الفهرس 
ANATOMY OF THE SHOULDEROnly 14 pages are availabe for public view
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Abstract
A
dhesive capsulitis (AC) of the shoulder is a common condition with an incidence in the general population varying considerably from 2 to 5.3% for primary and from 4.3to 38% for secondary AC. Although spontaneous resolution is the rule, years can ensue (mean 18-30 months) before joint mobility returns to normal.
It is characterized by gradual and progressive onset of shoulder pain and limited active and passive range of motion (ROM) in the shoulder. in the past the diagnostic terminology for this entiry, such as ”frozen shoulder”, was ambigious and based on clinical features and symptoms, medical history, and physical examination. However, the disease presents with characteristic pathophysiology features, including capsular thickening and fibrosis due to chronic inflammation of the joint capsule, which may lead to capsular adhesion.
Given that other diseases of the shoulder such as rotator cuff tears, bursitis and calcified tendinitis, may have similar clinical symptoms. MRI is useful for differentiating AC from other diseases. MRI offers better resolution and soft tissue contrast than other methods and is a key modality for differentiating shoulder diseases.
Based on previous studies that used MRI, the key diagnostic findings for AC include capsular thickening, a hyperintense T2 signal and contrast enhancement in the axillary capsule and rotator interval, and obliteration of the subcoracoid fat triange. Theses MRI findings have an important role in the diagnosis of early AC when clinical features are atypical and in shortening of the duration of joint stiffness by allowing treatment.
We hypothesized that these changes in AC were measured by MRI and could be related to the severity of clinical findings such as the patient’s ROM and shoulder pain. accordingly, the objective of the present study was to investigate the association between various clinical features and the MRI findings.
MRI is a useful tool for evaluation and prediction of clinical stage of adhesive capsulitis. We believe that imaging-based grading system can aid in the diagnosis of various stages of the disease even when the clinical manifestations are subtle. This helps in the initiation of appropriate treatment to halt the disease progression, prevent the complications, and avoid invasive treatment procedures. Adhesive capsulitis is a syndrome of shoulder pain and limited range of motion, the cause of which may be idiopathic or secondary to a variety of clinical conditions. Early diagnosis and establishment of clinical stage is important in the prompt and effective treatment of this disorder. MRI of the shoulder is an effective and noninvasive means of diagnosing suspecting cases and also provides information that may assist the clinician in differentiating between the early and late stages. Capsule and synovial thickness, as measured in the axillary pouch, demonstrates the greatest correlation with clinical stage of adhesive capsulitis. Earlier, more hypervascular stages exhibit greater combined synovial and capsular thickening, while later more fibrotic stages demonstrate only capsular thickening. Hyperintensity of capsular signal was most closely associated with stage 2 disease. Rotator interval scarring is a non-specific signs of AC and was not found to correlate with clinical stage.