Adhesive capsulitis — SCE Rheumatology MCQ

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ModerateOsteoarthritis and Soft Tissue RheumatologyAdhesive capsulitisSCE Rheumatology

A 31-year-old woman has diabetes, gradual shoulder pain and marked restriction of active and passive external rotation with normal radiography. What is the most appropriate investigation?

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Correct answer: A — Plain radiography to exclude alternative pathology

Plain radiography to exclude alternative pathology is the single best answer because global active and passive restriction, especially external rotation, suggests adhesive capsulitis. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Synovial fluid microscopy, Gram stain and culture is less suitable because it fits a different clinical pattern or a different treatment threshold; MRI of the sacroiliac joints, High-resolution CT chest and Renal biopsy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG226; NICE CKS soft tissue rheumatology