Association of Clinical Staging With MRI Findings Pre and Post Intra-articular Steroid Injections in Patients Suffering From Adhesive Capsulitis: A Prospective Single-Arm Interventional Study

Abstract

Background: Adhesive capsulitis is characterized by progressive capsular inflammation and fibrosis resulting in pain and restriction of shoulder movement. Although clinical staging remains the cornerstone of disease assessment, magnetic resonance imaging (MRI) provides objective information regarding structural changes that may complement clinical evaluation. This study aimed to evaluate the association between clinical staging and MRI findings and to assess clinical and radiological changes following intra-articular corticosteroid injection. Aim: The primary objective of this study was to evaluate the association between clinical staging and MRI findings in patients with adhesive capsulitis. The secondary objective was to assess changes in clinical, functional, and MRI parameters following intra-articular corticosteroid injection. Methods: This prospective single-arm interventional study included 19 patients aged 18-70 years diagnosed with adhesive capsulitis at All India Institute of Medical Sciences (AIIMS), Bibinagar. Clinical staging and range of motion were assessed. The following seven MRI parameters were evaluated: (1) thickness of the inferior glenohumeral ligament (IGHL) anterior band (humeral aspect), (2) thickness of the IGHL anterior band (glenoid aspect), (3) thickness of the axillary recess (humeral aspect), (4) thickness of the axillary recess (glenoid aspect), (5) coracohumeral ligament thickness, (6) anterior capsule thickness, and (7) obliteration of the subcoracoid fat triangle were assessed at baseline and after 12-14 weeks following intra-articular triamcinolone injection. Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, New York, USA), with p < 0.05 considered significant. Results: Nineteen patients with adhesive capsulitis were evaluated. Baseline MRI demonstrated progressive thickening of the anterior band of the inferior glenohumeral ligament (IGHL), axillary recess, and anterior capsule, with increasing clinical stage. Significant stage-wise differences were observed in MRI parameters, particularly in the IGHL anterior band and anterior capsule thickness (p < 0.05). Following intra-articular corticosteroid injection, significant improvements were observed in pain (Visual Analogue Scale (VAS)), functional outcome (Disabilities of the Arm, Shoulder and Hand (DASH)), shoulder range of motion, and MRI measurements, indicating both clinical and radiological improvement. Conclusion: MRI findings correlate significantly with clinical staging and demonstrate measurable structural improvement following intra-articular steroid injection. MRI serves as a valuable tool for staging, monitoring treatment response, and guiding individualized management in adhesive capsulitis.