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Anterior capsular abnormality: another important MRI finding for the diagnosis of adhesive capsulitis of the shoulder

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To evaluate the usefulness of anterior capsular abnormality, thickening, and abnormal signal intensity on MRI for the diagnosis of adhesive capsulitis of the shoulder.

Materials and methods

This retrospective study included 29 patients with adhesive capsulitis and 20 controls. Clinical criteria with significant restricted passive motion was used for the diagnosis of adhesive capsulitis. The anterior capsular thickness and signal intensity were evaluated on the thickest portion of anterior glenohumeral joint capsule, located deep to the subscapularis muscle. In addition, the previously known MR findings of adhesive capsulitis, such as humeral and glenoid capsular thickness in axillary recess, maximal axillary capsular thickness, and coracohumeral ligament thickness, were measured. The presence of humeral and glenoid capsular abnormal hyperintensity in axillary recess, abnormal hyperintensity, and obliteration of the subcoracoid fat triangle were also evaluated.


All MRI findings significantly differed between adhesive capsulitis and controls. Among MR findings, multivariable analysis showed that anterior capsular thickness, maximal axillary capsular thickness, and anterior capsular abnormal hyperintensity were variables that could differentiate adhesive capsulitis from the control group, with odds ratios of 7.97, 17.75, and 12.41, respectively (p < 0.05). In ROC analysis, the anterior capsular thickness showed high diagnostic performances with an AUC of 0.897. The cut-off value of anterior capsular thickness at 3.5 mm showed excellent diagnostic accuracy, with sensitivity of 68.97% and specificity of 100%.


Anterior capsular abnormality, thickening, and abnormal hyperintensity can be used for the diagnosis of adhesive capsulitis of shoulder, in addition to previously known abnormal MRI findings.

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  1. Tamai K, Akutsu M, Yano Y. Primary frozen shoulder: brief review of pathology and imaging abnormalities. J Orthop Sci. 2014;19(1):1–5.

    Article  PubMed  Google Scholar 

  2. Ryan V, Brown H, Minns Lowe CJ, Lewis JS. The pathophysiology associated with primary (idiopathic) frozen shoulder: a systematic review. BMC Musculoskelet Disord. 2016;17(1):340.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Lee MH, Ahn JM, Muhle C, Kim SH, Park JS, Kim SH, et al. Adhesive capsulitis of the shoulder: diagnosis using magnetic resonance arthrography, with arthroscopic findings as the standard. J Comput Assist Tomogr. 2003;27(6):901–6.

    Article  PubMed  Google Scholar 

  4. Lee JC, Sykes C, Saifuddin A, Connell D. Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation. Skelet Radiol. 2005;34(9):522–7.

    Article  CAS  Google Scholar 

  5. Jung JY, Jee WH, Chun HJ, Kim YS, Chung YG, Kim JM. Adhesive capsulitis of the shoulder: evaluation with MR arthrography. Eur Radiol. 2006;16(4):791–6.

    Article  PubMed  Google Scholar 

  6. Park S, Lee D-H, Yoon S-H, Lee HY, Kwack K-S. Evaluation of adhesive capsulitis of the shoulder with fat-suppressed T2-weighted MRI: association between clinical features and MRI findings. Am J Roentgenol. 2016;207(1):135–41.

    Article  Google Scholar 

  7. Sasanuma H, Sugimoto H, Fujita A, Kanaya Y, Iijima Y, Saito T, et al. Characteristics of dynamic magnetic resonance imaging of idiopathic severe frozen shoulder. J Shoulder Elb Surg. 2017;26(2):e52–7.

    Article  Google Scholar 

  8. Sridharan R, Engle MP, Garg N, Wei W, Amini B. Focal uptake at the rotator interval or inferior capsule of shoulder on 18 F-FDG PET/CT is associated with adhesive capsulitis. Skelet Radiol. 2017;46(4):533–8.

    Article  Google Scholar 

  9. Zappia M, Di Pietto F, Aliprandi A, Pozza S, De Petro P, Muda A, et al. Multi-modal imaging of adhesive capsulitis of the shoulder. Insights Imaging. 2016;7(3):365–71.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Gokalp G, Algin O, Yildirim N, Yazici Z. Adhesive capsulitis: contrast-enhanced shoulder MRI findings. J Med Imaging Radiat Oncol. 2011;55(2):119–25.

    Article  PubMed  Google Scholar 

  11. Lee SY, Park J, Song SW. Correlation of MR arthrographic findings and range of shoulder motions in patients with frozen shoulder. AJR Am J Roentgenol. 2012;198(1):173–9.

