Frozen Shoulder Diagnosis

Frozen shoulder, also known as adhesive capsulitis, refers to chronic aseptic inflammation of the shoulder capsule and surrounding soft tissues, leading to restricted shoulder movement and persistent pain. The disease progresses slowly, and if not diagnosed and treated in the early stages, it can easily develop into joint stiffness or even permanent functional limitation. Diagnosis of frozen shoulder relies on medical history, physical examination, functional assessment, and relevant imaging techniques.

Diagnostic Criteria for Frozen Shoulder

1. Clinical Symptom Evaluation

Patients often report persistent dull shoulder pain, which worsens at night or with weather changes. Early stages are mainly characterized by pain, followed by progressive stiffness and limited motion, showing distinct clinical phases.

2. Physical Examination

Assessing the range of shoulder flexion, abduction, and external rotation helps determine the extent of motion limitation. Tenderness is often noted on the affected shoulder, especially in the anterior deltoid and acromial regions.

3. Imaging Studies

X-rays can rule out bony pathologies of the shoulder joint, while MRI and ultrasound are more useful in detecting inflammatory thickening of the capsule, bursal effusion, tendon abnormalities, and other soft tissue lesions, serving as important diagnostic aids.

4. Functional Scoring

Standardized questionnaires such as the Constant score and DASH scale are used to evaluate the degree of functional impairment, assist in staging, and facilitate the development of personalized treatment plans.

5. Diagnostic Injection Test

In some cases, a local lidocaine injection is administered, and if symptoms improve significantly in a short period, this supports the diagnosis of frozen shoulder while excluding other conditions such as shoulder impingement syndrome.

6. Exclusion of Other Diseases

It is essential to exclude conditions such as cervical spondylosis, rotator cuff tears, biceps tendonitis, and rheumatoid arthritis before diagnosing frozen shoulder. Differential diagnosis based on imaging and physical signs is crucial to prevent misdiagnosis or missed diagnosis.

7. Medical History and Onset Features

Detailed inquiry into prior trauma, diabetes, cervical spine issues, and other underlying conditions helps determine potential triggers and disease progression. Most patients develop symptoms in middle age or later, with gradual worsening, consistent with the chronic inflammatory nature of the disease.

8. Heat Sensitivity and Passive Motion Tests

Applying heat to the shoulder and observing stiffness relief can help identify the adhesion stage. Passive arm raising or rotation tests further assess the extent of restriction and pain response, serving as key diagnostic tools.

9. Clinical Staging

Frozen shoulder is generally divided into three stages: pre-freezing (pain predominant), freezing (stiffness predominant), and thawing (functional recovery). Recognizing these stages helps with comprehensive assessment of the disease.

Conclusion

Experts at United Life International Medical Center remind us that early symptoms of frozen shoulder are easily overlooked and often mistaken for ordinary strain. Once persistent shoulder pain or limited mobility occurs, medical attention should be sought promptly. Combining imaging and functional assessments ensures accurate diagnosis. Novel treatments such as stem cell therapy have been shown to promote shoulder function recovery, with earlier intervention leading to better outcomes.