Role of MRI in assessment of shoulder capsule in symptomatic patients with previous proximal humeral fracture

Congress:

ESSR 2016

Poster Number:

P-0109

Type:

Scientific Poster

Keywords:

Trauma, Musculoskeletal joint, MR, Diagnostic procedure

Authors:

S. Menon¹, G. Constantinescu¹, R. Singh¹, S. Morgan², B. Bhattacharjee¹; ¹Dartford/UK, ²London and Dartford/UK

DOI:

10.1594/essr2016/P-0109

DOI-Link:

https://dx.doi.org/10.1594/essr2016/P-0109

Fig. 1: Thickening of the anterior band of the inferior glenohumeral ligament in a...

Fig. 2: Erosion of the inferior glenoid rim which possibly accounts for instability in...

Fig. 3

$Fig. 4: Capsular thickening in patient with previous humeral head fracture.$

Fig. 4: Capsular thickening in patient with previous humeral head fracture.

Purpose

Thickening of the inferior joint capsule is commonly seen following severe humeral neck/head trauma. It results in limitation of motion and joint stiffness. This post-traumatic condition overlaps with adhesive capsulitis and may cause diagnostic difficulties, in particular when plain films and Ultrasound only were used to investigate the condition. The aim of our study was to recognize early / diagnose the condition either as a standalone entity or as an overlap condition associated with adhesive capsulitis.

Methods and Materials

15patients whopresented with stiffness and motion limitation on a background of previoushumeral fracturewere referred within a year to our Department for MRI shoulder assessment. All patients suffered significant shoulder trauma with humeral neck and/or head fractures. A small number presented with associated pain. Some of these patients were investigated with US to exclude rotator cuff tears and / or impingement.

Results

15 patients were investigated with MRI shoulder within a year interval, following significant shoulder trauma in the past.Their clinical working diagnosis was adhesive capsulitis and / or impingement. A number of patients had inconclusive findings on Ultrasound (k1=4). All patients presented significant thickening of the inferior glenohumeral capsular fold on MRI. The age range varied between 20 to 80 years of age. There were 9 (k2=9) male and 6 (k3=6) female patients. A small number (k4=3) of patients also displayed soft tissue thickening and bright...

Conclusion

In a post-traumatic setting, MRI findings of inferior glenohumeral joint capsular fold in the shoulder may reflect capsular scarring as a standalone finding or in combination with features of adhesive capsulitis and / or impingement. This subgroup of patients may not respond well to glenohumeral joint hydrodilatation. Further dedicated studies may be needed to understand this condition, including post contrast MRI studies.

References

Acta Orthop. 2005 Jun;76(3):397-402. Long-term outcome of a proximal humerus fracture predicted after 1 year: a 13-year prospective population-based follow-up study of 47 patients. Olsson C1, Nordquist A, Petersson CJ. J Bone Joint Surg Br. 2011 Jan;93(1):1-11. doi: 10.1302/0301-620X.93B1.25702. Proximal humeral fractures: current concepts in classification, treatment and outcomes. Murray IR1, Amin AK, White TO, Robinson CM.