Multi-modal imaging of adhesive capsulitis of the shoulder

Insights into Imaging, Apr 2016

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. Key Points • Diagnosis of adhesive capsulitis is mainly based on clinical findings. • Imaging may be used to exclude articular or rotator cuff pathology. • Thickening of coracohumeral and inferior glenohumeral ligaments are common findings. • Rotator interval fat pad obliteration has 100 % specificity for adhesive capsulitis. • Ultrasound can be used to guide intra- and periarticular treatments.

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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)


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Marcello Zappia, Francesco Di Pietto, Alberto Aliprandi, Simona Pozza, Paola De Petro, Alessandro Muda, Luca Maria Sconfienza. Multi-modal imaging of adhesive capsulitis of the shoulder, Insights into Imaging, 2016, pp. 365-371, Volume 7, Issue 3, DOI: 10.1007/s13244-016-0491-8