Frozen Shoulder

Procedure

Patient seated. Press firmly with your thumb over the coracoid process (in the hollow just below the outer third of the collarbone), then with the same pressure over the acromioclavicular joint and over the front-outer edge of the acromion (subacromial area). Ask the patient to score the pain at each spot out of 10.

Positive Finding

Pain over the coracoid area at least 3 points higher (out of 10) than at both the acromioclavicular joint and the subacromial area.

Sensitivity / Specificity

Reference: Carbone S, Gumina S, Vestri AR, Postacchini R. Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis. Int Orthop. 2010;34(3):385-8. Mertens MG, Meeus M, Pieters L, Balasch-Bernat M, Dueñas L, Verborgt O, et al. An Instrument-Assisted Coracoid Pain Test: An Exploratory Diagnostic Accuracy Study. Int J Environ Res Public Health. 2022;19(19).

Interpretation

Supports frozen shoulder in a painful, stiff shoulder; the tissues around the coracoid (coracohumeral ligament and rotator interval) thicken early in the condition. Use it together with the defining finding, loss of passive movement in every direction (especially external rotation), and a normal X-ray to exclude glenohumeral arthritis and a locked posterior dislocation. From one study by the test's originators (Carbone 2010): 85 people with frozen shoulder compared with 595 people with other painful shoulder conditions (rotator cuff tear, calcific tendinitis, glenohumeral arthritis, acromioclavicular joint problems). Specificity was 87–89% depending on the comparison condition. In the only repeat study (Mertens 2022: 35 people with frozen shoulder and 35 healthy people, pressure measured with an algometer), the original version of the test was positive far less often, so its real-world sensitivity may be much lower. Not yet confirmed by independent researchers.

Procedure

Patient supine or seated. Stabilise the scapula and passively raise the arm out to the side until the end of range. Compare with the other side and with the patient's active range.

Positive Finding

Passive abduction clearly limited, with the scapula moving early, and similar to the active range.

Interpretation

In frozen shoulder, active and passive movement are both lost. When passive movement is full but active is limited, look instead for a rotator cuff problem. Frozen shoulder is a clinical diagnosis based on global restriction of passive range of motion; validated sensitivity/specificity for individual range-of-motion signs are not established.

Procedure

Patient supine or seated, arm at the side, elbow bent to 90°. Passively rotate the forearm outwards to the end of range and compare with the other side.

Positive Finding

Marked loss of passive external rotation compared with the other side, with a firm end-feel.

Interpretation

Loss of passive external rotation is the most characteristic finding in frozen shoulder. The same finding occurs with glenohumeral osteoarthritis and a locked posterior dislocation, so an X-ray is advised when external rotation is lost. The previously cited Reiman & Matheson (2011) reference could not be verified against PubMed.

Procedure

Patient supine, shoulder abducted to 90° if possible, elbow bent to 90°. Stabilise the scapula and passively rotate the forearm downwards, comparing sides. Functional internal rotation can also be recorded as how far up the back the thumb reaches.

Positive Finding

Clearly reduced internal rotation compared with the other side.

Interpretation

Frozen shoulder usually restricts external rotation, abduction and internal rotation together. Record the ranges to track recovery. Frozen shoulder is a clinical diagnosis based on global restriction of passive range of motion; validated sensitivity/specificity for individual range-of-motion signs are not established.

Procedure

Patient supine with the scapula stabilised against the plinth. Bring the arm across the body at 90° of flexion and compare the range with the other side.

Positive Finding

Reduced range compared with the other side, with a firm end-feel.

Interpretation

Reflects posterior capsule stiffness, which often accompanies frozen shoulder. A range measure for monitoring, not a diagnostic test. Frozen shoulder is a clinical diagnosis based on global restriction of passive range of motion; validated sensitivity/specificity for individual range-of-motion signs are not established.

Procedure

Observe from behind as the patient raises both arms as far as possible and lowers them.

Positive Finding

Early shrugging and upward rotation of the scapula to make up for lost glenohumeral movement.

Reference: Kibler WB et al., Br J Sports Med 2013; PMID 23580420

Interpretation

Compensatory scapular movement is expected when glenohumeral movement is lost. It describes how the patient moves, which helps plan exercise; it is not a diagnostic test. Kibler (2013, Br J Sports Med — not JOSPT as previously cited) provides a reliable observational method for scapular dyskinesis, not a diagnostic sensitivity/specificity pair.

Procedure

Ask the patient to raise both arms forwards overhead, then to place the hand behind the neck (abduction with external rotation), comparing sides.

Positive Finding

Reduced range, or unable to reach behind the neck because of stiffness or pain.

Interpretation

A functional measure of combined elevation and external rotation that is useful for tracking recovery. It is not a diagnostic test. Frozen shoulder is a clinical diagnosis based on global restriction of passive range of motion; validated sensitivity/specificity for individual range-of-motion signs are not established.