Age / Sex : 50 / F

Adhesive capsulitis (=Frozen shoulder)

Discussion

Findings:

Oblique coronal and sagittal fat-saturated T2 weighted images show thickening and edema of the joint capsule, well appreciated in the inferior aspect of the capsule (the axillary pouch of the inferior glenohumeral ligament).

Discussion:

Adhesive capsulitis of the shoulder, also known as frozen shoulder, is a condition characterized by thickening and contraction of the shoulder joint capsule and surrounding synovium. Symptoms last from 2.5 to 9 months, followed by a period of stiffness without pain for 4–12 months and a recovery period of 5–26 months.

Adhesive capsulitis presentation can be broken into three distinct stages:

l  Freezing: painful stage

As the symptoms progress, pain worsens and both active and passive range of motion (ROM) becomes more restricted.

l  Frozen: transitional stage

Because of pain at the end of the range of motion, arm movement may be limited, causing muscular disuse.

l  Thawing stage

It begins when the range of motion starts to improve.

In current clinical practice, the diagnosis of adhesive capsulitis remains clinical. However, at the early phase of the disease, clinical findings may be confusing and misleading. Early diagnosis and establishment of clinical stage is important in the prompt and effective treatment of this disorder. MRI of the shoulder is an effective and non-invasive means of diagnosing suspecting cases and also provides information that may assist the clinician in differentiating between the early and late stages.

Some key MRI features of adhesive capsulitis are related to capsular changes, including capsular thickening and T2 signal increase in the axillary recess, subcoracoid fat obliteration in the rotator interval, and contrast enhancement of the axillary and rotator interval joint capsule. According to the study by Gondim Teixeira et al., capsular hyperintensity at the inferior glenohumeral ligament on T2- weighted images is strongly related to adhesive capsulitis of the shoulder. This sign has a high sensitivity, high specificity, and excellent interobserver variability for the MR diagnosis adhesive capsulitis.

References

https://radiopaedia.org/articles/adhesive-capsulitis-of-the-shoulder

Gondim Teixeira PA, Balaj C, Chanson A, Lecocq S, Louis M, Blum A. Adhesive capsulitis of the shoulder: value of inferior glenohumeral ligament signal changes on T2-weighted fat-saturated images. AJR 2012; 198:[web]W589–W596