Mapping Clinical Findings to Arthroscopic Evidence of Rotator Interval Involvement in Frozen Shoulder: A Scoping Review

Abstract

Background: Frozen shoulder (FS) is characterized by pain and progressive loss of shoulder range of motion and is commonly diagnosed by history and physical examination. However, the structural basis of key physical examination findings remains incompletely defined. Recent studies have focused on rotator interval (RI) as a clinically important contributor of stiffness in the FS, highlighting the need to understand the relationship between clinical examination and arthroscopic findings for better diagnostic reasoning. Objective: The aim of this scoping review was to map the clinical examination findings against the arthroscopic evidence of RI and related capsuloligamentous involvement in FS, and to identify gaps in non-invasive diagnosis. Methods: A structured review was performed from the database inception through January 2026 according to the Joanna Briggs Institute methodology and reported in accordance with the PRISMA Extension for Scoping Reviews. PubMed and the Cochrane Library were searched. Eligible studies were charted according to clinical examination findings, arthroscopic or imaging findings, anatomical target, and relevance to the review objectives. Findings were synthesized descriptively. Results: Fifteen evidence sources were included. Passive external rotation loss, capsular-pattern restriction, internal rotation limitation, hand-behind-back restriction, and coracoid-region pain showed plausible links with rotator interval, coracohumeral ligament, and capsular pathology. Direct diagnostic accuracy evidence was limited. Conclusion: Key clinical findings may reflect rotator interval and capsular pathology in frozen shoulder, but no single test is definitive. A structured clinical examination with selective imaging may improve noninvasive diagnosis.