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Closing the clinical-imaging gap in adhesive capsulitis? Cutoff values of quantitative shoulder ultrasonography for diagnosis of equivocal cases

Allam MFA, Allam AFA, Ragaee SM, Khamies MS, Ismail AH, Mourad MAFE

Egyptian Journal of Radiology and Nuclear Medicine 2025 April 30;56

primary study

BACKGROUND: Adhesive capsulitis (AC) is an arthro-inflammatory condition characterized by painful progressive reduction of shoulder movements. Due to the increasing demand for an accurate imaging tool for positive contribution in AC diagnosis notably in early cases, the aim of this study was to assess the usefulness of quantitative dynamic and static sonography of the shoulder in identification of adhesive capsulitis and in providing proper cutoff values to close the clinical-imaging gap in the diagnosis and increase the sonographic accuracy notably in borderline and equivocal cases. METHOD(S): Sixty six patients diagnosed with adhesive capsulitis were enrolled in the study; the affected and contralateral shoulders of all of them were examined using multi-parametric static and dynamic sonography that was tailored to cover different portions of the capsule. RESULT(S): All symptomatic shoulders demonstrated at least one abnormal sonographic parameter, the majority of them showed more than one abnormality. There was statistically significant difference between the symptomatic and contralateral sound shoulders regarding the AP and RI soft tissue thickness. The optimal cutoff point for AP thickness was 3-mm that demonstrated high sensitivity 92.42% and specificity 98.48% for diagnosis of AC, depending on this cutoff value, 61 out of 66 (92.4%) cases were diagnosed with AC, the remaining 5/66 (7.5%) cases demonstrated signs of adhesions in another capsular location, 3/66 (4.5%) cases showed posterior capsular adhesions with IF folding, whereas 2/66 (3%) cases showed soft tissue thickening of the rotator interval anteriorly. Regarding the RI soft tissue thickness, the optimal cutoff point was 1.7-mm that demonstrated a maximum sensitivity of 81.82% and specificity of 75.76%, The IF folding was exclusively demonstrated in the symptomatic shoulders and was found in 39 out of 66 (59%) patients, the least detectable folding angle was 10 degree. The supraspinatus gliding movement was restricted in 41 out of 66 (62%) patients in their symptomatic shoulders; the contralateral shoulders did not display such feature, the least residual length of supraspinatus tendon showed value of 1.4 mm. CONCLUSION(S): We conclude that quantitative ultrasound is a good reliable method for diagnosis of adhesive capsulitis, the cutoff values of 3-mm for axillary pouch thickness and 1.7-mm for rotator interval soft tissue thickening along with dynamic tests could accurately diagnose the equivocal adhesive capsulitis cases, and close the clinical-imaging gap.

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