Rheumatology International

, Volume 39, Issue 3, pp 453–460 | Cite as

Determination of magnetic resonance imaging criteria for diagnosis of adhesive capsulitis

  • Jae Hoon Jung
  • Du Hwan Kim
  • Jaehyuck Yi
  • Du-Han Kim
  • Chul-Hyun ChoEmail author


The objective of this study was to identify optimal magnetic resonance imaging (MRI) parameters and their cutoff values for diagnosing adhesive capsulitis (AC). One hundred shoulder MRI images with stage 2 AC (AC group) and 100 MRI images without AC (control group) were randomly reviewed by two experienced shoulder specialists. They were asked whether MRI findings were compatible with AC and measurement of MRI parameters. Sensitivity, specificity, and accuracy were calculated. Correlation between MRI parameters and the range of motions was also analyzed. The mean capsular thickness in the axillary recess (AR) (5.9 mm in the AC group vs. 3.6 mm in the control group) on coronal oblique T2-weighted images and the rotator interval (RI) (7.2 mm vs. 4.8 mm, respectively) on oblique sagittal proton-density images were significantly greater in the AC group than in the control group, whereas the width of RI showed no significant difference between two groups. The highest diagnostic cutoff values were 4.5 mm for the AR and 6 mm for the RI, with sensitivity (91% and 88%, respectively), specificity (90% and 90%), and accuracy (90% and 89%). Capsular thickness in the AR and RI was significantly correlated with external rotation (P = 0.047) and internal rotation (P = 0.023). On conventional MRI, capsular thickness greater than 4.5 mm in the AR or 6 mm in the RI can be an optimal criterion for diagnosing AC. Capsular thickness in the AR and RI was correlated with the range of rotational motion.


Adhesive capsulitis Axillary recess Rotator interval Magnetic resonance image 



Jae Hoon Jung and Du Hwan Kim are co-first authors. We thank Eun-Ji Jeon and Yeji Kim for their support with data collection. We thank Scott Timpano for editing a draft of this manuscript.

Author contributions

JHJ, DHK, and C-HC were responsible for the conceptualization and design of the study, and wrote the manuscript. D-HK collected the data and statistical analysis. JHY contributed interpretation of data and critical review.


This work was supported by the Bisa Research Grant of Keimyung University in 2016.

Compliance with ethical standards

Conflict of interest

Jae Hoon Jung declares that he has no conflict of interest. Du Hwan Kim declares that he has no conflict of interest. Jaehyuck Yi declares that he has no conflict of interest. Du-Han Kim declares that he has no conflict of interest. Chul-Hyun Cho declares that  he has no conflict of interest.

Ethical standards

This study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors obtained the approval of Keimyung University Dongsan Medical Center institutional review board (IRB number 2016-07-032) with exemption of Informed consent for this study.


