investigations

Last edited 04/2022 and last reviewed 05/2022

Since frozen shoulder is generally a clinical diagnosis, investigations are carried out if other pathologies are suspected (1).

  • radiography
    • X-ray to rule out other conditions like osteoarthritis or a bone tumor
  • biochemical or haemoatological tests e.g. – ESR, CRP (1)

Notes (2):       

  • it has been stated that most orthopaedic surgeons would not investigate a frozen shoulder beyond a plain x ray
  • plain radiographs of the frozen shoulder may well be reported as normal, although they may show periarticular osteopenia as a result of disuse
  • a further review noted (3)
    • ultrasound and magnetic resonance imaging may be considered depending on the clinical features and differential diagnoses
    • differential diagnoses to consider include (4)
      • tears or tendinitis of the rotator cuff e.g. supraspinatus tendinitis or the painful arc syndrome - pain present in a small arc of movement, and only during active movement and, unlike frozen shoulder, the range of passive movements is generally normal
      • stiffness following shoulder injury - stiffness is greatest immediately after the injury and then declines. In a frozen shoulder, stiffness gradually increases after the injury over a period of several months
      • stiffness from disuse - a shoulder which is not used will gradually become stiff, for example, a broken forearm which is nursed overcautiously. However, the pattern of stiffness differs from that of a frozen shoulder
      • reflex sympathetic dystrophy - shoulder pain and stiffness may follow a stroke or myocardial infarction. A mild reflex sympathetic dystrophy may quite closely resemble a frozen shoulder, but severe forms of the disease also induce trophic and vasomotor changes in the hand
      • arthritis of the shoulder joint
      • polymyalgia rheumatica - especially if both shoulders are affected
      • infective arthritis in an immunosuppressed patient
      • polymyositis
      • Pancoast's syndrome
      • a posterior dislocation of the glenohumeral joint that has become locked
      • early Parkinson's disease (4)

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