Frozen Shoulder and the Capsular Pattern

Understanding Frozen Shoulder (Adhesive Capsulitis)

The American Heart Association notes that frozen shoulder has a high incidence (up to 72%) in certain populations, such as stroke patients 1

The American College of Radiology recommends that the classic capsular pattern involves greatest limitation in external rotation, followed by abduction, and then internal rotation 2, 3

The American College of Radiology suggests that MRI without contrast is often preferred for evaluating frozen shoulder as it can assess both bony morphology and soft tissue pathology 4
The American Heart Association found that range of lateral rotation has been identified as the factor most significantly related to shoulder pain onset 1

The American College of Sports Medicine notes that physical therapy approach should be tailored based on the specific pattern of limitation, with a focus on external rotation and abduction movements 1
The American Academy of Physical Medicine and Rehabilitation recommends avoiding overhead pulleys as they encourage uncontrolled abduction 1
The American College of Rheumatology found that intra-articular corticosteroid injections show significant short-term benefits 1
The American Physical Therapy Association suggests that functional electrical stimulation may improve shoulder lateral rotation 1

The American College of Sports Medicine notes that early intervention is crucial to prevent progression to a more severe frozen shoulder, and avoiding immobilization (such as arm slings) can help prevent frozen shoulder development 3, 5
The American Heart Association recommends patient education on proper positioning and movement to prevent further complications 1, 5

Patients with frozen shoulder typically do not demonstrate focal weakness, distinguishing it from rotator cuff pathology, according to the American Academy of Physical Medicine and Rehabilitation 6, 7
No swelling or atrophy is commonly observed in patients with frozen shoulder, as noted by the American Academy of Physical Medicine and Rehabilitation 7
Unlike rotator cuff dysfunction, patients with frozen shoulder do not demonstrate focal weakness with specific resistance testing, as stated by the American Academy of Physical Medicine and Rehabilitation 6, 7
The restriction is present in both active and passive motion equally, and do not confuse frozen shoulder with rotator cuff pathology—the latter shows focal weakness and may have preserved passive motion, according to the American Academy of Physical Medicine and Rehabilitation 6, 7

In individuals who have experienced a cerebrovascular accident, adhesive capsulitis is frequently accompanied by increased capsular stiffness and a shifted resting position of the scapula toward lateral rotation, which aids in recognizing the condition in this population. 8, 9

Tenderness on palpation of the shoulder region may be observed in post‑stroke patients with adhesive capsulitis, although it is not a definitive diagnostic sign. 8