Image-Guided Anesthetic +/- Corticosteroid Injection Shoulder or Surrounding Structures Image-guided injection of the glenohumeral joint for adhesive capsulitis can be performed with either fluoroscopy or US guidance. Image-guided corticosteroid injection has been shown to have a significant reduction in pain and an improvement in the range of motion for patients with adhesive capsulitis [105,106]. Use of US guidance for glenohumeral corticosteroid injection may be more accurate and produce a greater improvement in pain and functional scores relative to blind injection [107]. Patients with adhesive capsulitis have been found to be the only group with a statistically better outcome after glenohumeral joint injection than other patients; thus a positive response to a glenohumeral injection can be suggestive of the presence of adhesive capsulitis in the appropriate clinical context [23]. Fluoroscopic injection can also demonstrate diagnostic findings suggestive of adhesive capsulitis including joint space capacity <10 mL, diminished axillary recess, and irregularity of the capsular margin [108]. MR Arthrography Shoulder Mengiardi et al [109] reported that thickening of the coracohumeral ligament (specificity 95%, sensitivity 59%), thickening of the joint capsule (specificity 86%, sensitivity 64%), and obliteration of the subcoracoid triangle (specificity 100%, sensitivity 32%) are characteristic MR arthrography findings in adhesive capsulitis. However, fluid within the rotator interval or along the axillary recess due to the arthrogram injection itself can serve as a limitation to detecting findings of adhesive capsulitis on MRI arthrography. MRI Shoulder Without and With IV Contrast Contrast-enhanced MRI can increase the conspicuity of axillary recess capsular thickening [110] and rotator interval soft-tissue thickening [111], although there are conflicting data on the relationship of this capsular enhancement with patient symptoms [112].
Chronic Shoulder Pain PCAs. Image-Guided Anesthetic +/- Corticosteroid Injection Shoulder or Surrounding Structures Image-guided injection of the glenohumeral joint for adhesive capsulitis can be performed with either fluoroscopy or US guidance. Image-guided corticosteroid injection has been shown to have a significant reduction in pain and an improvement in the range of motion for patients with adhesive capsulitis [105,106]. Use of US guidance for glenohumeral corticosteroid injection may be more accurate and produce a greater improvement in pain and functional scores relative to blind injection [107]. Patients with adhesive capsulitis have been found to be the only group with a statistically better outcome after glenohumeral joint injection than other patients; thus a positive response to a glenohumeral injection can be suggestive of the presence of adhesive capsulitis in the appropriate clinical context [23]. Fluoroscopic injection can also demonstrate diagnostic findings suggestive of adhesive capsulitis including joint space capacity <10 mL, diminished axillary recess, and irregularity of the capsular margin [108]. MR Arthrography Shoulder Mengiardi et al [109] reported that thickening of the coracohumeral ligament (specificity 95%, sensitivity 59%), thickening of the joint capsule (specificity 86%, sensitivity 64%), and obliteration of the subcoracoid triangle (specificity 100%, sensitivity 32%) are characteristic MR arthrography findings in adhesive capsulitis. However, fluid within the rotator interval or along the axillary recess due to the arthrogram injection itself can serve as a limitation to detecting findings of adhesive capsulitis on MRI arthrography. MRI Shoulder Without and With IV Contrast Contrast-enhanced MRI can increase the conspicuity of axillary recess capsular thickening [110] and rotator interval soft-tissue thickening [111], although there are conflicting data on the relationship of this capsular enhancement with patient symptoms [112].