Adhesive capsulitis — SCE Rheumatology MCQ

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EasyOsteoarthritis and soft tissue rheumatologyAdhesive capsulitisSCE Rheumatology

A 54-year-old woman with diabetes presents with a 4-month history of gradually progressive unilateral shoulder pain and stiffness. There has been no trauma, fever or systemic illness. Examination shows restriction of both active and passive shoulder movement, with external rotation disproportionately affected. A plain shoulder radiograph is normal. What is the most likely diagnosis?

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Correct answer: A — Adhesive capsulitis

The diagnosis is adhesive capsulitis (frozen shoulder). Its characteristic examination finding is restriction of both active and passive glenohumeral movement, with passive external rotation disproportionately affected. The gradual onset, normal radiograph and association with diabetes further support the diagnosis. Rotator cuff tears and subacromial bursitis usually produce pain, weakness or a painful arc, while passive movement is relatively preserved. Polymyalgia rheumatica typically causes bilateral shoulder and hip-girdle aching with inflammatory features rather than a fixed unilateral capsular restriction. Septic arthritis generally presents acutely with severe pain, marked movement intolerance and often fever or systemic illness.

Reference: NHS Tayside RefGuide, Adhesive Capsulitis, symptoms and signs section, current page (next review 2027): https://www.rightdecisions.scot.nhs.uk/nhs-tayside-refguide/surgery-and-orthopaedics/orthopaedic-and-trauma-surgery/shoulder-and-elbow/adhesive-capsulitis/?UNLID=22638775202621594927