Decreased Shoulder External Rotation

This study looked at 379 patients with atraumatic shoulder pain. Patients were asked to externally rotate their shoulder in 0 degrees of abduction. A positive test was limited shoulder external rotation with pain at end range.

Of the patients with a positive external rotation sign, 25% were found to have glenohumeral arthritis as found on x-ray and the other 75% were deemed to have adhesive capsulitis and treated with intra-articular injection and a home stretching program.

Clinical diagnosis of adhesive capsulitis includes:

• Slow onset of shoulder pain
• Pain to lay on affected shoulder
• Pain at the deltoid insertion (classic pain site)
• Pain at the coracoid process (d/t thickening of rotator interval, coracohumeral ligament)
• Decreased and painful shoulder external rotation

The authors conclude that this simple test can be used to diagnose adhesive capsulitis, allowing earlier treatment and faster positive outcomes.

Reference: Wolf EM, Cox WK. The external rotation test in the diagnosis of adhesive capsulitis. Orthopedics. 2010 May 12;33(5).