Evaluation of Adhesive Capsulitis of the Shoulder with Fat-Suppressed T2 Weighted MRI: Association between Clinical Features and MRI Findings
Authors: Mohammed Mariam Hussein , Fahmi Fady Micheal , Ali Khalid Ahmed Mohamed , Elia Remon Zaher 
Published: August 2023

Introduction
•Adhesive capsulitis of the shoulder or frozen shoulder is a debilitating condition characterized by progressive pain, stiffness and limited range of motion about the glenohumeral joint, the term (adhesive capsulitis) to describe the findings of chronic inflammation and fibrosis of the joint capsule, characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder. (Zhao W, ZhengX, liu Y, et al.,2012).
•MRI has, in recent years, allowed for the visualization of several characteristic signs seen with this condition, including thickening and shortening of the coracohumeral (CHL) ligament, thus limiting external rotation is due to fibroblastic proliferation within the CHL, thickening of axillary pouch and rotator interval joint capsule, in addition to the obliteration of the subcoracoid fat triangle.(Cheng X, et al.,2017).

Aim of the work
to examine the association between clinical features (stages) and MRI findings in adhesive capsulitis of the shoulder.

Methods and material
seventy patients confirmed or suspected adhesive capsulitis of the shoulder. The diagnosis is based on MRI findings and clinical criteria. Patients who complain from shoulder pain and restricted ROM with detailed clinical information and history which permit the clinical staging of AC and patients with normal ROM in the opposite shoulder are also included (the initial diagnosis was based on the history and clinical symptoms) clinical criteria for the diagnosis of AC includes: restricted passive motion for greater than 30 degrees in the two or more planes of movement, gradually increasing shoulder pain that was more severe at rest at least 1 month duration, and normal radiographic findings .Patients who fullified these criteria underwent shoulder MRI to correlate MRI findings with pain intensity, range of motion and clinical stage. Study is approved by the ethics review board of Ain Shams University Hospital. For the MRI examination, (a 1.5 tesla Philips Healthcare) MRI machine at El-Demerdash University Hospitals with a dedicated shoulder surface phased –array coil. During imaging, patients were in supine position .MRI protocol consisted of the following sequences:Fat-suppressed T2: coronal oblique, sagittal and axial weighted images, proton density(PD), fast spin echo T1-Weighted sagittal images.All patients will be subjected to complete history taking, full clinical examination.
All MRI imaging examinations were conducted at radiology department of Ain Shams University. All patients were subjected to full history taking prior to scanning and full clinical examination.

Results
Regarding the diagnostic performance of shoulder MRI there is a statistically significant difference between degree of pain intensity according to Capsular thickening regarding humeral “mm” with p-value (p &lt; 0.05). The highest value was found moderate and severe pain group (5.67±1.39) compared to absent, minimal & mild pain group (4.42±1.29)., there was a statistically significant difference between two groups according to axillary recess regarding height “mm” with p-value (p &lt; 0.05). The highest value was found absent, minimal & mild pain group (7.02±2.68) compared to moderate and severe pain group (5.73±2.25).
There is no statistically significant association between pain intensity and MRI finding regarding Capsular Edema, Extra Capsular Edema, Obliteration of Subcoracoid Fat Triangle, Effusion of Biceps Tendon Sheath, Capsular Thickening Glenoid (mm) and Axillary Recess Width (mm), with p-value (p &gt; 0.05 NS).
•Qualitative and quantitative analysis
a highly statistically significant difference between absent and present of limitation of ROM “abduction” according to Capsular Thickening Glenoid (mm) with p-value (p &lt; 0.001). The highest value was found absent group (6.29±0.99) compared to present group (5.21±1.39).
•Additionally, the results showed 25 patients out of 70 having extra capsular edema anterior, 20 patients (48.8%) belong to absent abduction group and 5 patients (17.2%) belong to present abduction group, as there was a statistically significant negative relation with p-value (p = 0.014).
•There is no statistically significant association between absent and present of limitation of ROM “abduction” and MRI finding regarding Capsular Edema Glenoid, Capsular Edema Humeral, Extra Capsular Edema Posterior, Obliteration of Subcoracoid Fat Triangle, Effusion of Biceps Tendon Sheath, Capsular Thickening Humeral (mm), Axillary Recess Height (mm) and Axillary Recess Width (mm), with p-value (p &gt; 0.05 NS)

Conclusion
MRI can be useful for assessment several measures of clinical impairment in patients with adhesive capsulitis . thickening and hyperintensity of the joint capsule in the axillary recess on MRI is associated with limited ROM and duration of symptoms.