What is the hallmark presentation of adhesive capsulitis (frozen shoulder)?

• A. Gradual shoulder pain with progressive loss of ROM, especially external rotation
• B. Acute severe pain with full ROM
• C. Pain only at night
• D. Joint swelling with warmth

Answer: (A)

The main concept is that frozen shoulder presents with a gradual onset of shoulder pain accompanied by a progressive loss of range of motion, with external rotation being the most limited.

This happens because the glenohumeral joint capsule becomes thickened and contracted, so both active and passive movements are increasingly restricted. The loss of external rotation is usually the first and most pronounced limitation, reflecting tightening of the posterior capsule and surrounding structures. The pain often worsens with movement and may disrupt sleep, but the defining feature is the steady decline in motion over weeks to months, not an abrupt crisis.

Understandably, other patterns don’t fit as well. An acute, severe pain with full ROM isn’t typical of adhesive capsulitis, since ROM is already compromised. Pain that occurs only at night lacks the characteristic progressive stiffness. Joint swelling with warmth points toward inflammatory or septic processes, not the capsule contraction seen in frozen shoulder.