MRI Shoulder Without IV Contrast Zhao et al [113] showed that coracohumeral ligament thickening, anterior capsule thickening, and obliteration of the subcoracoid fat are the most characteristic findings of adhesive capsulitis on conventional MRI. Chi et al [114] found a sensitivity of 77% and a specificity of 53% for adhesive capsulitis with only coracohumeral ligament thickening on noncontrast MRI, with a lower sensitivity (23%) but a higher specificity (87%) in patients who had all 3 findings of adhesive capsulitis, including coracohumeral ligament thickening, rotator interval infiltration, and axillary recess thickening. Radiography Shoulder Additional Views There is insufficient evidence to support the use of additional radiographic views in the evaluation of chronic shoulder pain when adhesive capsulitis is suspected. US Shoulder US in the setting of potential adhesive capsulitis is often used to exclude rotator cuff tear. Although there are several US findings that can be seen in patients with adhesive capsulitis, US is not typically performed specifically for this indication. Thickening of the coracohumeral ligament, increased rotator interval soft tissue, and decreased external rotation on dynamic US are all highly sensitive and specific findings for adhesive capsulitis [115]. Thickening of the axillary recess capsule can be accurately measured with US and is associated with adhesive capsulitis [116]. Hyperemia with Doppler imaging, particularly with microflow imaging, can also be seen in the subcoracoid fat triangle in patients with adhesive capsulitis [117]. One study found that findings of adhesive capsulitis on US were correlated with clinical assessment, whereas findings on MRI were not [108]. Variant 6: Chronic shoulder pain. Suspect biceps tendon abnormality. Initial radiographs normal or inconclusive. Next imaging study.
Chronic Shoulder Pain PCAs. MRI Shoulder Without IV Contrast Zhao et al [113] showed that coracohumeral ligament thickening, anterior capsule thickening, and obliteration of the subcoracoid fat are the most characteristic findings of adhesive capsulitis on conventional MRI. Chi et al [114] found a sensitivity of 77% and a specificity of 53% for adhesive capsulitis with only coracohumeral ligament thickening on noncontrast MRI, with a lower sensitivity (23%) but a higher specificity (87%) in patients who had all 3 findings of adhesive capsulitis, including coracohumeral ligament thickening, rotator interval infiltration, and axillary recess thickening. Radiography Shoulder Additional Views There is insufficient evidence to support the use of additional radiographic views in the evaluation of chronic shoulder pain when adhesive capsulitis is suspected. US Shoulder US in the setting of potential adhesive capsulitis is often used to exclude rotator cuff tear. Although there are several US findings that can be seen in patients with adhesive capsulitis, US is not typically performed specifically for this indication. Thickening of the coracohumeral ligament, increased rotator interval soft tissue, and decreased external rotation on dynamic US are all highly sensitive and specific findings for adhesive capsulitis [115]. Thickening of the axillary recess capsule can be accurately measured with US and is associated with adhesive capsulitis [116]. Hyperemia with Doppler imaging, particularly with microflow imaging, can also be seen in the subcoracoid fat triangle in patients with adhesive capsulitis [117]. One study found that findings of adhesive capsulitis on US were correlated with clinical assessment, whereas findings on MRI were not [108]. Variant 6: Chronic shoulder pain. Suspect biceps tendon abnormality. Initial radiographs normal or inconclusive. Next imaging study.