Is X-Ray Needed in the Diagnosis of Frozen Shoulder?

Dr Angela Cadogan, PhD, NZRPS

Frozen shoulder is still poorly understood on many levels. However the diagnostic criteria for have remained unchallenged for decades: Frozen shoulder is a clinical diagnosis characterised by:

1. a global loss of passive ROM
2. a ‘normal’ x-ray (to exclude other causes of joint stiffness).

In my career, I have seen people diagnosed and treated for frozen shoulder for more than 2-3 years with a ‘wait and see’ approach, or with multiple injections without an x-ray to exclude other causes of stiffness.  Some of these people were subsequently diagnosed with osteoarthritis, avascular necrosis, and (one) posterior dislocation.  Other causes of shoulder pain and stiffness include primary or secondary bone tumour, traumatic, osteoporotic or pathologic fracture and muscle guarding.

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