MR Imaging Biomarkers for Clinical Impairment and Disease Progression in Patients with Shoulder Adhesive Capsulitis: A Prospective Study

Abstract

Background: MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment.

Purpose: To determine the correlation of MRI findings with the Constant-Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients.

Materials and methods: This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment.

Results: There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal (p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening (p < 0.05).

Conclusions: In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up.

Keywords: MRI; adhesive capsulitis; constant-murley score; inferior gleno-humeral ligament; shoulder.

Figure 1

(a–d) Frontal oblique non-contrast fat-suppressed T2-weighted fast spin-echo MRI shows method used to grade glenohumeral inferior ligament signal on its glenoidal (white arrow) and humeral (dotted arrow) insertions, without signal abnormality in the right shoulder of a 55-year-old woman with adhesive capsulitis graded 1 in (a), a discontinuous glenoidal side IGHL hypersignal graded 2 in the left shoulder of the same woman with contralateral adhesive capsulitis in (b), a global both side IGHL hypersignal graded 3 in the left shoulder of a 43-year-old man with adhesive capsulitis in (c) and an overflow of the hypersignal in adjacent soft tissues (thick white arrow) graded 4 in the right shoulder of a 46 years old man with adhesive capsulitis in (d).

Figure 2

Coronal oblique non-contrast fat-suppressed T2-weighted fast spin-echo MRI of the right shoulder in a 44-year-old woman with adhesive capsulitis shows method used to measure inferior glenohumeral ligament thickness at its glenoidal (dotted double arrow) (4 mm) and humeral insertion (double arrow) (4.5 mm).

Figure 3

Sagittal oblique non-contrast fat-suppressed T2-weighted fast spin-echo MRI of the left shoulder in a 55-year-old man with adhesive capsulitis shows method used to measure coracohumeral ligament thickness (double white arrow) (4 mm). Additionally, note its high signal intensity.

Figure 4

Box-plot showing mean mobility score (y-axis) according to inferior glenohumeral ligament intensity grade (x-axis) for reader 1 and reader 2.

Figure 5

Bar plot representing pain score duration (PDS) (number of patients on y-axis) according to inferior glenohumeral ligament signal intensity (IGHL SI) (x-axis), shown for reader 1 for grade 1 + 2 and 3 + 4 in (a), for each grade (1, 2, 3, 4) in (b), and for reader 2 for grade 1 + 2 and 3 + 4 in (c), for each grade in (d).

Figure 6

Box plot representing inferior glenohumeral ligament thickness (y-axis) according to clinical outcomes for reader 1 on the glenoidal (a) and humeral side (b), and for reader 2 on the glenoidal (c) and humeral side (d).