Dear friends!
I received several interesting answers to my case! Thank you all! I guess both the capsular and the glenoid findings then suggest a reason for the pain.
Have a lovely day!
Best
Roar
Here are some of them:
"Glenoid osteochondral lesion (OCD) plus severe chronic adhesive capsulitis"
"While I can’t say that I have seen the capsule over findings that you are pointing out, the glenoid finding is an OCD as repetitive stress. We see more of them and weight lifters just given my patient population."
"In my perspective this thickening can be related to scarring or chronic adhesive capsulitis.
The subchondral signal intensity change I believe is a pseudodefect from the bare area at the central glenoid."
And this comment from Bradley Scher, included text from the cited article:
"Interesting case, thank you for sharing. Traditionally, I am more used to overhand athletes young or old having internal impingement with sequelae in posteriorly (including capsular thickening as a reactive change from tensile stress, chondral loss, etc). The posterior band of the IGHL, I am aware, can get the so-called Bennett lesion. Having said all that, I think there are instances of similar findings, but involving the anterior shoulder (possibly mechanics?).
Here is a fragment of an "older" radiographics article…
Curious what others tell you, but I assume this is chronic scarring/thickening from repetitive microtrauma.
https://pubs.rsna.org/radiology/doi/10.1148/radiol.2017170481"
Anterior Capsule Injury
The anterior capsule, particularly the anterior band of the inferior glenohumeral ligament, is the primary restraint to anterior translation of the humerus in abduction and external rotation (84–86). A less common injury than those previously discussed, anterior capsular injuries have been observed in professional baseball players without preceding acute trauma (87). These tears are isolated and not associated with glenohumeral dislocation or anterior instability. It is postulated that anterior capsular injury may result from repetitive microtrauma from external rotation tensile overload and may be more common in older overhead athletes, as the capsule becomes less compliant with age and more likely to tear than stretch (87). Of note, humeral avulsion of the glenohumeral ligament has also been observed in athletes with repetitive overhead activity, likely a different manifestation of the same mechanism (88–90).
Patients with anterior capsular tears present with anterior shoulder pain, inability to throw at a high level, and loss of internal rotation. On MR images and at surgery, these injuries are complete midsubstance tears of the anterior capsule, often oblique in orientation through the anterior band of the inferior glenohumeral ligament. At conventional MR imaging and MR arthrography, extracapsular extravasation of joint fluid or contrast, respectively, into the anterior periarticular soft tissues is seen (Fig 9) (87). In a small series on anterior capsular injuries in professional baseball players, all of the patients failed nonsurgical treatment and underwent surgical repair, with the overwhelming majority returning to their prior level of play (87).
