Diagnosing Frozen Shoulder

Diagnosing frozen shoulder is a process of elimination—the physician must rule out conditions that cause similar symptoms, such as a rotator cuff tear.¹Adhesions in the Shoulder. PubMed Health website. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025850/. Accessed May 22, 2016.

A diagnosis requires a patient interview and physical exam, and may also involve medical imaging, such as an x-ray, and lab tests.

Patient interview. The physician may ask about the following:²Frozen shoulder causes. National Health Services website.http://www.nhs.uk/Conditions/Frozen-shoulder/Pages/Causes.aspx. Last reviewed March 17, 2016. Accessed August 12, 2016.

• Type of symptoms and the impact symptoms have on day-to-day tasks
• Degree of pain
• Whether or not pain affects sleep
• Additional health issues or injuries
• Medications that are being taken
• Prior treatment for this condition
• Movements or treatments that lesson or aggravate pain

The patient should tell the physician about any previous shoulder surgeries, because shoulder surgery can cause shoulder stiffness.¹Adhesions in the Shoulder. PubMed Health website. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025850/. Accessed May 22, 2016.

See Rotator Cuff Tear Surgery

Physical examination. After the patient interview, the physician will conduct a physical exam that may include:

• Moving the shoulder in multiple directions to test whether or not there is movement, and to see if pain is elicited with these motions
• Applying force on the shoulder to determine painful areas
• Comparing the shoulder’s “passive range of motion” (when an outside force—usually another person—moves the patient’s shoulder) to “active range of motion” (when the patient moves his/her own shoulder). Limited external rotation (reaching backward with the elbow bent to 90 degrees and held closely to the body) is one of the hallmarks of a frozen shoulder.

People with frozen shoulder will be restricted with both active and passive ranges of motion.

The physician will also note any swelling or bruising. Decreased muscle tone may also be apparent, since muscles can deteriorate from lack of use.

See Soft Tissues of the Shoulder

Medical imaging. A doctor may order:

• X-rays of the shoulder to identify any bone-related issues, such as bone spurs.
• Magnetic resonance imaging (MRI) to identify any damage to soft tissues, such as a rotator cuff tear. While an MRI can potentially show inflammation, it cannot definitively diagnose frozen shoulder.³Frozen Shoulder. MedlinePlus website. https://www.nlm.nih.gov/medlineplus/ency/article/000455.htm. Last updated November 2014. Accessed May 29, 2016.

These images are used to check for and rule out other problems, such as shoulder dislocation, a loose bone fragment, osteoarthritis, or bone tumors.

See Shoulder Dislocation Injury (Dislocated Shoulder)

Lab tests. In some cases, blood tests are also part of the diagnosis process. These tests may be run to detect:

• Diabetes, because people with diabetes are at an increased risk of developing frozen shoulder.
• Polymyalgia rheumatic, an inflammatory condition that causes stiffness and muscle discomfort. If left untreated, people with polymyalgia rheumatica may develop frozen shoulder.
• Shoulder tumors that can limit movement and cause pain in the shoulder.⁴Quan GM, Carr D, Schlicht S, Powell G, Choong PF. Lessons learnt from the painful shoulder; a case series of malignant shoulder girdle tumours misdiagnosed as frozen shoulder. Int Semin Surg Oncol. 2005;2(1):2. Tumors in the shoulder are rare.

In some cases, a diagnosis is delayed because frozen shoulder symptoms can overlap with other shoulder problems.