Hi Ocaders,
Need opinion with a case.
50-year-old gentleman came in with c/o of limited overhead abduction for 2 months. To rule out adhesive capsulitis.
I did not find too much wrong with labrum, capsule, or the cuff expect some tendinosis of caudal undersurface fibres of subscapularis. There are some diffuse marrow signal changes. No specific marrow edema. Rotator interval also looks ok !! Not too much of retroversion either. But on sagittal images there appears to be considerable posterior decentring of the humeral head in relation to the glenoid.
No history of trauma or sports related activities in the past.
I am wondering what the cause of such posterior instability ? Also thinking of bringing the patient back in and doing the other shoulder to see if the abnormalities are bilateral.
Please share your expertise. I will compile all the responses.
Regards
Hi,
Everyone is quite unanimous about adhesive capsulitis.
Reponses to the shoulder case
Ruben steinja: Looks normal except for minimal posterior subluxation—but no labra’s tear or glenoid hypoplasia. Unless there is a history of instability, I doubt arthrography or surgery needed—likely just PT
Avneesh Chhabra: Mod AC OA with mild sasd bursitis.
Peri capsular edema and axillary pouch are enough to suggest adh capsulitis
The edema can be circumferential-ant or only posterior.
RI involvement can be absent.
T2 Dixon water or stir images are more sensitive for edema in RI. Your T2W sag imaging can miss it.
Posterior decentering is normal phenomenon in internal rotation or as part of OA. Its a useful finding to pick up in athletes with posterior peelback syndrome or Kim’s lesion, etc. Ignore in this case.
Bruno Vande Berg: AC for me.
If pt comes back, obtain fat sat enh. T1 (coronal and sag) on both
sides. It can be surprising..
I think that there is moderate increased signal at the capsule insertion
on your coronal fsPD above and below the glenoid. In my experience, sag
DPfs is not frequently positive (near coracoacromial Lgt) . AC
predominates at capsule insertion
marrow changes could be due to increased bone turn over associated with
AC but is is usually more patchy. On T1, decreased signal should be
visible if red marrow and T1 should almost be normal if increased bone
remodeling.
thanks for all the responses
regards