61F with 2 weeks pain, no other history. No mention of ROM.
There is considerable intermediate T1, bright PDFS signal fusiform thickening of the CHL, but I really don’t see thickening of the RI capsule and the axillary capsule looks normal.
Maybe mild chronic supraspinatus tendinosis; looks mostly normal.
Is this Adhesive Capsulitis? I know that, in the acute phase, ROM can be normal—and when I suggest it I often get a phone call from an orthopedist telling me I don’t know what I’m talking about.
(Would be an odd isolated pattern for trauma..and I have no trauma history)
[CHL 61F 2wks pain.jpg]
[CHL 61F 2wks pain (1).jpg]
[CHL 61F 2wks pain (2).jpg]
[CHL 61F 2wks pain (3).jpg]
CHL-61F-2wks-pain.pdf
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.