2101
3. Axial and sagittal FSE sequence (TR/TEeff=4000 ms/36 ms
with a 512×320 matrix, two signals acquired, 15-cm FOV,
3.0-mm slice thickness and no interslice gap, ETL 8–10. A
23-G catheter was inserted into an antecubital vein and a total
bolus of 10 ml of gadolinium was injected. The next two
sequences were performed without delay.
4. Oblique coronal and axial post-gadolinium T1-weighted fat-
suppressed FSE sequence with a 320×256 matrix, two signals
acquired, 15 -cm FOV, 3.0-mm slice thickness and ETL 8–10.
seen in the rotation interval extending towards the bi-
ceps anchor.
Magnetic resonance imaging is commonly used to in-
vestigate shoulder disorders and remains the obvious
modality to non-invasively identify changes in the syno-
vium and capsule typical of adhesive capsulitis, and to
exclude other causes of shoulder pain and dysfunction
which may mimic this disorder. To our knowledge, no
study has correlated the MR imaging findings of adhe-
sive capsulitis with those found at surgery. We per-
formed a study in order to characterize the MR imaging
findings in a group of patients with adhesive capsulitis
prior to undergoing arthroscopic capsulotomy.
The rotator interval was assessed with respect to fibrovascular scar
tissue formation. This was believed to be present if there was a
discrete focus of homogeneous intermediate signal within the rota-
tor interval, often obliterating the fat surrounding the coracohu-
meral and superior glenohumeral ligaments and coming in contact
with the subscapularis tendon The biceps anchor was also evaluat-
ed. This was felt to be abnormal if a focus of abnormal signal
obliterated the fat encasing the biceps tendon sheath. Increased
signal on the FSE sequences (TR/TEeff=3500 ms/45 ms) with fat
saturation was evaluated and enhancement, if any, was noted on
the post-contrast T1-weighted images. Gadolinium enhancement
was assessed as either mild, moderate or marked.
The axillary pouch was assessed with respect to thickening and
enhancement. Thickening greater than 4 mm was felt to be signifi-
cant [12], as was any enhancement. The rotator cuff was assessed
using established MR imaging criteria [13]. The MR images were
interpreted by two musculoskeletal radiologists by means of con-
sensus. The interpretation represents the original report.
Materials and methods
From September 1998 to July 2001, 24 shoulder joints in 24 pa-
tients with clinical evidence of adhesive capsulitis were referred
by several upper limb orthopaedic surgeons and rheumatologists
for MR imaging prior to arthroscopic capsulotomy. There were 17
women and 7 men with a mean age of 53.5 years (age range
38–71 years). The right shoulder was affected in 13 cases and the
left in 11 which made up the study cohort.
All patients reported an insidious onset of shoulder pain and dys-
function ranging from 15 weeks to 26 months (mean 10.2 months).
Eight patients had a history of diabetes and one had autoimmune thy-
roid disease. The initial diagnosis was made on the basis of history
and clinical findings. All patients had undergone medical treatment
including anti-inflammatory medication, physiotherapy and hydrodi-
latation (14 of 24) and were considered refractory cases.
Clinical criteria for the condition included pain and stiffness
for greater than fifteen weeks, increasing in nature and most se-
vere at rest with restriction of passive motion greater than 30° in
two or more planes of movement. Exclusion criteria included
rheumatoid arthritis, previous shoulder surgery, previous trauma
or abnormal radiographs.
Following MR imaging, 24 shoulder joints in 24 patients
underwent arthroscopic surgery. The interval from the time of MR
imaging to surgery ranged from 4 to 28 days (mean 9.2 days). The
surgeon had access to the MR imaging reports.
Results
In the control group the rotator interval was shown to be
a space between the glenoid and coracoid process, with
the subscapularis tendon lying inferiorly and the biceps
tendon sitting above. Its contents include the coracohu-
meral and superior glenohumeral ligaments, which were
Twenty-two patients with clinical suspicion of rotator cuff pa-
thology were also referred for MR imaging (12 men, 10 women;
mean age 54.5 years). None of these patients were felt clinically to seen as distinct structures surrounded by fatty tissue
have adhesive capsulitis. There were 14 right shoulders and 10 left
(Fig. 1) best seen on sagittal imaging. The axillary pouch
shoulders. The mean duration of symptoms was 3.2 months (range
was a continuous band of low signal hanging like a ham-
10 days to 13 months) and the interval from consultation to MR
mock between the humeral head and inferior glenoid
labrum. It was best appreciated on the coronal oblique
images.
scanning was 17.2 days (range 0–45 days). This made up the con-
trol group.
Patients were examined with a 1.5-T superconducting unit
(Signa Horizon, GE Medical Systems, Milwaukee, Wis.) at two
clinical sites. Both MR units had an LX platform; the only differ-
ence was in bore length. The patients lay in a supine position with
the arm placed in a neutral position by the side. A phased-array
surface coil (Shoulder Array, Medrad, Indianola, Pa.) was centred
over the glenohumeral joint and strapped in place.
An axial localising image was obtained followed by these se-
quences:
Twenty-four cases of adhesive capsulitis were re-
ferred for MR imaging in 24 patients prior to surgery.
The results are summarized in Table 1. The MR imaging
demonstrated soft tissue abnormality in the rotator inter-
val in 22 of 24 studies. The superior glenohumeral liga-
ment was at least partially encased in 22 cases and the
lesion would often extend to and involve the coracohu-
meral ligament (16 of 22; Fig. 2). The rotator interval le-
sion was shown to sit in front and often coming in con-
tact with the undersurface of the biceps anchor (17 of
24). The amount of fibrovascular scar tissue was variable
(Fig. 3). Of the 24 studies, 10 showed definite thickening
of the axillary pouch >4 mm (Fig. 4) [12].
1. Oblique coronal fast spin-echo (FSE) sequence (TR/TEeff=
4000 ms/36 ms) along the axis of the supraspinatus muscle,
512×320 matrix, two signals acquired, 15-cm field of view
(FOV), 3-mm slice thickness with no gap and echo train length
(ETL) 8–10.
2. Oblique coronal FSE sequence (TR/TEeff=3500 ms/45 ms)
with a 256×256 matrix (zipped to 512), two signals acquired,
15-cm FOV, 3.5-mm slice thickness and 0.5-mm interslice gap
with frequency-selective fat suppression (Chem Sat, GE Medi-
cal Systems, Milwaukee, Wis.) and ETL 8–10.
Twenty patients (20 of 24), showed gadolinium en-
hancement of the rotator interval soft tissue lesion or
Wosnesenskii
