Shoulder stiffness: diagnosis.

BACKGROUND

Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder').

OBJECTIVE

This article summarises the functional anatomy of the shoulder joint, the pathology of the conditions that lead to shoulder stiffness, and methods to differentiate them.

DISCUSSION

Clinical history and examination is effective in differentiating rotator cuff tears, impingement and frozen shoulder. Restriction of glenohumeral joint motion, particularly in external rotation, with no abnormality on X-ray is strongly suggestive of the diagnosis of frozen shoulder. Plain true anteroposterior X-rays are important to identify glenohumeral joint arthritis. Ultrasound is often helpful for confirming or denying rotator cuff tears when there is doubt on the clinical examination.