Thanks for all of your comments and thoughts on this case.There was zero consensus and I didn’t find any real guidance with regards to my actual question about that (admittedly subtle) erosion at the anterior humeral head.
To be clear, we do not routinely use iv contrast to evaluate adhesive capsulitis…..we do whatever our referrers request….and this was the rare shoulder MRI requested with iv contrast—-by a non-orthopedist, for an indication of chronic pain and numbness.
I have NO idea about her ROM….and not confidence that it was even evaluated.
There is, unsurprisingyly, a range of opinions as to whether we consider adhesive capsulitis if the RI is spared.
In my thorough literature review on the subject I have found the requirement for RI involvement to be a regional belief, that held true in the geographic distribution of opinions…and I’ll leave that there.
I firmly believe from my imaging experience with available clinical exam information that the distribution of capsulitis can be variable and can absolutely spare the RI….so that has no bearing on the diagnosis in my opinion.
Munib Sana shared an interesting tidbit that I did not know….said that he had seen a similar case of "paraneoplastic synovitis" that looked similar.
He shared a relevant article https://pubmed.ncbi.nlm.nih.gov/22075194/ which is an overview of rheumatic manifestations of cancer….including one relevant case image series.
That begs the question of causation vs correlation, but I never even heard of this with regards to adhesive capsulitis.
Then Adam Singer shared a case with uptake in a woman with breast cancer with chest wall uptake along with shoulder joint uptake, that correlated with classic findings of adhesive capsulitis
