BACKGROUND: Adhesive capsulitis often is difficult to diagnose in its early 
stage and to differentiate from other commonly seen shoulder disorders with the 
potential to cause pain and limited range of movement.
OBJECTIVES: The purpose of this study was to establish consensus among a group 
of experts regarding the clinical identifiers for the first or early stage of 
primary (idiopathic) adhesive capsulitis.
DESIGN: A correspondence-based Delphi technique was used in this study.
METHODS: Three sequential questionnaires, each building on the results of the 
previous round, were used to establish consensus.
RESULTS: A total of 70 experts from Australia and New Zealand involved in the 
diagnosis and treatment of adhesive capsulitis completed the 3 rounds of 
questionnaires. Following round 3, descriptive statistics were used to screen 
the data into a meaningful subset. Cronbach alpha and factor analysis then were 
used to determine agreement among the experts. Consensus was achieved on 8 
clinical identifiers. These identifiers clustered into 2 discrete domains of 
pain and movement. For pain, the clinical identifiers were a strong component of 
night pain, pain with rapid or unguarded movement, discomfort lying on the 
affected shoulder, and pain easily aggravated by movement. For movement, the 
clinical identifiers included a global loss of active and passive range of 
movement, with pain at the end-range in all directions. Onset of the disorder 
was at greater than 35 years of age.
CONCLUSIONS: This is the first study to use the Delphi technique to establish 
clinical identifiers indicative of the early stage of primary (idiopathic) 
adhesive capsulitis. Although limited in differential diagnostic ability, these 
identifiers may assist the clinician in recognizing early-stage adhesive 
capsulitis and may inform management, as well as facilitate future research.