Multi-modal imaging of adhesive capsulitis of the shoulder
Insights Imaging
Multi-modal imaging of adhesive capsulitis of the shoulder
Marcello Zappia 0 1 2 4 5
Francesco Di Pietto 0 1 2 4 5
Alberto Aliprandi 0 1 2 4 5
Simona Pozza 0 1 2 4 5
Paola De Petro 0 1 2 4 5
Alessandro Muda 0 1 2 4 5
Luca Maria Sconfienza 0 1 2 4 5
0 Servizio di Radiologia, IRCCS Policlinico San Donato , Via Morandi 30, 20097 San Donato Milanese, Milano , Italy
1 Dipartimento di Diagnostica per Immagini, AORN A. Cardarelli , Via Antonio Cardarelli 9, 80131 Napoli , Italy
2 Dipartimento di Medicina e di Scienze della Salute, Università degli Studi del Molise , Via De Sanctis 1, 86100 Campobasso , Italy
3 Luca Maria Sconfienza
4 UO Radiologia 1, IRCCS Azienda Ospedaliera Universitaria San Martino-IST , Viale Benedetto XV 10, 16132 Genova , Italy
5 Dipartimento di Radiologia, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico , Via Zuretti 29, 10126 Torino , Italy
Adhesive capsulitis of the shoulder is a clinical condition characterized by progressive limitation of active and passive mobility of the glenohumeral joint, generally associated with high levels of pain. Although the diagnosis of adhesive capsulitis is based mainly on clinical examination, different imaging modalities including arthrography, ultrasound, magnetic resonance, and magnetic resonance arthrography may help to confirm the diagnosis, detecting a number of findings such as capsular and coracohumeral ligament thickening, poor capsular distension, extracapsular contrast leakage, and synovial hypertrophy and scar tissue formation at the rotator interval. Ultrasound can also be used to guide intra- and periarticular procedures for treating patients with adhesive capsulitis.
Shoulder; Adhesive capsulitis; Ultrasound; Arthrography; Magnetic resonance
Introduction
Adhesive capsulitis (AC) of the shoulder is a clinical
condition characterized by progressive limitation of active and
passive mobility of the glenohumeral joint, generally associated
with high levels of pain [
1
].
Although the diagnosis of AC is based mainly on clinical
examination, various imaging modalities, including
arthrography, ultrasound, magnetic resonance imaging
(MRI), and MR arthrography (MRA), may help to confirm
the diagnosis and to detect the presence of associated
characteristics such as rotator cuff abnormalities or intra-articular
pathology [
2
].
In this paper, we review the major clinical and imaging
findings encountered in patients with AC.
Fig. 1 Conventional
arthrography, anteroposterior
view. (a) Normal distension of the
axillary recess (black arrow) and
the subscapular recess (thick
arrow). (b) Reduced distension of
the axillary recess (black arrow)
and subscapular recess associated
with medial leakage of contrast
(white arrow) in a patient with
adhesive capsulitis
Epidemiology and pathogenesis
AC was initially described by Duplay in 1872, who called the
condition Bscapulohumeral periarthritis^ In 1934, Codmann used
the designation Bfrozen shoulder^ [
1
], and the term Badhesive
capsulitis^ was first introduced in 1945 by Neviaser [
3
].
The prevalence of AC in the general population is 2–5 %,
with most patients over 40 years of age and with women
slightly more affected than men [
4
]. Contralateral shoulder
involvement is uncommon [
4
]. Several predisposing factors
have been reported, including trauma, hemiplegia, cerebral
haemorrhage, hyperthyroidism, cervical discopathy, diabetes,
hypercholesterolemia, and inflammatory lipoproteinemia [
5
].
The pathogenesis and macroscopic abnormalities of AC were
first reported in 1945 by Neviaser et al., who described this
condition as thickening and contraction of the glenohumeral joint
capsule [
3
]. The authors also noted the adhesion of the capsule to
the humeral head, thus introducing the concept of AC. More
recent studies have noted abnormalities of the rotator cuff
interval, and in particular, the coracohumeral ligament [
6
]. Bunker et
al. found a higher prevalence of cytokines and growth factors in
tissue specimens of patients with AC compared to controls, and
also reported the absence of metalloproteinase MMP-14, needed
to activate the proteolytic enzyme gelatinase A [
7
]. Some years
later, proliferative synovitis was associated with AC, often
involving the sheath of the long head of the biceps tendon, and
chronic inflammatory involvement of the supraspinatus tendon
was also reported. Macnab suggested that autoimmunity might
be responsible for the condition as a whole [
8
]. At any rate, the
exact etiology of the condition is still unknown.
Various classifications of AC have been proposed. The
most widely used is that of Lundberg et al., who classified
the condition as primary when a clear cause could not be
established, and secondary when AC capsulitis occurred after
a definite event (e.g., trauma). However, other classifications
based on degree of capsular retraction, degree of movement,
and arthrographic findings have (...truncated)