Age / Sex : 51 / F

Chief complaint: shoulder pain, left (D: 3 months)

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Courtesy: 황지영(Ji Young Hwang), 이화여자대학교 병원(Ewha Womans University, School of Medicine)

Adhesive capsulitis (Frozen shoulder)

Discussion

Findings:

 1. Thickening of inferior joint capsule at the level of axillary recess

2. Soft tissue infiltration in rotator interval replacing subcoracoid fat triangle

 3. Coracohumeral ligament thickening

Diagnosis: Adhesive capsulitis (Frozen shoulder)

Discussion: Frozen shoulder was used in the disease entity which clinical symptoms were slow onset of pain, inability to sleep on the affected arm, and restriction of both active and passive elevation and external rotation in 1934 by Codman. Then, Neviaser described characteristic synovial changes in the glenohumeral joint in patients with frozen shoulder and suggested the term adhesive capsulitis in 1945. Patients are commonly 40–70 years old and predominantly female.

Arthroscopic findings of adhesive capsulitis are inflammation of extraarticular tissue in the region of the rotator cuff interval, synovitis at the anterosuperior glenohumeral joint, and thickening of the coracohumeral ligament (CHL).

MRI or MR arthrographic findings of adhesive capsulitis are decreased joint capacity, obliteration of the axillary recess, capsular thickening of more than 4 mm in the axillary recess. The CHL thickening and obliteration of subcoracoid fat triangle are seen in rotator interval. This subcoracoid fat triangle sign is easy to detect on sagittal oblique images. After gadolinium enhancement, joint capsule and synovium in the rotator cuff interval and in the axillary recess are enhanced. The enhanced fibrovascular tissue in the rotator cuff interval encasing the CHL,  superior glenohumeral ligament and the biceps tendon.

References:

Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233:486–492