Clinical Identifiers for Early-Stage Primary/Idiopathic Adhesive Capsulitis: Are We Seeing the Real Picture?. Issue 7 (1st July 2014)

• Record Type: Journal Article
• Authors: Walmsley, Sarah; Osmotherly, Peter G.; Rivett, Darren A.
• Is Part Of: Physical therapy. Volume 94:Issue 7(2014)
• Page Start: 968
• Page End: 976
• Publication Date: 2014-07-01
• Subjects: Physical therapy -- Periodicals; Physical therapy; Physical Therapy Modalities; Rehabilitation; Physical and Rehabilitation Medicine; Periodicals; 615.8205
• DOI: 10.2522/ptj.20130398
• Languages: English
• ISSNs: 0031-9023

Abstract

Abstract : Background: Adhesive capsulitis is often difficult to diagnose in its early stage and to differentiate from other common shoulder disorders. Objective: The aim of this study was to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study. Design: This was a cross-sectional study. Methods: Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately following an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of ≥70% for passive external rotation was deemed a positive anesthetic response (PAR). Results: Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR]=0.26, P =.03), pain at the end of range of all measured active movements (OR=0.06, P =.02), and global loss of passive glenohumeral movements (OR=0.23, P =.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR. Limitations: The lack of a recognized reference standard for diagnosing early-stage adhesive capsulitis remains problematic in all related research. Conclusions: None of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage.