Objective: The purpose of this study was to assess the usefulness of magnetic resonance (MR) arthrography of the glenohumeral joint in the diagnosis of adhesive capsulitis.
Methods: MR arthrography of the glenohumeral joint was performed in 16 patients with arthroscopically proven adhesive capsulitis and 11 controls. Thickness of the joint capsule and synovium, filling ratio of the fluid-distended axillary recess to the posterior joint cavity, and a width of the rotator cuff interval were measured by 2 musculoskeletal radiologists. The measurements of those parameters for the patients with adhesive capsulitis and the controls were compared. Interobserver variability for the measurements of each parameter was calculated.
Results: The mean thickness of the joint capsule and synovium was 2.97 mm in patients with adhesive capsulitis and 1.86 mm in controls (P < 0.001). The mean filling ratio of the fluid-distended axillary to the posterior joint cavity was 0.51 in patients with adhesive capsulitis and 0.82 in controls (P = 0.004). The mean width of the rotator cuff interval was 7.45 mm in patients with adhesive capsulitis and 8.48 mm in controls (P > 0.05). Intraclass correlation coefficient for interobserver variability showed good agreement (95% CI; 0.72–0.95).
Conclusions: On MR arthrography, thickening of the joint capsule and synovium and diminished filling ratio of the axillary recess to posterior joint cavity appeared to be useful diagnostic criteria for the diagnosis of adhesive capsulitis of the shoulder.
Adhesive capsulitis of the shoulder is a common clinical problem causing significant functional morbidity and pain. 1 This condition should accurately be diagnosed to be effectively treated; however, its correct diagnosis might be difficult because many shoulder conditions have similar clinical symptoms. 2–5 Arthrography of the glenohumeral joint has been used and regarded as a reliable means of detecting this condition, of which findings were well-established. 6,7
Magnetic resonance (MR) arthrography allows excellent visualization of capsulolabral and other intra-articular structures as well as the rotator cuff which are often not visualized well in the absence of the significant quantities of native joint fluid on conventional MR imaging. 8–13 We expected MR arthrography would be another imaging modality widely used in the diagnosis of adhesive capsulitis in which the capsule and synovium are thickened and joint capacity is decreased, although there have been some reports about diagnosis of this condition using MR imaging and indirect MR arthrography. 3,14 Hence, to assess the usefulness of MR arthrography in the diagnosis of adhesive capsulitis, we reviewed MR arthrograms of the glenohumeral joint in patients with adhesive capsulitis and controls, with arthroscopic findings as the reference standard.
From the Departments of Radiology (Drs Lee, Ahn, Sung Hyun Kim, and Park) and Orthopedic Surgery (Dr Seung Ho Kim), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Nuclear Medicine, Christian-Albrechts University of Kiel, Kiel, Germany (Dr Muhle); Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Dr Sung Moon Kim); and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (Dr Kang).
Reprints: Joong Mo Ahn, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnamgu, Seoul 135-710, Korea (e-mail: firstname.lastname@example.org).