Hallmark symptom of adhesive capsulitis?

• A. Sudden shoulder pain with swelling
• B. Gradual loss of range of motion in the shoulder
• C. Weakness in the arm
• D. Pain with neck extension

Answer: (B)

Adhesive capsulitis presents with a gradual, progressive loss of shoulder range of motion that affects both active and passive movement, due to thickening and contracture of the joint capsule. This stiffness develops over weeks to months and often hits first with external rotation and abduction, even when there isn’t severe ongoing pain. The pattern is typically a slow, limiting restriction rather than a sudden, dramatic change.

This contrasts with a sudden shoulder pain with swelling, which points to an acute process like a traumatic injury, inflammatory arthritis, or intra-articular effusion rather than a slowly tightening capsule. Weakness in the arm can come from nerve injuries or tendon tears, which produce different clinical pictures with focal weakness rather than diffuse, multi-directional stiffness. Pain with neck extension suggests cervical radiculopathy or other neck pathology causing referred shoulder pain, not primary shoulder joint stiffness.