A stiff or frozen shoulder, medically known as adhesive capsulitis, is a condition characterized by restricted and painful shoulder movement. It occurs when the connective tissue surrounding the shoulder joint, called the shoulder capsule, becomes thick, tight and inflamed. This leads to a painful loss of both active and passive shoulder motion.
Stiff shoulder is usually diagnosed based on a physical examination and medical history. However, special tests can also be performed by a physiotherapist or doctor to confirm the diagnosis and determine the severity of the adhesive capsulitis. One such special test is the Apley scratch test.
The Apley Scratch Test
The Apley scratch test specifically checks for limited external rotation and abduction of the shoulder joint, which are the two movements most affected by a frozen shoulder. It is named after Alan Graham Apley, a British orthopedic surgeon who first described the test in 1980.
How it’s Done:
The test is carried out in the following manner:
- The patient is asked to place the hand of the affected arm behind his/her back with the palm touching the lower back. This tests how far they can actively rotate the arm externally.
- The patient then places the hand of the unaffected arm behind the back and tries to touch the back of the hand of the affected arm. This tests the external rotation in a passive manner.
- The same sequence is repeated but with the palm touching the upper back between the shoulder blades. This checks active and passive abduction.
- The examiner then compares the range of motion of the unaffected shoulder to determine any limitations in the affected shoulder.
- If a patient is unable to touch the lower back with the affected hand, it indicates reduced active external rotation.
- Being unable to reach over the shoulder and touch the hand of the affected side signals decreased passive external rotation and abduction.
- A disparity of more than 10 degrees between the two sides is considered a positive test for adhesive capsulitis.
- The smaller the range of motion, the more severe the frozen shoulder is deemed.
Advantages of the Apley Test:
- Quick and easy to perform during a routine clinical assessment of the shoulder.
- Does not require any equipment or setup.
- Assesses both active and passive movements in a single test.
- Gives a direct left-to-right comparison within the same patient.
- Results are highly reproducible and reliable when conducted by a trained professional.
- Allows the monitoring of progress with repeated testing at follow-ups.
The Apley scratch test is useful in several clinical scenarios:
- Confirming a diagnosis of adhesive capsulitis based on loss of external rotation and abduction.
- Determining the severity of a frozen shoulder by quantifying the range of motion loss.
- Ruling out other causes of shoulder pain that would not affect these specific motions.
- Monitoring the improvements gained through conservative treatment or physical therapy over time.
- Evaluating post-operative recovery after interventions like manipulation under anesthesia or arthroscopic release surgery.
- Providing a standardized measurement for research studies on frozen shoulder treatments.
- Results can vary based on the examiner’s experience and the patient’s effort.
- May be difficult to interpret in obese patients or those with physical limitations.
- Does not check for internal rotation which can also be impaired in adhesive capsulitis.
- Provides only sagittal plane motions and no assessment of shoulder strength or stability.
- Not suitable as an isolated test – should be combined with a complete history and physical exam.
- Does not identify the underlying cause or reason for the frozen shoulder.
The Apley scratch test is a simple yet effective maneuver that directly quantifies the two most affected movements in a frozen shoulder. When incorporated as part of a thorough shoulder assessment, it can provide objective confirmation of limited mobility and severity grading to guide appropriate treatment. Periodic retesting delivers an measurable parameter to judge improvements over time. Thus, being easy to perform and reproducible, it remains a valuable clinical tool for any practitioner dealing with the sticky predicament of a stiff shoulder.