibits forward elevation of the arm.  Thickening of the posterior capsule restricts rotation with the arm at 90°of abduction.

Many consider global loss of active and passive glenohumeral range of motion as a diagnostic criterion, but a focus on passive external rotation loss is better evidenced, simple, memorable, and less likely to lead to confusion.  Previous adhesive capsulitis capsular restrictions have been considered greater than 50% loss of passive external rotation in comparison to the uninvolved shoulder, or loss of motion greater than 25% in at least 2 movement planes.  A 20° or more decreased passive ER at the side deficit is easier to check and remember, and should cause one to entertain the diagnosis of adhesive capsulitis.



1. Andrew S. Neviaser, MD; Robert J. Neviaser, MD: Adhesive Capsulitis of the Shoulder.  J Am Acad Orthop Surg September 2011 vol. 19 no. 9:536-542
2. William N. Levine, MD, Christine P. Kashyap, MD, Sean F. Bak, MD, Christopher S. Ahmad, MD, Theodore A. Blaine, MD, and Louis U. Bigliani, MD:  Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg 2007;16(5):569-573.

 Submitted by:
James A. Slough, MD
Buffalo, NY