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Use Imaging To Exclude Other Causes
- Start with plain radiographs to exclude fracture or significant arthritis and use ultrasound or MRI to assess the rotator cuff.
- On MRI, look for thickening of the joint capsule and decreased axillary recess space to support adhesive capsulitis.
Differentiate Instability And Impingement
- Use apprehension, relocation and load-and-shift tests to assess instability, which are usually negative in adhesive capsulitis.
- Note that impingement signs can be positive but patients often report pain at rest too, which helps distinguish the condition.
Match Treatment To Disease Phase
- Tailor management to the disease phase: focus on pain control in the painful phase and range-of-motion restoration in the frozen phase.
- Use treatments to enable effective physiotherapy rather than to shorten the overall disease course.