3 thoughts on “Shoulder MRI 60F 2 weeks Is this Adhesive Capsulitis?”
linklj
Hi Hilary, I would call features of inflammatory phase capsulitis. FWIW i think she would do well with trans interval steroid into the joint, into the thickened CHL and subcoracoid fat plane.
I bet she has some end range discomfort with ER and suspect she will have marginally reduced ER vs the contralateral side
glickman.peter
I’d call it, but recognize there are some normal patients with findings that look just like adhesive capsulitis, as in Fig 3 of this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233594/
In young patients I give a ddx of anterior superior impingement, which can look very similar.
Best wishes to all.
hilary.umans
Thanks for both comments.
James, what I found unusual, in my experience, is the mass like inflammation of the CHL with no thickening or edema that I can see of the capsule—not even the adjacent RI capsule. But she is a 60 yo woman and the cuff is nearly normal…I agree it must be adhesive capsulitis.
Peter, I agree that changes of adhesive capsulitis can be non-specific…in this case there are no findings to suggest anterior superior impingement. We are fortunate in that we have both Sag T1 and PDFS images as part of our routine shoulder MRI—Fig 3 in the reference you include is T1 only, and without a fluid sensitive image, it is impossible to sort out effusion in the RI/superior subscapular recess from capsular thickening.
In https://pubmed.ncbi.nlm.nih.gov/15358849/ Mengiardi, et al. reported 100% specificity and 32% sensitivity of complete obliteration of the subcoracoid fat triangle…which is what Fig. 3 in your reference demonstrates—-so, according to their study, that Should be adhesive capsulitis.
I find that the literature on this subject is full of contradictions.
Hi Hilary, I would call features of inflammatory phase capsulitis. FWIW i think she would do well with trans interval steroid into the joint, into the thickened CHL and subcoracoid fat plane.
I bet she has some end range discomfort with ER and suspect she will have marginally reduced ER vs the contralateral side
I’d call it, but recognize there are some normal patients with findings that look just like adhesive capsulitis, as in Fig 3 of this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233594/
In young patients I give a ddx of anterior superior impingement, which can look very similar.
Best wishes to all.
Thanks for both comments.
James, what I found unusual, in my experience, is the mass like inflammation of the CHL with no thickening or edema that I can see of the capsule—not even the adjacent RI capsule. But she is a 60 yo woman and the cuff is nearly normal…I agree it must be adhesive capsulitis.
Peter, I agree that changes of adhesive capsulitis can be non-specific…in this case there are no findings to suggest anterior superior impingement. We are fortunate in that we have both Sag T1 and PDFS images as part of our routine shoulder MRI—Fig 3 in the reference you include is T1 only, and without a fluid sensitive image, it is impossible to sort out effusion in the RI/superior subscapular recess from capsular thickening.
In https://pubmed.ncbi.nlm.nih.gov/15358849/ Mengiardi, et al. reported 100% specificity and 32% sensitivity of complete obliteration of the subcoracoid fat triangle…which is what Fig. 3 in your reference demonstrates—-so, according to their study, that Should be adhesive capsulitis.
I find that the literature on this subject is full of contradictions.