Frozen Shoulder: Understanding, Self-Assessment, and Professional Diagnosis

How to test frozen shoulder?

Testing for frozen shoulder primarily involves assessing the characteristic progressive loss of both active and passive range of motion in multiple planes, accompanied by pain, which distinguishes it from other shoulder conditions. While self-assessment can provide clues, a definitive diagnosis requires evaluation by a healthcare professional.

Understanding Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, medically known as adhesive capsulitis, is a debilitating condition characterized by stiffness and pain in the shoulder joint. It occurs when the connective tissue capsule surrounding the shoulder joint thickens and tightens, restricting movement. The condition typically progresses through three stages:

• Freezing Stage: Gradual onset of pain, with a progressive loss of range of motion. Pain often worsens at night.
• Frozen Stage: Pain may decrease, but the stiffness remains significant, making daily activities challenging. The shoulder is "frozen" in its limited range.
• Thawing Stage: Gradual improvement in range of motion and a reduction in pain. This stage can take several months to years.

Unlike many other shoulder conditions, frozen shoulder is unique because it affects both active (movement you perform yourself) and passive (movement performed by someone else) range of motion, and it typically restricts movement in multiple directions.

The Hallmarks of Frozen Shoulder: Key Indicators

The most defining characteristic of frozen shoulder is a significant and progressive loss of both active and passive range of motion across multiple planes (e.g., elevation, rotation, abduction). This restriction is often disproportionate to the level of pain.

Key Indicators Include:

• Gradual Onset of Pain: Pain often starts subtly and worsens over time.
• Progressive Stiffness: The shoulder gradually becomes stiffer, limiting everyday activities.
• Pain at Rest and During Activity: Pain can be present even when not moving the shoulder, and it often intensifies with movement, particularly at the extremes of motion.
• Difficulty with Daily Tasks: Struggling with activities like reaching overhead, behind the back, or out to the side (e.g., washing hair, fastening a bra, reaching for a seatbelt).
• Sleep Disturbance: Pain often worsens at night, making it difficult to find a comfortable sleeping position.

Self-Assessment: Initial Observations and Simple Tests

While self-assessment cannot replace a professional diagnosis, it can help you identify patterns consistent with frozen shoulder. The key is to compare the affected shoulder's movement and sensation to your unaffected shoulder.

1. Observe Your Daily Activities:

• Reaching Overhead: How high can you lift your arm directly in front of you?
• Reaching Out to the Side: Can you raise your arm directly out to the side to shoulder height or higher?
• Reaching Behind Your Back (Internal Rotation): Can you reach your opposite shoulder blade with the back of your hand? Can you fasten a bra or tuck in a shirt?
• External Rotation: Can you place your hand behind your head, or rotate your arm outwards from your side?

2. Assess Pain Characteristics:

• When does the pain occur? Is it constant?
• Does the pain feel like a deep ache or a sharp, catching pain?
• Does the pain intensify when you try to move beyond a certain point?

3. Simple Range of Motion (ROM) Tests (Active and Passive): For each test, gently move your arm as far as comfortable, then gently use your other hand to try and push it a little further (passive range of motion). Note if the movement is restricted and if pain increases.

• Forward Flexion (Active & Passive):

  • How to Test: Stand upright. Keeping your arm straight, slowly lift your affected arm forward and up, as if reaching for the ceiling. Note how high you can go.
  • Passive Assessment: Use your other hand to gently push the affected arm a little higher.
  • Observation: In frozen shoulder, both active and passive forward flexion will be significantly limited, often stopping well short of overhead.

• Abduction (Active & Passive):

  • How to Test: Stand upright. Slowly lift your affected arm directly out to the side, away from your body, as if making a "T" shape. Note the angle you can achieve.
  • Passive Assessment: Use your other hand to gently push the affected arm a little further out.
  • Observation: Both active and passive abduction will be restricted. You may find it difficult to lift the arm beyond 90 degrees or even less.

• External Rotation (Active & Passive):

  • How to Test: Stand with your elbow bent at 90 degrees, tucked into your side. Keeping your elbow fixed, rotate your forearm outwards, away from your body, as if opening a door.
  • Passive Assessment: Gently use your other hand to push the affected forearm further outwards.
  • Observation: This is often one of the most significantly limited movements in frozen shoulder. Both active and passive external rotation will be very restricted.

• Internal Rotation (Active & Passive):

  • How to Test: Reach your affected arm behind your back, trying to touch your opposite shoulder blade or reach up your spine.
  • Passive Assessment: This is harder to self-assess passively, but you can gently try to guide your hand higher up your back with your other hand.
  • Observation: Both active and passive internal rotation will be limited, making it difficult to reach behind you.

Crucial Observation: The key differentiator for frozen shoulder during these tests is that both active (you moving it) and passive (someone else moving it, or you gently assisting it) range of motion are significantly limited in multiple planes. If you can move your arm further when someone else helps you (or you use your other hand), it might indicate a different issue, such as a muscle weakness or rotator cuff problem.

Differentiating Frozen Shoulder from Other Conditions

Many shoulder conditions cause pain and limited movement, but frozen shoulder has distinct characteristics:

• Rotator Cuff Tears/Tendinitis: Often cause pain with specific active movements, but passive range of motion may be less affected or near normal, especially in multiple planes. Weakness is often a primary symptom.
• Shoulder Impingement: Pain often occurs with overhead movements, but full passive range of motion might be preserved.
• Arthritis: Can cause stiffness and pain, but the pattern of limitation might differ, and X-rays would show joint space narrowing or bone spurs.

The hallmark of frozen shoulder is the global restriction of passive range of motion, particularly in external rotation, abduction, and forward flexion, which is not easily overcome by gentle external force.

When to Seek Professional Diagnosis

While self-assessment can raise suspicion, it is not a substitute for a professional medical diagnosis. If you suspect you have frozen shoulder, or are experiencing persistent shoulder pain and stiffness, consult a healthcare professional.

A professional assessment typically involves:

• Thorough Physical Examination: A doctor or physical therapist will assess your active and passive range of motion, palpate the shoulder, and perform specific tests to rule out other conditions.
• Medical History: Discussing your symptoms, their onset, and any relevant medical conditions (e.g., diabetes, thyroid issues, which are risk factors for frozen shoulder).
• Imaging Tests: While frozen shoulder is primarily a clinical diagnosis, imaging may be used to rule out other conditions.
  • X-rays: To rule out arthritis or bone spurs.
  • MRI (Magnetic Resonance Imaging): Can show thickening of the joint capsule and rule out rotator cuff tears or other soft tissue injuries.

Important Considerations and Next Steps

• Early Intervention: If diagnosed with frozen shoulder, early intervention with physical therapy can be beneficial in managing pain and preserving as much motion as possible.
• Patience is Key: Frozen shoulder is a self-limiting condition, meaning it eventually resolves on its own, but it can take a long time (1-3 years).
• Avoid Forcing Movement: Do not aggressively stretch or force your shoulder through pain, especially in the freezing stage, as this can worsen inflammation. Gentle, controlled movements under professional guidance are crucial.
• Medical Management: Your doctor may recommend pain relievers, anti-inflammatory medications, corticosteroid injections, or in some cases, hydrodilatation or manipulation under anesthesia for severe, persistent cases.

Understanding how to identify the characteristic signs of frozen shoulder can empower you to seek timely and appropriate care, leading to better management and recovery outcomes.