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This is a 51-year-old woman who has decreased

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range of motion and pain in her shoulder.

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Oblique coronal fat suppressed situated sequence

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demonstrating small amount of fluid within the joint space.

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But what catches our attention here is this intermediate

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signal intensity tissue interposed between

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the cranial fibers of the subscapularis and the

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anterior leading edge of the supraspinatus tendon.

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So we are right at the area of the rotator

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interval, root of the coracoid process.

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You can see the long head of biceps tendon.

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Uh, going out of the joint space through the rotator

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interval opening into the biceps tendon sheath.

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Now, on oblique sagittal images, these are

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T1 weighted images, we can better see the

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effacement of the fat in the retrocoracoid space.

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However, it's important to note that We should

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check on T2 weighted images because fluid can

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travel into the rotator interval region and it's

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going to look intermediate signal intensity on T1.

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So always, always check back and forth T1 against fluid

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sensitive sequence, in this case a FATSAT T2 weighted sequence.

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And when we look at the retrocoracoid space, it is not fluid.

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It's intermediate signal intensity on

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T1, intermediate signal intensity on T2.

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So this is synovial proliferation in

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the setting of adhesive capsulitis.

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The rotator interval space is the period of proliferation.

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prime location to assess for adhesive capsulitis

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because there are no tendon fibers in that space.

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It's located between the supraspinatus

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superiorly and the psoas scapularis inferiorly.

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Um, so it provides a window to the synovial lining of the joint.

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When there is adhesive capsulitis, we are

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going to have effacement of that space.

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So just to locate you here, supraspinatus.

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Infraspinatus rotator interval, and you see the

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effacement of the fat right behind the coracoid process.

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So this is very, very, uh, compelling

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for the diagnosis of adhesive capsulitis.

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Once we are suspicious of adhesive capsulitis,

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the next step is to go to the axillary recess.

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Why?

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Because in that location, we also have capsule lined

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by synovium without any interposition of tendon fibers.

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And in this patient, we have a very thickened inferior capsule.

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We can see it right here.

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A very thick and inferior capsule, which is also

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edematous, and it can be noted as well in the

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anterior inferior joint recess on the sagittal images.

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So if we cross-reference, we use our cross-referencing

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tool, and we go to the inferior capsule, Right there you see

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the correlation with that area of synovial thickening and

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proliferation with edema in the setting of adhesive capsulitis.