0:00

This is an important diagnosis. I mean,

0:02

this is something that if your eyes are not trained, looking at it,

0:07

this is something that often will get missed.

0:09

And a patient will have remarkable symptoms. The orthopedic surgeon knows this.

0:13

Uh, they can make a clinical diagnosis for this is sometimes when the clinical

0:17

picture is confusing and they wanna, uh, uh,

0:20

make sure that that's the diagnosis and they get imaging.

0:23

But a lot of times this is evident, uh, obvious clinically. Um,

0:27

and this is an, uh, nice example of adhesive capsulitis.

0:31

It has been marked with arrows here. So this is your inferior joint capsule,

0:34

the IGL inferior G glenohumeral ligament. It's thickened,

0:38

it's intermediate signal, and there is this trace per capsular edema.

0:43

I think. Um, um, now a lot of residents ask me, uh, when the,

0:47

they see thickened eyes, I that, is this a disease capsulitis?

0:51

So it's not the thickness because remember, this is a redundant structure.

0:54

It's like a fold and it can have like if, um,

0:57

it can have an extra fold and it'll look really thickened.

1:01

So my recommendation is just not to go by the thickness,

1:04

but try to look for this abnormal gray signal with that trace per capsular

1:09

edema. Those are your hallmark signs for, for adhesive capsulitis. And,

1:14

uh, again, it, um, it's a painful condition. Uh,

1:18

pa patients have painful, restricted, um, um, uh,

1:21

restriction of motion for the joint. And, um, another, um,

1:27

classic location for changes of, so if you see the whole,

1:29

this whole anterior capsule, there is this soft tissue thickening. Um,

1:33

and per capsular edema, another great location.

1:36

You see that synovitis in the rotator interval. That's an, that's an also, uh,

1:41

a classic, uh, manifestation of adhesive capsulitis and shoulder. So this is,

1:46

uh, on coronal images. So if, uh, there's synovitis in the rotator interval,

1:49

there's thickening along this entire anterior capsule, inferior capsule.

1:54

Let's go posteriorly. Um, we see if we see any changes. Yeah, so even,

1:58

even this,

1:59

this little haze that you see here is the inflammation of the joint capsule. Um,

2:05

sagittal images are also great in looking at that rotator intervals synovitis.

2:09

So, um, if you see that synovitis, um, in the rotator,

2:14

you see that that's been marked with the arrow.

2:16

Normally this is filled with just clear fluid and there are a few ligaments,

2:20

your caracal humeral and the Caro carac chromal ligaments. Uh,

2:24

but other than that, uh, this,

2:26

this rotator interval should have the biceps tendon and clear joint

2:31

fluid around it. So here, there's a lot of gray signal.

2:33

So all this is synovitis in the rotator interval. And even,

2:36

even if you are scrolling the TAL images, you see that peri capsular haze.

2:40

This is again, your interior thickened joint capsule, which is, um,

2:44

just intermediate signal intensity.

2:46

You don't see that nice black band of the joint cap. So, uh,

2:51

again, big structures look okay, your cuff is looking okay. Um, the,

2:55

the AC joint is not bad. There's no joint effusion, there's no

2:59

Subacromial subdeltoid bursitis. So the first, um,

3:03

impression that you get, oh, it looks like a normal joint.

3:05

But once you carefully look at the capsules, uh, you know that, um,

3:09

and this is not mild. This is like really, um, a significant, um,

3:14

grade of, um, adhesive capsulitis here.