X-Ray Features of Adhesive Capsulitis
Adhesive capsulitis typically shows normal or unremarkable findings on plain radiographs, as it is fundamentally a soft-tissue disorder affecting the joint capsule rather than bone. 1
Key Radiographic Characteristics
Normal Radiographic Appearance
- Plain X-rays are usually normal in adhesive capsulitis because the pathology involves capsular fibrosis and inflammation, not bony changes 1
- Radiographs are primarily useful to exclude other causes of shoulder pain such as fractures, dislocations, or glenohumeral arthritis 1
- Standard shoulder radiographic series (AP views in internal/external rotation plus axillary or scapula-Y view) will demonstrate normal bony anatomy and alignment 1
When X-Rays Are Indicated
- Initial imaging should be plain radiographs to rule out traumatic or degenerative bony pathology that could mimic adhesive capsulitis 1
- X-rays help differentiate adhesive capsulitis from conditions like rotator cuff arthropathy, fractures, or glenohumeral osteoarthritis 1
Alternative Imaging Modalities
Nuclear Medicine Findings
- Bone scintigraphy demonstrates increased radiotracer activity in adhesive capsulitis, though this is rarely used clinically 1, 2
- This finding is nonspecific and can also be seen with fractures and rotator cuff tears 1
MRI Findings (When Needed)
- Coracohumeral ligament thickening on MRI yields high specificity for adhesive capsulitis when imaging is pursued 3
- MRI is not necessary for diagnosis but can be helpful when the clinical picture is unclear 3
Clinical Pitfalls
Common mistake: Ordering extensive imaging when the diagnosis can be made clinically through history (gradual onset of pain with progressive stiffness) and physical examination (restricted active and passive range of motion, especially external rotation) 3, 4
Key caveat: If radiographs show abnormalities such as fractures, arthritis, or calcific tendinitis, the diagnosis is likely not primary adhesive capsulitis but rather secondary capsular restriction from another underlying pathology 4