Adhesive capsulitis-MRI

34 year male presents with shoulder pain, no trauma. MRI shows- poor definition of coracohumeral ligament with abnormal intermediate amorphous signal (with hypointense foci on all sequences) surrounding the ligament with ill definition of superior glenohumeral ligament & rotator interval with mild free fluid in the shoulder joint – likely suggesting adhesive capsulitis.

Synonym – periarthritis / frozen shoulder.

Discussion by Dr MGK Murthy, Dr GA Prasad

Inflammatory  condition of pain & severely reduced joint motion ( frozen shoulder) caused by thickening, contraction, and adhesion of the glenohumeral capsule, synovium, and glenohumeral ligaments, with resultant decreased capsular compliance. Most commonly encountered in female patients who are 40 to 60 years of age. Adhesive  capsulitis begins as an inflammatory hypervascular synovitis, which prompts a progressive fibroblastic response in the adjacent capsule.  Coracohumeral ligament ( CHL) is the key structure involved which becomes rigid & inelastic. 

Typical MR findings include: 

-          synovial hypertrophy and debris within the rotator interval seen as replacement of the normal rotator interval fat by granulation tissue or fibrous tissue.

-          thickening of the rotator interval capsule.

-          thickening of the ligaments of the rotator interval, SGHL, and CHL

-          thickening of the joint capsule along the axillary pouch.

-          increased width of the axillary recess. The thickness of the capsule of the axillary recess is best demonstrated on coronal images at the mid glenoid level. Thickened  inferior glenohumeral ligament greater than 4 mm is often seen in the axillary pouch.

-          IV gadolinium enhancement increases the specificity of the diagnosis by demonstrating enhancement of the rotator interval capsule and enhancement of the capsuloligamentous structures in the axillary recess.