The role of MRI and Ultrasonography in Diagnosis and Treatment of Glenohumeral Joint Adhesive Capsulitis

Abstract

Adhesive capsulitis is a common disorder of the glenohumeral joint. Delayed diagnosis is the result of overlapping signs and symptoms with other disorders affecting the shoulder. Typically, the disease shows gradual progression of pain and loss of the range of motion. The hallmark of the physical examination is limitation of both passive and active motion without any associated degenerative changes on plain radiographs. Conservative and/or surgical treatments have shown conflicting results. Poor outcome may be related to co-morbid factors mainly including prolonged immobilization, rotator cuff pathology and diabetes mellitus among others. This review will present the current literature data on the natural history and pathophysiology of the disease, and will highlight the role of imaging in the prompt and accurate diagnosis as well as in the imaged-guided treatment with emphasis on ultrasonography.

Keywords: MR imaging; adhesive capsulitis; frozen shoulder; hydrodilatation; treatment/ultrasound-guided; ultrasonography.

Figure 1.

Oblique US image along the coracohumeral ligament in a 79-year-old male patient with a clinical diagnosis of adhesive capsulitis. Thickening of the ligament is shown (arrows).

Figure 2.

Oblique sagittal US image shows an abnormal hypoechoic tissue in the rotator cuff interval (arrows). The long head biceps tendon is also shown (open arrow).

Figure 3.

A 62-year-old female patient with 2-month pain in the left shoulder. Fat suppressed PD-w MR images in the axial (a), oblique sagittal (b), and oblique coronal (c,d) planes, show the abnormal signal in the rotator cuff interval (thin arrows a,d), and in the axillary recess (thick arrows, b). The abnormal signal in the supraspinatus tendon (open arrow, c), suggests degenerative tendinopathy.

Figure 4.

A 66-year-old female patient with a history of CPPD and osteoarthritis in the right shoulder. Fat suppressed contrast enhanced T1-w MR images in the axial (a), oblique sagittal (b) and oblique coronal (c,d) planes, show the abnormal enhancement in the rotator cuff interval (thick arrows a,b,d), and in the axillary recess (thin arrows, b,c). Crystal induced osteoarthritis is shown in the lower glenohumeral joint with osteophyte formation (open arrows, c). A small subcortical degenerative cyst is shown in the humeral head (arrowheads b,c).

Figure 5.

A 58-year-old female patient with a history of hydroxyapatite deposition disease over the subscapularis tendon and second ray adhesive capsulitis. The oblique sagittal T1-w (a) and fat suppressed contrast enhanced T1-w oblique sagittal (b) and axial (c) MR images show the calcific tendinopathy (arrows, a,b,c), the abnormal signal in the rotator cuff interval (arrowhead a) and the enhancement located in the rotator cuff interval (short open arrow) and in the axillary recess (long open arrows).

Figure 6.

MR arthrographic fat suppressed T1-w MR images in the axial (a) and oblique sagittal (b,c) planes in a patient with a diagnosis of adhesive capsulitis (a,b), there is abnormal tissue in the inferior and posterior axillary recess (arrows) and a limited capacity of the joint which is not distended. In a patient with shoulder instability without any indication of adhesive capsulitis (c), a normal joint space configuration is shown (open arrows).

Figure 7.

Passive manipulations following hydrodistension, in the supine position.

Figure 8.

Passive manipulations in the sitting position, following hydrodistension.