  1. 1.
    Zhao W, Zheng X, Liu Y, Yang W, Amirbekian V, Diaz LE, Huang X (2012) An MRI study of symptomatic adhesive capsulitis. PLoS One 7(10):e47277. CrossRefGoogle Scholar
  2. 2.
    Neviaser TJ (1980) Arthrography of the shoulder. Orthop Clin N Am 11(2):205–217Google Scholar
  3. 3.
    Omari A, Bunker TD (2001) Open surgical release for frozen shoulder: surgical findings and results of the release. J Shoulder Elbow Surg 10(4):353–357. CrossRefGoogle Scholar
  4. 4.
    Warner JJ, Allen A, Marks PH, Wong P (1996) Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Jt Surg Am 78(12):1808–1816CrossRefGoogle Scholar
  5. 5.
    Wiley AM (1991) Arthroscopic appearance of frozen shoulder. Arthroscopy 7(2):138–143CrossRefGoogle Scholar
  6. 6.
    Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewicz TL (1997) Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res 15(3):427–436. CrossRefGoogle Scholar
  7. 7.
    Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA (2011) Current review of adhesive capsulitis. J Shoulder Elbow Surg 20(3):502–514. CrossRefGoogle Scholar
  8. 8.
    Zappia M, Di Pietto F, Aliprandi A, Pozza S, De Petro P, Muda A, Sconfienza LM (2016) Multi-modal imaging of adhesive capsulitis of the shoulder. Insights Imaging 7(3):365–371. CrossRefGoogle Scholar
  9. 9.
    Loyd JA, Loyd HM (1983) Adhesive capsulitis of the shoulder: arthrographic diagnosis and treatment. South Med J 76(7):879–883CrossRefGoogle Scholar
  10. 10.
    Harris G, Bou-Haidar P, Harris C (2013) Adhesive capsulitis: review of imaging and treatment. J Med Imaging Radiat Oncol 57(6):633–643. CrossRefGoogle Scholar
  11. 11.
    Connell D, Padmanabhan R, Buchbinder R (2002) Adhesive capsulitis: role of MR imaging in differential diagnosis. Eur Radiol 12(8):2100–2106. CrossRefGoogle Scholar
  12. 12.
    Emig EW, Schweitzer ME, Karasick D, Lubowitz J (1995) Adhesive capsulitis of the shoulder: MR diagnosis. Am J Roentgenol 164(6):1457–1459. CrossRefGoogle Scholar
  13. 13.
    Gokalp G, Algin O, Yildirim N, Yazici Z (2011) Adhesive capsulitis: contrast-enhanced shoulder MRI findings. J Med Imaging Radiat Oncol 55(2):119–125. CrossRefGoogle Scholar
  14. 14.
    Jung JY, Jee WH, Chun HJ, Kim YS, Chung YG, Kim JM (2006) Adhesive capsulitis of the shoulder: evaluation with MR arthrography. Eur Radiol 16(4):791–796. CrossRefGoogle Scholar
  15. 15.
    Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M (2004) Frozen shoulder: MR arthrographic findings. Radiology 233(2):486–492. CrossRefGoogle Scholar
  16. 16.
    Song KD, Kwon JW, Yoon YC, Choi SH (2011) Indirect MR arthrographic findings of adhesive capsulitis. Am J Roentgenol 197(6):W1105–W1109. CrossRefGoogle Scholar
  17. 17.
    Li JQ, Tang KL, Wang J, Li QY, Xu HT, Yang HF, Tan LW, Liu KJ, Zhang SX (2011) MRI findings for frozen shoulder evaluation: is the thickness of the coracohumeral ligament a valuable diagnostic tool? PLoS One 6(12):e28704. CrossRefGoogle Scholar
  18. 18.
    Kim KC, Rhee KJ, Shin HD (2009) Adhesive capsulitis of the shoulder: dimensions of the rotator interval measured with magnetic resonance arthrography. J Shoulder Elbow Surg 18(3):437–442. CrossRefGoogle Scholar
  19. 19.
    Lee MH, Ahn JM, Muhle C, Kim SH, Park JS, Kim SH, Kim SM, Kang HS (2003) Adhesive capsulitis of the shoulder: diagnosis using magnetic resonance arthrography, with arthroscopic findings as the standard. J Comput Assist Tomogr 27(6):901–906CrossRefGoogle Scholar
  20. 20.
    Lee SY, Park J, Song SW (2012) Correlation of MR arthrographic findings and range of shoulder motions in patients with frozen shoulder. Am J Roentgenol 198(1):173–179. CrossRefGoogle Scholar
  21. 21.
    Park S, Lee DH, Yoon SH, Lee HY, Kwack KS (2016) Evaluation of adhesive capsulitis of the shoulder with fat-suppressed T2-weighted MRI: association between clinical features and MRI findings. Am J Roentgenol 207(1):135–141. CrossRefGoogle Scholar
  22. 22.
    Hannafin JA, Chiaia TA (2000) Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res 372:95–109CrossRefGoogle Scholar
  23. 23.
    Lefevre-Colau MM, Drape JL, Fayad F, Rannou F, Diche T, Minvielle F, Demaille-Wlodyka S, Mayoux-Benhamou MA, Fermanian J, Poiraudeau S, Revel M (2005) Magnetic resonance imaging of shoulders with idiopathic adhesive capsulitis: reliability of measures. Eur Radiol 15(12):2415–2422. CrossRefGoogle Scholar
  24. 24.
    Sofka CM, Ciavarra GA, Hannafin JA, Cordasco FA, Potter HG (2008) Magnetic resonance imaging of adhesive capsulitis: correlation with clinical staging. HSS J 4(2):164–169. CrossRefGoogle Scholar
  25. 25.
    Gondim Teixeira PA, Balaj C, Chanson A, Lecocq S, Louis M, Blum A (2012) Adhesive capsulitis of the shoulder: value of inferior glenohumeral ligament signal changes on T2-weighted fat-saturated images. Am J Roentgenol 198(6):W589–W596. CrossRefGoogle Scholar
  26. 26.
    Manton GL, Schweitzer ME, Weishaupt D, Karasick D (2001) Utility of MR arthrography in the diagnosis of adhesive capsulitis. Skelet Radiol 30(6):326–330CrossRefGoogle Scholar
  27. 27.
    Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Park JS, Ryu KN (2018) Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder. Eur Radiol. Google Scholar
  28. 28.
    Ahn KS, Kang CH, Kim Y, Jeong WK (2015) Diagnosis of adhesive capsulitis: comparison of contrast-enhanced MRI with noncontrast-enhanced MRI. Clin Imaging 39(6):1061–1067. CrossRefGoogle Scholar
  29. 29.
    Neer CS, Satterlee CC, Dalsey RM, Flatow EL (1992) The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res 280:182–185Google Scholar
  30. 30.
    Ozaki J, Nakagawa Y, Sakurai G, Tamai S (1989) Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. J Bone Jt Surg Am 71(10):1511–1515CrossRefGoogle Scholar
  31. 31.
    Ahn KS, Kang CH, Oh YW, Jeong WK (2012) Correlation between magnetic resonance imaging and clinical impairment in patients with adhesive capsulitis. Skelet Radiol 41(10):1301–1308. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryCity HospitalDaeguSouth Korea
  2. 2.Department of Rehabilitation Medicine, Dongsan Medical Center, School of MedicineKeimyung UniversityDaeguSouth Korea
  3. 3.Department of Radiology, Dongsan Medical Center, School of MedicineKeimyung UniversityDaeguSouth Korea
  4. 4.Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of MedicineKeimyung UniversityDaeguSouth Korea

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