The importance of magnetic resonance imaging findings in predicting treatment outcome in patients with adhesive capsulitis

The shoulder joint is the largest joint with the ability to move in the human body. The functionality of the shoulder-arm complex is adversely affected by various pathologies. Shoulder pains are common musculoskeletal complaints in the population. "Adhesive Capsulitis" is a disorder that restrict movements of the shoulder joint and is characterized by shoulder pain. It is characterized by active and passive restriction of glenohumeral motion following the spontaneous beginning of pain in the shoulder. The onset is mostly insidious and of idiopathic origin. The current consensus definition of the American Shoulder and Elbow Surgeons is "a condition of uncertain etiology characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic." There is no consensus on the definition of the disease, as well as its pathology, etiology and treatment. Adhesive capsulitis is a clinical diagnosis but MRI can be used for the etiology, differential diagnosis and treatment planning. The course of the disease may be prolonged and it may affect the quality of life or the ability to work. The aim of adhesive capsulitis treatment is pain reduction and improvement of joint function. Physical therapy modalities and exercises are the most common conservative treatment approaches both for pain relief and motion limitation reduction in adhesive capsulitis. Based on this knowledge, the purpose of our study was to reveal the importance of MRI findings in predicting the treatment result in patients diagnosed with adhesive capsulitis. In this sense, the differences in terms of physical treatment results between patients with and without MRI findings specific for adhesive capsulitis (soft tissue signal changes at the rotator interval level and thickening and increased intensity in the inferior glenohumeral ligament as a reflection of the axillary recess were evaluated as findings supporting adhesive capsulitis on MRI) were investigated. A similar study could not be found with a detailed literature search. 30 patients clinically diagnosed with adhesive capsulitis participated in the study. All the patients were evaluated with MRI and their physical therapy programs were then planned. The physical therapy consisted of 15 sessions of HP, US, TENS as well as EHA and active and passive stretching exercises. The patients were evaluated using various scales (EHA measurement, VAS, HAQ, Q-DASH) at the first examination and at the end of the treatment. No significant difference was found between pre-treatment and post-treatment evaluations of patients with and without MRI findings. However, a significant improvement was seen in all scales and scores after physical therapy in both groups. In conclusion, the data of this study reveal that MRI can only be used for the exclusion of shoulder pathologies with similar clinical findings in adhesive capsulitis. Having specific MRI findings supporting adhesive capsulitis does not affect the treatment result or provide prognostic data. Physical therapy makes a positive contribution in the treatment of adhesive capsulitis. Our study is the first to investigate the relationship between MRI findings and treatment results in adhesive capsulitis. However, properly planned studies in larger series are needed to reach more precise and accurate conclusions. Key words: Adhesive capsulitis (frozen shoulder), Magnetic resonance imaging, Physical therapy application