Adhesive capsulitis

Diagnostic algorithm for adhesive capsulitis

Initial diagnostics of adhesive capsulitis always starts in the clinician's office: a thorough history is taken, and a functional examination is performed. A mandatory criterion is the detection of restricted external rotation.

To rule out other pathological processes with similar symptoms, routine clinical practice utilizes basic diagnostic imaging methods: classical radiography, ultrasound (US), and magnetic resonance imaging (MRI).

Nevertheless, it is traditional arthrography that allows for a definitive confirmation of the diagnosis. The resulting arthrograms visualize distinct specific signs of the disease:

• Overall reduction in the normal volume of the joint cavity.
• Presence of intra-articular adhesions or synaechiae (synaechiae).
• Marked retraction of the axillary recess (retracted axillary recess).
• Noticeable reduction in the size of the subcoracoid recess (reduced subcoracoid recess).
• Development of a complete block of the tendon sheath of the long head of the biceps.

In addition to its purely diagnostic role, arthrography in this pathology has a crucial therapeutic effect. During the contrast administration procedure, controlled stretching of the affected joint—distension—occurs, which helps improve its function.

Application of MR arthrography

The MR arthrography (MR arthrography) technique involves the preliminary intra-articular administration of a diluted gadolinium chelate solution (gadolinium chelate). This method is historically considered the gold standard for a number of clinical situations.

Main indications for MR arthrography:

1. Assessment of the labroligamentous complex (labroligamentous complex) in young patients with glenohumeral instability (glenohumeral instability) during the planning stage of reconstructive surgery.
2. Detailed study of the structure of the triangular fibrocartilaginous complex of the wrist (triangular fibrocartilaginous complex).
3. Visualization of the articular cartilage and acetabular labrum (labrum) of the hip joint.

It is worth noting modern trends in diagnostic imaging: the use of high-field 3T scanners combined with state-of-the-art coils makes it possible to obtain images whose quality approaches that of classical MR arthrography as closely as possible. This gradually reduces the need for invasive intra-articular contrast administration. For other joints, the technique is used much less frequently, mainly to search for loose intra-articular bodies or to assess the integrity of the hyaline cartilage.

Role of CT arthrography

CT arthrography (CT arthrography) serves as an excellent alternative in cases where the patient has absolute contraindications to MRI. The method is also in high demand for postoperative evaluation of the menisci and articular cartilage.

The key advantages of CT arthrography over its MRI counterpart lie in significantly higher spatial resolution (spatial resolution) and extremely fast image acquisition. The scanning speed minimizes the risk of motion artifacts from accidental patient movement to an absolute minimum.

A representative example is the clinical case of a 32-year-old patient complaining of ankle pain following microfracture of the superolateral part of the talar dome (talar dome) due to a traumatic osteochondral defect. Routine STIR MRI demonstrated only subchondral bone marrow edema, failing to adequately assess the state of the cortical layer. At the same time, CT arthrography (in coronal reconstruction), possessing the highest spatial and contrast resolution, clearly showed completely intact fibrocartilage (fibrocartilage) in the surgical intervention zone.

Arthrography and therapeutic foot injections

Selective intra-articular injections of corticosteroid drugs are actively used for the conservative treatment of arthritis localized in the hindfoot and midfoot. The diagnostic value of such a procedure is high: a positive reaction to the administered local anesthetic reliably confirms the exact source of pain symptoms.

Foot anatomy has its own characteristics. Quite often, natural communications (anastomoses) are revealed between the talocrural (talocrural) and posterior subtalar (posterior subtalar) joints, as well as between the numerous joints of the midfoot.

It is arthrography that plays a critically important role in visualizing these anatomical communications. Only a contrast study can accurately show the surgeon which specific joints will be affected by the administration of the drug. This information is crucial for preoperative planning of single, double, or triple arthrodesis (fusion).

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Topographic anatomy of the axillary and subcoracoid recesses of the shoulder joint
• Technique for image-guided intra-articular distension
• Evaluation of the labroligamentous complex of the shoulder joint in instability
• Structure and functions of the triangular fibrocartilaginous complex of the wrist
• Planning foot arthrodesis surgery based on arthrography data
• Comparative analysis of 3T MRI and traditional MR arthrography capabilities

Other topics in the "Musculoskeletal System" section

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