Movement and pain patterns in early stage primary/idiopathic adhesive capsulitis: a factor analysis

Objectives

To evaluate patients clinically diagnosed with early stage primary/idiopathic adhesive capsulitis to determine the existence of any pattern of movement loss and associated pain that may facilitate early recognition.

Design

Cross-sectional study.

Setting

Private upper limb specialty clinic, Newcastle, Australia.

Participants

Fifty-two patients clinically diagnosed with early stage adhesive capsulitis by a medical practitioner or physiotherapist.

Main outcome measures

Percentage loss of active and passive ranges of eight shoulder movements and the pain level at the end of each movement. The reason for limitation of movement was also recorded.

Results

Factor analysis clearly identified two groups for percentage loss of active range of movement. Notably external rotation movements grouped separately from other movements. A single group emerged for percentage loss of passive range of movement suggesting a non-specific global loss. For both pain at the end of active range of movement and passive range of movement two groups emerged, however the delineation between the groups was less clear than for percentage loss of active range of movement suggesting a pattern of end range pain may be less useful in identifying patients in this stage.

Conclusions

External rotation movements in neutral and abduction generally group together and behave differently to other shoulder movements in patients clinically diagnosed with early stage primary/idiopathic adhesive capsulitis. In particular external rotation in abduction has emerged as the most painfully limited movement in this sample. This study provides preliminary evidence of patterns of range of movement and end range pain that require testing in a population of mixed shoulder diagnoses to determine their diagnostic utility for early stage adhesive capsulitis.