CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable?

Abstract

ObjectiveTo determine if diagnostic signs of adhesive capsulitis (AC) of the shoulder at Magnetic Resonance Imaging (MRI) and arthrography (MRA) are applicable to CT arthrography (CTA).Methods22 shoulder CTAs with AC were retrospectively reviewed for features described in MR literature. The control group was composed of 83 shoulder CTA divided into four subgroups 1) normal (N = 20), 2) omarthrosis (N = 19), 3) labral injury (N = 23), and 4) rotator cuff tear (N = 21). Two musculoskeletal radiologists assessed the rotator interval (RI) for obliteration, increased width and thickening of coracohumeral ligament (CHL). The width and capsule thickness of the axillary recess were measured.ResultsThe width of the axillary recess was significantly decreased in the AC group (4.6 ± 2.6 mm versus 9.9 ± 4.6 mm, p ≤ 0.0001; sensitivity and specificity of 84% and 80%). Thickness of the medial and lateral walls of the axillary capsule was significantly increased in the AC group (5.9 ± 1.3 mm versus 3.7 ± 1.1 mm, p ≤ 0.0001 and 5.7 ± 1 mm versus 3.5 ± 1.3 mm, p ≤ 0.0001, respectively). CHL thickness was significantly increased in the AC group (4.1 ± 1 mm (p ≤ 0.001)) in comparison to others groups. Obliteration of the RI was statistically significantly more frequent in patients with AC (72.7% (16/22) vs. 12% (10/83), p < 0.0001). Width of the RI did not differ significantly between patients and controls (p ≥ 0.428).ConclusionDecreased axillary width, and thickened axillary capsule are MR signs of AC applicable to CTA. Evaluation of rotator interval seems useful and reproducible only for obliteration.

SSR white paper: guidelines for utilization and performance of direct MR arthrography

“…Reliance on visualization of axillary pouch abnormalities on dMRA alone is unclear as there is conflicting data with respect to the utility of axillary recess capsular thickening and diminished filling capacity [ 71 , 226 – 229 , 231 – 233 ]. Complete obliteration of the subcoracoid fat triangle has poor sensitivity but high specificity for adhesive capsulitis; however, coracohumeral ligament and IGHL thickening have a higher correlation with range of motion impairment [ 71 , 227 , 232 ]. The utility of measuring the rotator interval dimensions on dMRA is also limited with conflicting evidence [ 163 , 230 , 232 ].…”

“…Complete obliteration of the subcoracoid fat triangle has poor sensitivity but high specificity for adhesive capsulitis; however, coracohumeral ligament and IGHL thickening have a higher correlation with range of motion impairment [ 71 , 227 , 232 ]. The utility of measuring the rotator interval dimensions on dMRA is also limited with conflicting evidence [ 163 , 230 , 232 ]. On 3D volumetric assessment, decreased joint capacity has also been reported with greater frequency in AC patients versus control subjects [ 163 ].…”

Value of Anterior Band of the Inferior Glenohumeral Ligament Area as a Morphological Parameter of Adhesive Capsulitis

“…The primary objective of the management of AC associated with stiffness is to restore or improve the shoulder ROM. Various imaging modalities, such as arthrogram, ultrasonography, and Doppler ultrasound, facilitate precise diagnosis [12, 15]. MRI is also commonly used to investigate shoulder disorders and exclude concomitant conditions [13].…”

Diagnosis dan Tata Laksana Capsulitis Adhesiva

“…15 CT arthrography mampu mendiagnosis capsulitis adhesiva yakni dapat mendeteksi adanya penebalan kantong aksila. 16 TATA LAKSANA Belum ada bukti yang cukup untuk mendukung pengobatan operatif dini untuk capsulitis adhesiva. Namun, ada konsensus umum bahwa pengobatan operatif (pelepasan kapsul artroskopik dan/atau manipulasi dengan anestesi) merupakan pilihan jika pengobatan non-operatif gagal setelah periode 6 bulan.…”