    Article  PubMed  Google Scholar 

  12. Teixeira PAG, Balaj C, Chanson A, Lecocq S, Louis M, Blum A. Adhesive capsulitis of the shoulder: value of inferior Glenohumeral ligament signal changes on T2-weighted fat-saturated images. Am J Roentgenol. 2012;198(6):W589–96.

    Article  Google Scholar 

  13. Carette S, Moffet H, Tardif J, Bessette L, Morin F, Frémont P, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheumatol. 2003;48(3):829–38.

    Article  CAS  Google Scholar 

  14. Brue S, Valentin A, Forssblad M, Werner S, Mikkelsen C, Cerulli G. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007;15(8):1048–54.

    Article  CAS  PubMed  Google Scholar 

  15. Uhthoff HK, Boileau P. Primary frozen shoulder: global capsular stiffness versus localized contracture. Clin Orthop Relat Res. 2007;456:79–84.

    Article  PubMed  Google Scholar 

  16. Lho Y-M, Ha E, Cho C-H, Song K-S, Min B-W, Bae K-C, et al. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder. J Shoulder Elb Surg. 2013;22(5):666–72.

    Article  Google Scholar 

  17. Wiley AM. Arthroscopic appearance of frozen shoulder. Arthroscopy. 1991;7(2):138–43.

    Article  CAS  PubMed  Google Scholar 

  18. Uitvlugt G, Detrisac DA, Johnson LL, Austin MD, Johnson C. Arthroscopic observations before and after manipulation of frozen shoulder. Arthroscopy. 1993;9(2):181–5.

    Article  CAS  PubMed  Google Scholar 

  19. Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint—indication, surgical technique, results. Knee Surg Sports Traumatol Arthrosc. 2001;9(3):178–86.

    Article  CAS  PubMed  Google Scholar 

  20. Omari A, Bunker TD. Open surgical release for frozen shoulder: surgical findings and results of the release. J Shoulder Elb Surg. 2001;10(4):353–7.

    Article  CAS  Google Scholar 

  21. Yoon S-H, Lee HY, Lee HJ, Kwack K-S. Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial. Am J Sports Med. 2013;41(5):1133–9.

    Article  PubMed  Google Scholar 

  22. Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011;83(4):417–22.

    PubMed  Google Scholar 

  23. Buchbinder R, Green S, Forbes A, Hall S, Lawler G. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004;63(3):302–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Emig EW, Schweitzer ME, Karasick D, Lubowitz J. Adhesive capsulitis of the shoulder: MR diagnosis. AJR Am J Roentgenol. 1995;164(6):1457–9.

    Article  CAS  PubMed  Google Scholar 

  25. Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology. 2004;233(2):486–92.

    Article  PubMed  Google Scholar 

  26. Merila M, Helio H, Busch LC, Tomusk H, Poldoja E, Eller A, et al. The spiral glenohumeral ligament: an open and arthroscopic anatomy study. Arthroscopy. 2008;24(11):1271–6.

    Article  PubMed  Google Scholar 

  27. Merila M, Leibecke T, Gehl HB, Busch LC, Russlies M, Eller A, et al. The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale. Eur Radiol. 2004;14(8):1421–6.

    Article  CAS  PubMed  Google Scholar 

  28. Kolts I, Busch LC, Tomusk H, Rajavee E, Eller A, Russlies M, et al. Anatomical composition of the anterior shoulder joint capsule. A cadaver study on 12 glenohumeral joints. Ann Anat. 2001;183(1):53–9.

    Article  CAS  PubMed  Google Scholar 

  29. Pouliart N, Boulet C, Maeseneer M, Shahabpour M. Advanced imaging of the glenohumeral ligaments. Semin Musculoskelet Radiol. 2014;2014:374–97.

    Article  Google Scholar 

  30. Pouliart N, Somers K, Gagey O. Arthroscopic glenohumeral folds and microscopic glenohumeral ligaments: the fasciculus obliquus is the missing link. J Shoulder Elb Surg. 2008;17(3):418–30.

    Article  Google Scholar 

  31. Warner JJ, Caborn DN, Berger R, Fu FH, Seel M. Dynamic capsuloligamentous anatomy of the glenohumeral joint. J Shoulder Elb Surg. 1993;2(3):115–33.

    Article  CAS  Google Scholar 

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Correspondence to Dong Hyun Kim.

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This work was supported by the Soonchunhyang University Research Fund.

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The authors declare that they have no conflict of interest.

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Park, J., Choi, YH., Chai, J.W. et al. Anterior capsular abnormality: another important MRI finding for the diagnosis of adhesive capsulitis of the shoulder. Skeletal Radiol 48, 543–552 (2019).

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