Do the Findings of Magnetic Resonance Imaging, Arthrography, and Ultrasonography Reflect Clinical Impairment in Patients With Idiopathic Adhesive Capsulitis of the Shoulder?



      To investigate the correlation between arthrography, magnetic resonance imaging (MRI), and ultrasonography (US) findings in patients with idiopathic adhesive capsulitis (IAC) of the shoulder and their clinical presentation as well as functional impairment.


      Cross-sectional observational study.


      Institutional practice.


      Patients (N=75) with a clinical diagnosis of unilateral IAC.


      Contrast-enhanced MRI, single-contrast arthrography, and US were performed in all patients.

      Main Outcome Measures

      The thickness of the axillary recess, coracohumeral ligament (CHL), and enhanced portion in the rotator cuff interval was measured using MRI. Arthrography was used to calculate the total score of shoulder arthrographic criteria. US was used to measure the thickness of the inferior glenohumeral ligament (IGHL) and CHL, and the IGHL ratio and CHL ratio were calculated by comparing those of the unaffected side.


      None of the MRI parameters was correlated with clinical assessment scores. The total score of shoulder arthrographic criteria was negatively correlated with passive range of motion of the total shoulder motion (P<.05), shoulder forward flexion (P<.05), and abduction (P<.05). The total Constant-Murley score was well correlated with the total score of shoulder arthrographic criteria (P<.05). The total shoulder joint space capacity was positively correlated with passive range of motion of the total shoulder motion (P<.05) and shoulder forward flexion (P<.05). The IGHL thickness, IGHL ratio, CHL thickness, and CHL ratio were negatively correlated with shoulder external rotation (P<.05).


      The findings of arthrography and US in patients with IAC of the shoulder were correlated with clinical assessment scores, whereas all measuring parameters on MRI were not. US is recommended as the preferred option for diagnosing IAC of the shoulder because it is noninvasive, reflects the clinical features of IAC, and provides anatomical accuracy.


      List of abbreviations:

