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Imaging Studies for Adhesive Capsulitis

The evaluation of a patient with adhesive capsulitis is not complete without an appropriate series of plain radiographs. True glenohumeral anterior-posterior views, along with axillary, scapular outlet and acromioclavicular views are considered necessary to exclude other shoulder girdle conditions which result in pain and stiffness. These films may often reveal osteopenia, but should not show any other definitive pathology. Additional radiographs of the neck, chest, or arm should be obtained if clinically indicated to exclude such problems as cervical radiculopathy, lung cancer, or humeral bone tumor.

Other types of advanced imaging have been used in patients with adhesive capsulitis. Magnetic resonance imaging (MRI) may demonstrate thickening of the inferior capsule, and when performed with intravenous gadolinium may reveal enhancement in the capsule or synovium. MRI arthrography and standard arthrography can show decreased intra-articular volume and will commonly reveal a reduction in the size of the inferior capsular recess. Additional findings can include variable distention of the biceps sheath or the subscapularis recess. Dynamic ultrasound has been shown to display a reduction in supraspinatus excursion with attempted shoulder movement. Radionucleide scanning has demonstrated increased uptake of technetium on “posterior views” in frozen shoulder, versus increased anterior uptake in subacromial conditions and uptake involving the distal upper extremity in patients with reflex sympathetic dystrophy. None of these advanced tests, however, have been shown to be diagnostic of adhesive capsulitis and often are unnecessary unless needed to exclude other diagnoses.

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