title: Clinical identifiers for early-stage primary/idiopathic adhesive capsulitis: are we seeing the real picture?
abstract: BACKGROUND
  Adhesive capsulitis is often difficult to diagnose in its early stage and to differentiate from other common shoulder disorders.
  
  
  OBJECTIVE
  The aim of this study was to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study.
  
  
  METHODS
  This was a cross-sectional study.
  
  
  METHODS
  Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately following an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of ≥70% for passive external rotation was deemed a positive anesthetic response (PAR).
  
  
  RESULTS
  Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR]=0.26, P=.03), pain at the end of range of all measured active movements (OR=0.06, P=.02), and global loss of passive glenohumeral movements (OR=0.23, P=.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR.
  
  
  CONCLUSIONS
  The lack of a recognized reference standard for diagnosing early-stage adhesive capsulitis remains problematic in all related research.
  
  
  CONCLUSIONS
  None of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage.
authors.affiliation: S. Walmsley, MAppSc(Ortho Physio), Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia. sarah.walmsley@uon.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Walmsley
authors.affiliation: P.G. Osmotherly, PhD, Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Osmotherly
authors.affiliation: D.A. Rivett, PhD, Discipline of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle.
authors.forename: Darren A
authors.initials: DA
authors.lastname: Rivett
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D018771:Arthralgia / Q000209:etiology*; D002062:Bursitis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology*
chemical_list: D000779:Anesthetics, Local