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Posterior capsule edema in adhesive capsulitis: comparison with established non-contrast MRI findings and multivariable analysis

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate posterior glenohumeral capsule edema compared to other MRI findings in adhesive capsulitis (AC).

Methods

This study was approved by the local Institutional Review Board and it is HIPAA compliant. A retrospective search identified subjects who received fluoroscopically guided intra-articular corticosteroid injections for AC and had an MRI within 6 months prior to injection. The study group was compared with an age-, sex-, and side-matched control group who underwent the same procedures but did not have AC. MRIs were evaluated for edema of posterior capsule, anterior capsule, axillary pouch, coracohumeral ligament (CHL) and rotator interval (RI), thickness of axillary pouch and CHL, thickness of anterior capsule, RI and subcoracoid fat replacement, and teres minor atrophy and edema. Multivariable analysis was performed.

Results

A total of 57 subjects with AC and 57 matched controls were studied: mean age 52 ± 7 (range 31–71) years, 37 female and 20 male, 22 right and 35 left. Posterior capsule edema was more common in the AC group vs. control group (66.7 vs 17.5%, p < 0.001). Multivariable analysis showed posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness (optimum cutoff = 4 mm) were significant independent predictors of AC. Simplified analysis using these three variables had an area under the curve of 0.860 (95%CI: 0.792–0.928). With all three variables present, the sensitivity and specificity for AC were 32% and 98%, respectively.

Conclusions

Posterior joint capsule edema may be helpful to confirm AC. Posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness produce a strong model for distinguishing AC from controls.

Clinical relevance statement

Edema involving the posterior shoulder joint capsule is an imaging marker of capsulitis and is useful in differentiating patients with adhesive capsulitis from those without in conjunction with other proven MRI findings.

Key Points

• Posterior capsule edema has a sensitivity of 66.7% and a specificity of 82.5% for the detection of adhesive capsulitis.

• Posterior capsule edema, coracohumeral ligament (CHL) edema, and axillary pouch (glenoid) thickness were significant independent predictors of adhesive capsulitis, and combining these variables together produces a very strong model for distinguishing cases from controls (AUC = 0.860).

• Optimal cutoff values for CHL, axillary pouch (humeral), axillary pouch (glenoid), and axillary pouch (total) thickness were 2.5, 2.6, 4, and 6.3 mm, respectively.

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Abbreviations

AC:

Adhesive capsulitis

CHL:

Coracohumeral ligament

EMR:

Electronic medical record

PACS:

Picture archiving and communication system

RI:

Rotator interval

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Rajdeep Kapoor and Jad S. Husseini contributed equally as first authors to the project

  2. Connie Y. Chang and F. Joseph Simeone contributed equally as last authors to the project

Authors and Affiliations

  1. Gainesville Radiology Group, Gainesville, FL, USA

    Rajdeep Kapoor

  2. Northeast Georgia Health System, Gainesville, FL, USA

    Rajdeep Kapoor

  3. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Jad S. Husseini, William E. Palmer, Martin Torriani & Connie Y. Chang

  4. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Steven J. Staffa

  5. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street – YAW 6046, Boston, MA, 02114, USA

    F. Joseph Simeone

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  1. Rajdeep Kapoor
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Corresponding author

Correspondence to F. Joseph Simeone.

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Guarantor

The scientific guarantor of this publication is F. Joseph Simeone.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Kapoor, R., Husseini, J.S., Staffa, S.J. et al. Posterior capsule edema in adhesive capsulitis: comparison with established non-contrast MRI findings and multivariable analysis. Eur Radiol 34, 260–269 (2024). https://doi.org/10.1007/s00330-023-09966-6

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