The external rotation test in the diagnosis of adhesive capsulitis

This article evaluates the effectiveness of the external rotation test in diagnosing capsulitis. The test is performed with the upper arm in a neutral position at the patient's side and the elbow in 90 degrees of flexion. The test is positive when pain is produced with this maneuver. All patients (379) evaluated for atraumatic shoulder pain during 1 calendar year were studied. The patients were divided into external rotation positive (91 patients) and external rotation negative (311 patients) groups. Patients with atraumatic shoulder pain with a positive external rotation test were presumed to have adhesive capsulitis in the absence of glenohumeral arthritis. Patients diagnosed with adhesive capsulitis received an intra-articular steroid injection and a home therapy program. Patients were contacted 10 to 19 months following treatment to determine their status and need for any further care. A diagnosis of adhesive capsulitis was made in 75% of external rotation positive patients (68 patients). Glenohumeral arthritis evidenced by radiographs was the only other diagnosis that produced a positive external rotation test (23 patients) in this group of atraumatic shoulders. Only 1 of 68 patients (1.4%) with a diagnosis of adhesive capsulitis (external rotation positive) had surgery during the follow-up period. However, 86 of 311 (27.7%) patients in the external rotation negative group underwent surgery (P<.0001). In the external rotation positive group, 3 patients (5%) sought second opinions, while 95% (55/58) sought no further care. Our data suggest that patients with a history of atraumatic shoulder pain and a positive external rotation test on examination should be considered for adhesive capsulitis in the absence of glenohumeral arthritis.