MRI of adhesive capsulitis of the shoulder: distension of the bursa in the superior subscapularis recess is a suggestive sign of the pathology.
OBJECTIVE
To evaluate the diagnostic values of the superior subscapularis recess sign in patients with shoulder adhesive capsulitis. The sign consists in evaluating in MRI of the shoulder the presence of fluid distension of the bursa in the superior subscapularis recess.


METHODS
We evaluated MRI of 165 shoulders in 48 consecutive patients with a diagnosis of shoulder adhesive capsulitis in the freezing phase (group I), in 49 short-wide superior cuff tear (group II) and in 65 controls (group III) between 2010 and 2013. On the T2 weighted images, we evaluated the presence of an high intensity signal within the superior subscapularis recess, consistent with fluid distension of the bursa.


RESULTS
The sign was found in 43/48 patients (89.58%) with shoulder adhesive capsulitis in 3/49 (6.12%) patients with superior cuff tear and in 1/65 controls (1.53%) (p<0.001). The mean diagnostic values were: sensibility 0.91; specificity 0.96-0.98; positive predictive value 0.93-0.97; negative predictive value 0.92-0.94; likelihood ratios for an abnormal test result 15.16-60.6; likelihood ratios for a normal test result 0.086-0.095.


CONCLUSIONS
For the orthopedic surgeon or the clinician, the sign is useful to confirm in MRI the clinical diagnosis of shoulder adhesive capsulitis; accordingly, the radiologist should describe and relate this sign to the pathology in the report, looking eventually for further typical sign of shoulder adhesive capsulitis.
Department of Orthopaedic and Traumatology, University of Rome Sapienza, Italy. Electronic address: stefcarbone@yahoo.it.
Stefano
S
Carbone
Department of Radiologic Sciences, University of Rome Sapienza, Italy.
Alessandro
A
Napoli
Department of Orthopaedic and Traumatology, University of Rome Sapienza, Italy.
Stefano
S
Gumina
D000328:Adult; D000368:Aged; D002061:Bursa, Synovial / Q000473:pathology*; D002062:Bursitis / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012540:Scapula / Q000473:pathology*; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000473:pathology*
Diagnosis; Freezing phase; Frozen shoulder; Shoulder adhesive capsulitis; Subscapularis recess