Correlations between clinical features and MRI findings in early adhesive capsulitis of the shoulder: a retrospective observational study

Abstract

Background: This retrospective study investigated the association between clinical features and MRI findings in patients with early adhesive capsulitis of the shoulder. Methods: The study included 29 patients with early adhesive capsulitis of the shoulder. The clinical diagnostic criteria were significantly restricted passive range of motion (ROM) and a symptom duration of up to 9 months. Various measurements related to adhesive capsulitis, including humeral and glenoid capsular thickness in the axillary recess, maximal axillary capsular thickness, coracohumeral ligament thickness, and anterior capsular thickness were measured on MRI. Abnormal humeral and glenoid capsular hyperintensity in the axillary recess, abnormal hyperintensity in the rotator interval, and obliteration of the subcoracoid fat triangle were also evaluated. Correlations between MRI findings and clinical features, including limited ROM, pain, and symptom duration were sought. Results: Maximal axillary and humeral capsular thickness measured on MRI were negatively correlated with ROM for internal rotation. Also, hyperintensity in axillary recess and glenoid capule were correlated with ROM for abduction. Humeral capsular hyperintensity was correlated with ROM for forward flexion. There were no MRI findings that showed correlations with ROM for external rotation and severity of pain. The hyperintensity in the humeral capsule among MRI findings was only correlated with duration of symptoms. Conclusions: MRI can be useful for assessment of several measures of clinical impairment in patients with adhesive capsulitis. Thickening and hyperintensity of the joint capsule in the axillary recess on MRI is associated with limited ROM and duration of symptoms.

Sequential Ultrasound Assessment of Peri-Articular Soft Tissue in Adhesive Capsulitis of the Shoulder: Correlations with Clinical Impairments—Sequential Ultrasound in Adhesive Capsulitis

“…Inflammation and sequential fibrotic constriction of the periarticular and joint structures are potential causes of disability in adhesive capsulitis. Several reports demonstrated abnormalities in these structures in adhesive capsulitis, including thickening of the CHL, AR and RI, enhancement in the AR and obliteration of the fat triangle below the coracoid process in MRI analyses [ 7 , 19 , 20 ]. Ultrasound measurements also demonstrated a thickening of the RI, CHL, and AR in patients with adhesive capsulitis [ 4 , 8 , 9 , 10 , 11 ].…”

“…However, Hand et al [ 27 ] have shown that 41% of 223 patients had residual complaints during a follow-up of 2–20 years. Additionally, Kim et al [ 7 ] reported that 20.1% of 234 patients had residual shoulder pain and 39.7% of participants had persistent motion deficits after 2 years of follow-up. These discrepancies between studies could be the result of uncertainty of the pathophysiology and the natural course of adhesive capsulitis.…”

“…Recently, several findings specific for adhesive capsulitis have been suggested based on the anatomical structural abnormalities identified through magnetic resonance imaging and ultrasound [ 1 , 4 , 5 , 6 , 7 , 8 ]. Among them, ultrasound takes the spotlight, owing to its cost-effectiveness, and non-invasive nature.…”

“…In refractory cases where conservative treatment has been applied, surgical treatment can be the treatment option [ 1 , 14 ]. However, 20–50% of patients with adhesive capsulitis can develop long-lasting symptoms [ 7 , 15 ]. There are few discussions about why these residual symptoms remain.…”

Frozen shoulder

“…66,67 The connection between calcitonin and FS was first noted when postmenopausal women being treated for osteoporosis with salmon calcitonin showed improvements in their FS symptoms. 68 Salmon calcitonin reduces TGFβ, type I collagen and type III collagen synthesis as well as fibroblast adhesion in cultured cells, 69 all of which are key mediators of fibrosis in FS. These results were confirmed in a double-blind, randomized, controlled trial in which intranasal calcitonin treatment improved shoulder pain and function faster than placebo in patients with FS.…”