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Injected under US guidance. He was unusually painful during skin infiltration with lidocaine. I got into the joint and he was in so much pain he told me to stop. I suggested I try to reposition the needle in the joint, which he barely tolerated and I was able to inject, clearly into the joint with the capsule rising and no visible extravasation during injection.
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My question is about this smooth erosion at the anterior para-articular margin of the HH. I have now seen a few cases just like this in the context of adhesive capsulitis, which he has both clinically and by imaging. In a prior case I shared on OCAD there was superimposed BME and I wondered if it might be gout masquerading as adhesive capsulitis. Some thought yes, some no…others suggested subcoracoid impingement—-in this case, his coracoid is miles away from his HH.
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He has no capsulitis in the RI. I presume the post arthro extravasation was related to his adhesive capsulitis. He did not experience any pain relief with IA lidocaine.
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Obl images show the axillary capsular thickening/edema and mild pericapsular edema (these are PDFS)…evident also on straight Ax images.
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SO, my question is
Does adhesive capsulitis cause erosions? In this location in particular?
Or do all of these patients have gout?
Or is this a particularly prominent “pseudo-defect” in someone with absolutely no findings to indicate subcoracoid impingement.
Hilary Umans
