American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is typically observed in patients with adhesive capsulitis?

1. Limited external rotation

2. Visible swelling

3. Increased range of motion

4. Pain during rest

The correct answer is: Limited external rotation

Adhesive capsulitis, also known as frozen shoulder, is characterized by significant limitation in shoulder movement, particularly in external rotation. Patients with adhesive capsulitis often experience a gradual onset of shoulder pain and, over time, a notable restriction in both active and passive range of motion. Limited external rotation is a hallmark of this condition due to the inflammation and fibrosis of the shoulder capsule, which restricts movement and contributes to the characteristic "frozen" state of the shoulder. In contrast to the limitations seen in adhesive capsulitis, visible swelling is not typical as the condition primarily involves internal changes rather than noticeable external signs. Increased range of motion would contradict the diagnosis, as patients typically experience a progressive loss of mobility. Although pain during rest may occur, it is more commonly associated with activities, especially overhead motions or reaching behind the back. Therefore, limited external rotation is a defining feature of adhesive capsulitis, making it the correct answer.