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<v ->Let's turn our attention now

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from Tenosynovitis,

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we're gonna move on

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and talk a bit about Adhesive capsulitis.

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Because there seems to be a role

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for MR Imaging in the assessment

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of patients who have adhesive capsulitis.

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Now I'm gonna emphasize the shoulder.

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I will show an example or two

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of adhesive capsulitis elsewhere

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but the vast majority of cases that we see

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are cases in the shoulder.

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If you go into the literature you will see

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a number of tables that look just like this

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that indicate four particular stages

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of Adhesive Capsulitis.

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They have kind of interesting names,

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Pre-freezing stage,

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Freezing stage,

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Frozen stage

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and Thawing stage,

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kind of catchy names.

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But if you go ahead and look at these stages

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and add up the amount of months

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that could be involved in this condition,

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you're gonna end up

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sometimes in some patients with a disorder

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that lasts two or three years.

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The point that I would make is not all patients

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go through all of these stages.

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Some indeed have only an inflammatory stage,

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others go on to a non-inflammatory stage as well.

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And the clinical findings vary according

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to what particular stage of the disease

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is in effect.

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It is a problem,

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adhesive capsulitis of the shoulder

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that occurs in middle aged and elderly persons,

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more often a woman,

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associated a meaningful association with diabetes.

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You can see here,

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I've listed that 15% of diabetic

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have adhesive capsulitis

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and 30% of those with adhesive capsulitis have diabetes.

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Now there are other comorbidities,

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I've listed a few others here,

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and the pathology will vary between

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inflammatory changes to non-inflammatory fibrosis.

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MR Imaging in fact can be used

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to study this particular condition

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if you learn its target sites.

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And although adhesive capsulitis eventually

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can involve all regions of the shoulder

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and all regions of the glenohumeral joint

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it has a propensity early on

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to involve the rotator interval.

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Now, one of the ways you can study

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that particular part of the glenohumeral joint

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is to use your sagittal images

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and find the coracohumeral ligament extending

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out toward the coracoid process.

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And typically as you know,

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it is a rather clean looking ligament.

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It will have fat above and below it

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and particularly the triangular fat below it

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has received a lot of attention.

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What occurs in many persons early on

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with adhesive capsulitis is Edema.

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And you can see in the top picture what

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that edema would look like,

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and that produces obliteration

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of portions of the fat

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and makes it difficult for you

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to find the coracohumeral ligament.

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If you having trouble figuring

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out where the rotator interval is

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all you have to do is follow the biceps tendon

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as it courses through the joint,

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because it follows the rotator interval.

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So there you can see the biceps tendon.

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Therefore it is not surprising

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that when you have rotator interval involvement

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you also can develop involvement of the biceps tendon

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and develop adhesions between it and the sub humeral head

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Now, some people suggest that if you are concerned

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about adhesive capsulitis you may want to turn

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to the use of intravenous gadolinium.

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We don't do this routinely,

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but there's at least one recent article

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that indicated that in some cases,

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the T2 weighted images are not diagnostic

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and using IV Gadolinium can help you

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showing enhancement particularly in the axillary pouch

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and in the rotator interval.

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Here's one nice example

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showing you the enhancement associated

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with adhesive capsulitis throughout the joint,

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not only at the top, but more lower down

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and even in the area of the axillary pouch

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here's another example showing you

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what can you see if you use intravenous gadolinium

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extensive enhancement.

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Note here, I mean,

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this is capsular enhancement all around the joint.

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Now we've been impressed

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with how often you're gonna see adhesions

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between the biceps tendon and the humeral head.

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I mentioned this yesterday in one of my slides

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and you can see it when there are adhesions

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you develop this particular lesion within the humeral head

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mainly cystic in nature,

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deep to the biceps tendon.

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And this has a fancy name.

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I mentioned it yesterday.

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It's known as Chondral Print.

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It may be associated with cartilage erosion.

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It's also seen with slap lesions

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and following treatment of various slap lesions.

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In this case note the thicken

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and edema within the axillary pouch.

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Here's another example of a patient with adhesive capsulitis

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and you can see the thickening

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and abnormal signal within the biceps tendon.

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So always looked in that area as well.

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For findings of adhesive capsulitis.