Imaging
Adhesive Capsulitis
- Preliminary Diagnosis: Adhesive Capsulitis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of adhesive capsulitis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of adhesive capsulitis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Adhesive Capsulitis
I. What imaging technique is first-line for this diagnosis?
MR arthrography is the first-line imaging modality for detection of adhesive capsulitis.
Imaging protocol should include both fat-suppressed and non-fat-suppressed images, plus T1WI postcontrast images.
II. Describe the advantages and disadvantages of this technique for diagnosis of adhesive capsulitis.
Advantages
MR arthrography is diagnostic with findings of fibrosis in the rotator cuff interval, <8-10 mL joint capacity before contrast extravasation, and enhancing thickened capsule in the rotator cuff interval.
MRI is able to detect other causes of pain or weakness in the joint such as tendinopathy, tenosynovitis, bursitis, or tears.
MRI does not make use of any ionizing radiation.
Disadvantages
Normally with adhesive capsulitis a joint capacity of <8-10 mL with arthrography is diagnostic. However, false-negative results occur with an associated full-thickness rotator cuff tear. This can be detected on subsequent MRI of the joint.
As with any invasive procedure, complications do exist with arthrography although they are very rare and usually minor.
MRI is an expensive and time-consuming modality that requires marked patient cooperation to limit motion artifact.
MRI with intravenous contrast requires that the patient have good renal function with a GFR >60. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR >30 and <60.
III. What are the contraindications for the first-line imaging technique?
Patients with non-MR-compatible metallic hardware or foreign bodies.
IV. What alternative imaging techniques are available?
CT arthrography
Ultrasound
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of adhesive capsulitis.
CT arthrography
Advantages
Can also detect a joint capactiy of <8-10 mL
CT scanning may be perfomed much quicker, requires less patient cooperation, and is associated with less motion artifact compared with MRI.
Disadvantages
CT does not demonstrate soft tissues of the rotator cuff interval, rotator cuff musculature, and tendons with as precise anatomic detail as can MRI. MR arthrography is far superior.
Subsequent MRI will likely need to be performed in light of negative CT results, increasing costs and delaying time to diagnosis.
Ultrasound
Advantages
Ultrasound may be diagnostic is diagnosing adhesive capsulitis.
Allows real-time imaging with assessment of capsular compliance during patient movement.
Can also detect tendinopathy, tendonitis, bursitis, and tear
Disadvantages
Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology
Limited evaluation in obese patients
VI. What are the contraindications for the alternative imaging techniques?
CT arthrography
Contraindicated in pregnancy, especially within the first two trimesters
Documented history or multiple prior significant reactions to contrast
Ultrasound
No significant contraindications exist.
Copyright © 2017, 2014 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Sign Up for Free e-newsletters
ONA Articles
- FDA: Number of U.S. Women With Breast Implant-Caused Cancer Has Increased
- Immunotherapy for HER2-positive Breast Cancer: Recent Advances and Combination Therapeutic Approaches
- Nurse-Led vs Oncologist-Led Breast Cancer Follow-up Program: Early Feasibility Results of an Ongoing Study
- A Review of Clinical Outcomes in Patients With Early-Stage Burkitt Lymphoma
- Survey Demonstrates Relationship Between Symptom Burden, Medical Disability Leave Among Myeloproliferative Neoplasms
- Oncology Nurse Navigation Facilitates Timely Treatment of Pancreatic Cancer
- Oncology Nurses Weigh In on Their Patient-Centered Communication Practices, Needs
- Substitute for Lidocaine
- FDA: Number of U.S. Women With Breast Implant-Caused Cancer Has Increased
- Identifying the Needs of Multidisciplinary Team Treating Geriatics Cancer Patients
- Sequence of Immunotherapy, Targeted Therapy, Radiation Therapy Influences Overall Survival in Melanoma Brain Metastases
- Survey Demonstrates Implicit Bias Toward Cervical Cancer Diagnoses Among Nurses, Women
- Use of Watchful Waiting Up for Low-Risk Localized Prostate Cancer
- Sharing Personal Contact Information With Patients
- Country-Specific Norms Created for Cancer-Related Quality of Life
Regimen and Drug Listings
GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION
Bone Cancer | Regimens | Drugs |
Brain Cancer | Regimens | Drugs |
Breast Cancer | Regimens | Drugs |
Endocrine Cancer | Regimens | Drugs |
Gastrointestinal Cancer | Regimens | Drugs |
Genitourinary Cancer | Regimens | Drugs |
Gynecologic Cancer | Regimens | Drugs |
Head and Neck Cancer | Regimens | Drugs |
Hematologic Cancer | Regimens | Drugs |
Lung Cancer | Regimens | Drugs |
Other Cancers | Regimens | |
Rare Cancers | Regimens | |
Skin Cancer | Regimens | Drugs |