Skeletal Radiology

, Volume 35, Issue 9, pp 673–678 | Cite as

Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool?

  • Carlos Homsi
  • Marcelo Bordalo-Rodrigues
  • Jader J. da Silva
  • Xavier M. G. R. G. Stump
Scientific Article



To determine the accessibility of the coracohumeral ligament (CHL) by ultrasound (US) and to determine CHL thickness in adhesive capsulitis of the shoulder.

Design and patients

US examinations were carried out in 498 consecutive shoulders of 306 individuals (194 women and 112 men), mean age 47.4 years (range 15–92 years), in order to identify and measure the maximum thickness of the CHL. The patients were divided into three study groups: asymptomatic shoulders (n=121), painful shoulders (n=360) and shoulders with arthrographic evidence of adhesive capsulitis (n=17). The mean maximal thickness of CHL was compared among the 3 study groups (non-parametric test of Kruskal–Wallis, p<0.05).


The CHL was visualized in 92 out of 121 shoulders in the asymptomatic group (76.0%), in 227 out of 360 shoulders in the painful shoulder group (63.0%), and in 15 out of 17 shoulders in the adhesive capsulitis group (88.2%). The average thickness of the CHL was significantly greater in adhesive capsulitis (3 mm) than in the asymptomatic (1.34 mm) and painful (1.39 mm) shoulders. No significant difference was found between asymptomatic and painful shoulders.


CHL depiction can be achieved in a reasonable proportion of shoulders. A thickened CHL is suggestive of adhesive capsulitis. More studies are needed for clinical validation of these data.


Arthrography Ultrasound Ligament Shoulder Normal variant Adhesive capsulitis 


  1. 1.
    Codman EA. Tendinitis of the short rotators. In: Codman EA, ed. Ruptures of the supraspinatus tendon and other lesions on or about the subacromial bursa. Boston, Mass: Thomas Todd; 1934Google Scholar
  2. 2.
    Neviaser JS. Adhesive capsulitis of the shoulder (the frozen shoulder). Med Times 1962;90:783–807PubMedGoogle Scholar
  3. 3.
    Neviaser JS. Adhesive capsulitis and the stiff and painful shoulder. Orthop Clin North Am 1980;11:327–331PubMedGoogle Scholar
  4. 4.
    Zuckerman JD, Cuomo F. Frozen shoulder. In: Matsen FA, Fu FH, Hawkins RJ, (eds.) The shoulder: a balance of mobility and stability. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 1993pp 253–267Google Scholar
  5. 5.
    Uitvlugt G, Detrisac DA, Johnson LL, Austin MD, Johnson C. Arthroscopic observations before and after manipulation of frozen shoulder. Arthroscopy 1993;9:181–185PubMedCrossRefGoogle Scholar
  6. 6.
    Neviaser JS. Adhesive capsulitis of the shoulder. J Bone Joint Surg Am 1945;27:211–222Google Scholar
  7. 7.
    Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br 1995;77:677–683PubMedGoogle Scholar
  8. 8.
    Omari A, Bunker TD. Open surgical release for frozen shoulder: surgical findings and results of the release. J Shoulder Elbow Surg 2001; 10:353–357CrossRefPubMedGoogle Scholar
  9. 9.
    Ozaki J, Nakagawa Y, Sakurai G, Tamai S. Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. J Bone Joint Surg Am 1989;71:1511–1515PubMedGoogle Scholar
  10. 10.
    Neer CS 2nd, Satterlee CC, Dalsey RM, Flatow EL. The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res 1992;182–185Google Scholar
  11. 11.
    Lequesne M, Dang N, Bensasson M, Mery C. Increased association of diabetes mellitus with capsulitis of the shoulder and shoulder-hand syndrome. Scand J Rheumatol 1977;6:53–56PubMedGoogle Scholar
  12. 12.
    Kay NR, Slater DN. Fibromatoses and diabetes mellitus. Lancet 1981;2:303CrossRefPubMedGoogle Scholar
  13. 13.
    Neviaser TJ. Arthrography of the shoulder. Orthop Clin North Am 1980;11:205–217PubMedGoogle Scholar
  14. 14.
    Emig EW, Schweitzer ME, Karasick D, Lubowitz J. Adhesive capsulitis of the shoulder: MR diagnosis. AJR Am J Roentgenol 1995;164:1457–1459PubMedGoogle Scholar
  15. 15.
    Carrillon Y, Noel E, Fantino O, Perrin-Fayolle O, Tran-Minh VA. Magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder. Rev Rhum Engl Ed 1999;66:201–206PubMedGoogle Scholar
  16. 16.
    Connell D, Padmanabhan R, Buchbinder R. Adhesive capsulitis: role of MR imaging in differential diagnosis. Eur Radiol 2002;12:2100–2106PubMedGoogle Scholar
  17. 17.
    Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M Frozen. shoulder: MR arthrographic findings. Radiology 2004;233:486–492PubMedCrossRefGoogle Scholar
  18. 18.
    Lee JC, Sykes C, Saifuddin A, Connell D. Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation. Skeletal Radiol 2005;34:522–527CrossRefPubMedGoogle Scholar
  19. 19.
    Homsi C, Rodrigues MB, Silva JJ, Stump X, Morvan G. [Anomalous insertion of the pectoralis minor muscle: ultrasound findings]. J Radiol 2003;84:1007–1011PubMedGoogle Scholar
  20. 20.
    Ryu KN, Lee SW, Rhee YG, Lim JH. Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography. J Ultrasound Med 1993;12:445–449PubMedGoogle Scholar
  21. 21.
    van Holsbeeck M, Vanderschueren J, Wohlend J Shoulder. Sonography in adhesive capsulitis. In:83rd Annual Meeting of the Radiological Society of North America. Chicago, USA; 1997Google Scholar
  22. 22.
    Martinoli C, Bianchi S, Prato N, et al. US of the shoulder: non-rotator cuff disorders. Radiographics 2003;23:381–401; quiz 534PubMedCrossRefGoogle Scholar
  23. 23.
    Martinoli C, Podestà R, Morag Y, Jacobson J, Miller B, Bianchi S. Ultrasound of the reflection pulley of the long biceps tendon. In:Annual Meeting of the Radiological Society of North America. Chicago, USA;2004Google Scholar
  24. 24.
    Ferrari DA. Capsular ligaments of the shoulder. Anatomical and functional study of the anterior superior capsule. Am J Sports Med 1990;18:20–24PubMedCrossRefGoogle Scholar
  25. 25.
    Rouviére H. Anatomía humana descriptiva y topográfica. Madrid: Casa Editorial Bailly-Bailliere; 1959Google Scholar
  26. 26.
    Le Double A. Traité des variations du système musculaire de l'homme et de leur signification au point de vue de l’anthropologie zoologique. Paris: Schleicher Frères Editeurs; 1897Google Scholar

Copyright information

© ISS 2006

Authors and Affiliations

  • Carlos Homsi
    • 1
    • 2
    • 3
    • 4
  • Marcelo Bordalo-Rodrigues
    • 1
    • 2
    • 3
    • 4
  • Jader J. da Silva
    • 1
    • 2
    • 3
    • 4
  • Xavier M. G. R. G. Stump
    • 1
    • 2
    • 3
    • 4
  1. 1.Bela VistaBrazil
  2. 2.Diagnostic Imaging DivisionHospital Alemão Oswaldo CruzParaísoBrazil
  3. 3.Diagnostic Imaging DivisionHospital Santa CatarinaBela VistaBrazil
  4. 4.Diagnostic Imaging DivisionHospital do CoraçãoParaísoBrazil

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