Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options

Abstract

Adhesive capsulitis, commonly referred to as “frozen shoulder,” is a debilitating condition characterized by progressive pain and limited range of motion about the glenohumeral joint. It is a condition that typically affects middle-aged women, with some evidence for an association with endocrinological, rheumatological, and autoimmune disease states. Management tends to be conservative, as most cases resolve spontaneously, although a subset of patients progress to permanent disability. Conventional arthrographic findings include decreased capsular distension and volume of the axillary recess when compared with the normal glenohumeral joint, in spite of the fact that fluoroscopic visualization alone is rarely carried out today in favor of magnetic resonance imaging (MRI). MRI and MR arthrography (MRA) have, in recent years, allowed for the visualization of several characteristic signs seen with this condition, including thickening of the coracohumeral ligament, axillary pouch and rotator interval joint capsule, in addition to the obliteration of the subcoracoid fat triangle. Additional findings include T2 signal hyperintensity and post-contrast enhancement of the joint capsule. Similar changes are observable on ultrasound. However, the use of ultrasound is most clearly established for image-guided injection therapy. More aggressive therapies, including arthroscopic release and open capsulotomy, may be indicated for refractory disease, with arthroscopic procedures favored because of their less invasive nature and relatively high success rate.

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All authors have contributed to the conception, design, and drafting of the article and/or to its critical revision for important intellectual content. All authors have given final approval of the version to be published and agree to be accountable for all aspects of the work if questions arise related to its accuracy or integrity. All of the illustrations included as part of this manuscript are original work by the co-author M.R.S.

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Fields, B.K.K., Skalski, M.R., Patel, D.B. et al. Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol 48, 1171–1184 (2019). https://doi.org/10.1007/s00256-018-3139-6

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Keywords

  • Frozen shoulder
  • Adhesive capsulitis
  • Coracohumeral ligament
  • Magnetic resonance imaging
  • Subcoracoid fat triangle
  • Glenohumeral joint capsule