What is the role of MRI in the diagnosis of frozen shoulder syndrome (FSS) (adhesive capsulitis)?

Updated: Nov 12, 2020
  • Author: Jefferson R Roberts, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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MRI is not initially indicated in cases of FSS. However, if the patient does not improve after a period of time (6 weeks to 3 months), then MRI is appropriate to rule out a possible rotator cuff tear or intra-articular pathology. [46, 47]  Chi et al concluded that non-contrast MRI (ie, without direct MRI arthrography), in conjunction with clinical criteria, can support accurate diagnosis of FSS. [48]  

A 2018 systematic review and meta-analysis identified six features on non-arthrogram MRI that may be used to diagnose FSS, as follows [49] :

  • Coracohumeral ligament thickening (diagnostic odds ratio [DOR] 13)
  • Fat obliteration of the rotator interval (DOR 8)
  • Rotator interval enhancement (DOR 44; sensitivity and specificity > 80%)
  • Axillary joint capsule enhancement (DOR 52; sensitivity and specificity > 80%)
  • Inferior glenohumeral ligament hyperintensity (DOR 31)
  • Inferior glenohumeral ligament thickening (DOR 28)

Zappia et al hypothesize that the high pericapsular signal intensity corresponds to hypervascular synovitis during the frozen phase of FSS. [42]  Park et al have correlated MRI findings with the clinical stage of FSS; see Table 2, below. [50]

Table 2 MRI findings according to clinical stage of FSS (Open Table in a new window)

Stage Joint capsular thickness (mm) in humeral portion of the axillary access Joint capsule edema  in humeral portion of axillary recess Obliteration of subcoracoid fat triangle
1 4.67 97% 74%
2 3.73 83% 56%
3 3.67 64% 21%

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