      CHL (coracohumeral ligament), CMS (Constant-Murley score), IAC (idiopathic adhesive capsulitis), IGHL (inferior glenohumeral ligament), MRI (magnetic resonance imaging), PROM (passive range of motion), US (ultrasonography), VAS (visual analog scale)
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        • Mengiardi B.
        • Pfirrmann C.W.
        • Gerber C.
        • Hodler J.
        • Zanetti M.
        Frozen shoulder: MR arthrographic findings.
        Radiology. 2004; 233: 486-492
        • Bell S.
        • Coghlan J.
        • Richardson M.
        Hydrodilatation in the management of shoulder capsulitis.
        Australas Radiol. 2003; 47: 247-251
        • Tasto J.P.
        • Elias D.W.
        Adhesive capsulitis.
        Sports Med Arthrosc. 2007; 15: 216-221
        • Brue S.
        • Valentin A.
        • Forssblad M.
        • Werner S.
        • Mikkelsen C.
        • Cerulli G.
        Idiopathic adhesive capsulitis of the shoulder: a review.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1048-1054
        • Hannafin J.A.
        • Chiaia T.A.
        Adhesive capsulitis: a treatment approach.
        Clin Orthop Relat Res. 2000; : 95-109
        • Sofka C.M.
        • Ciavarra G.A.
        • Hannafin J.A.
        • Cordasco F.A.
        • Potter H.G.
        Magnetic resonance imaging of adhesive capsulitis: correlation with clinical staging.
        HSS J. 2008; 4: 164-169
        • Ahn K.
        • Kang C.H.
        • Oh Y.
        • Jeong W.
        Correlation between magnetic resonance imaging and clinical impairment in patients with adhesive capsulitis.
        Skeletal Radiol. 2012; 41: 1301-1308
        • Loyd J.
        • Loyd H.
        Adhesive capsulitis of the shoulder: arthrographic diagnosis and treatment.
        South Med J. 1983; 76: 879-883
        • Neviaser T.
        Arthrography of the shoulder.
        Orthop Clin North Am. 1980; 11: 205-217
        • Emig E.
        • Schweitzer M.E.
        • Karasick D.
        • Lubowitz J.
        Adhesive capsulitis of the shoulder: MR diagnosis.
        AJR Am J Roentgenol. 1995; 164: 1457-1459
        • Lefevre-Colau M.M.
        • Drapé J.L.
        • Fayad F.
        • et al.
        Magnetic resonance imaging of shoulders with idiopathic adhesive capsulitis: reliability of measures.
        Eur Radiol. 2005; 15: 2415-2422
        • Homsi C.
        • Bordalo-Rodrigues M.
        • Da Silva J.J.
        • Stump X.M.
        Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool?.
        Skeletal Radiol. 2006; 35: 673-678
        • Lee J.
        • Sykes C.
        • Saifuddin A.
        • Connell D.
        Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation.
        Skeletal Radiol. 2005; 34: 522-527
        • Michelin P.
        • Delarue Y.
        • Duparc F.
        • Dacher J.N.
        Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture.
        Eur Radiol. 2013; 23: 2802-2806
        • Dias R.
        • Cutts S.
        • Massoud S.
        Frozen shoulder.
        Brit Med J. 2005; 331: 1453
        • Conboy V.B.
        • Morris R.W.
        • Kiss J.
        • Carr A.J.
        An evaluation of the Constant-Murley shoulder assessment.
        J Bone Joint Surg Br. 1996; 78: 229-232
        • Constant C.
        • Murley A.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Relat Res. 1987; 214: 160-164
        • Ombregt L.
        A system of orthopaedic medicine.
        Elsevier Health Sciences, London2013
        • Huskisson E.
        Visual analogue scales.
        in: Melzack R. Pain measurement and assessment. Raven Pr, New York1983: 33-37
        • Park G.Y.
        • Lee J.H.
        • Kwon D.G.
        Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder.
        Ultrasonography. 2017; 36: 139
        • Kwon D.R.
        • Kim M.Y.
        • Chae Y.J.
        • Park J.S.
        • Kim J.S.
        • Yi T.I.
        Comparison of coracohumeral ligament thickness between asymptomatic shoulders and adhesive capsulitis in Korean.
        J Korean Acad Rehabil Med. 2009; 33: 392-395
        • Bulgen D.
        • Binder A.
        • Hazleman B.
        • Park J.
        Immunological studies in frozen shoulder.
        J Rheumatol. 1982; 9: 893
        • Bulgen D.
        • Hazleman B.
        • Voak D.
        HLA-B27 and frozen shoulder.
        Lancet. 1976; 307: 1042-1044
        • Bunker T.D.
        • Reilly J.
        • Baird K.S.
        • Hamblen D.L.
        Expression of growth factors, cytokines and matrix metalloproteinases in frozen shoulder.
        J Bone Joint Surg Br. 2000; 82: 768-773
        • Rodeo S.A.
        • Hannafin J.A.
        • Tom J.
        • Warren R.F.
        • Wickiewicz T.L.
        Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder.
        J Orthop Res. 1997; 15: 427-436
        • Connell D.
        • Padmanabhan R.
        • Buchbinder R.
        Adhesive capsulitis: role of MR imaging in differential diagnosis.
        Eur Radiol. 2002; 12: 2100-2106
        • Song K.D.
        • Kwon J.W.
        • Yoon Y.C.
        • Choi S.H.
        Indirect MR arthrographic findings of adhesive capsulitis.
        Am J Roentgenol. 2011; 197: W1105-W1109
        • Zhao W.
        • Zheng X.
        • Liu Y.
        • et al.
        An MRI study of symptomatic adhesive capsulitis.
        PLoS One. 2012; 7: e47277
        • Shaikh A.
        • Sundaram M.
        Adhesive capsulitis demonstrated on magnetic resonance imaging.
        Orthopedics. 2009; 32: 2
        • Schultheis A.
        • Reichwein F.
        • Nebelung W.
        Orthopade. 2008; 37 ([German]) (1068-72): 1065-1066
        • Yoon J.P.
        • Chung S.W.
        • Lee B.J.
        • et al.
        Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder.
        Knee Surg Sports Traumatol Arthrosc. 2015; : 1-9
        • Neviaser J.S.
        Arthrography of the shoulder joint.
        J Bone Joint Surg Am. 1962; 44: 1321-1359
        • Lundberg B.J.
        The frozen shoulder: clinical and radiographical observations the effect of manipulation under general anesthesia structure and glycosaminoglycan content of the joint capsule local bone metabolism.
        Acta Orthop Scand. 1969; 40: 1-59
        • Itoi E.
        • Tabata S.
        Range of motion and arthrography in the frozen shoulder.
        J Shoulder Elbow Surg. 1992; 1: 106-112
        • Kim I.
        • Yi J.H.
        • Lee J.
        • et al.
        Limited subacromial gliding of the supraspinatus tendon during dynamic ultrasonography can predict a decrease in capacity and MR arthrographic features of the shoulder joint.
        Eur Radiol. 2012; 22: 2365-2370
        • McNally E.G.
        • Rees J.L.
        Imaging in shoulder disorders.
        Skeletal Radiol. 2007; 36: 1013-1016
        • Walmsley S.
        • Osmotherly P.G.
        • Walker C.J.
        • Rivett D.A.
        Power Doppler ultrasonography in the early diagnosis of primary/idiopathic adhesive capsulitis: an exploratory study.
        J Manipulative Physiol Ther. 2013; 36: 428-435