Key result
Pain at the end of range of all measured active movements was the only remaining identifier but was associated with reduced odds of a positive anesthetic response (OR 0.06, P=0.02).
Why the study?
Adhesive capsulitis is difficult to diagnose in its early stage and to differentiate from other common shoulder disorders, and clinical identifiers lack validation.
Do the 8 proposed clinical identifiers accurately diagnose early-stage primary/idiopathic adhesive capsulitis?
Cross-Sectional (n=64)
Do the 8 proposed clinical identifiers accurately diagnose early-stage primary/idiopathic adhesive capsulitis?
Previously proposed expert consensus clinical identifiers for early-stage adhesive capsulitis were not validated, indicating they may not be reliable diagnostic tools for this stage.
Answers are grounded in this paper and cite their sources.
Proposed identifiers should not guide early adhesive capsulitis diagnosis; challenges expert consensus and leaves open need for validated criteria.
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.
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Walmsley et al. (2014) conducted a cross-sectional in Early-stage primary/idiopathic adhesive capsulitis (n=64). Proposed clinical identifiers (e.g., pain at the end of range of all measured active movements) was evaluated on Positive anesthetic response (PAR) defined as pain relief of ≥70% for passive external rotation (OR 0.06, p=0.02). Pain at the end of range of all measured active movements was the only remaining identifier but was associated with reduced odds of a positive anesthetic response (OR 0.06, P=0.02).
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