Ewha Med J.  2025 Jan;48(1):e10. 10.12771/emj.2025.e10.

Radiological characteristics of shoulder diseases in older adults, including adhesive capsulitis, rotator cuff tear, and osteoarthritis of the glenohumeral joint: a narrative review

• Kim MS
• Jung TH

• KMID: 2567557
• DOI: http://doi.org/10.12771/emj.2025.e10

Abstract

Shoulder diseases, including adhesive capsulitis, rotator cuff tear, and osteoarthritis of the glenohumeral joint, can significantly impair daily activities in older adult patients. This review aims to examine the radiologic findings associated with these shoulder conditions in older patients, providing insights for accurate diagnosis and effective treatment. Adhesive capsulitis, commonly known as frozen shoulder, leads to pain and restricted movement, thereby causing shoulder dysfunction. Recent advances in diagnostic technology have greatly enhanced the sensitivity and accuracy of diagnosing this condition through radiologic evaluations, including MRI, magnetic resonance arthrography (MRA), and high-resolution ultrasound. Rotator cuff disease is another frequent issue in older adults, with full-thickness tears occurring in 50%–80% of cases. Both MRI and MRA are highly sensitive and specific in identifying rotator cuff tears. Additionally, ultrasonography is recognized for its high sensitivity and specificity in detecting tears of the supraspinatus tendon. Although osteoarthritis of the glenohumeral joint is less commonly prevalent, its advanced stages can severely affect the function of the upper extremity. Plain radiography is typically the first imaging technique used to assess this type of osteoarthritis. As the condition worsens, CT is utilized to measure glenoid bone loss, glenoid version, and inclination, which are crucial for accurate surgical planning. Each imaging modality provides distinct benefits: plain radiographs for initial structural assessment, ultrasonography for real-time evaluation of soft tissues, MRI/MRA for detailed visualization of capsular and tendinous lesions, and CT for precise bony analysis.

Keyword

Magnetic resonance imaging; Osteoarthritis; Rotator cuff injuries; Shoulder joint; X-Ray computed tomography

Figure

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  Fig. 1. Ultrasonography. Thickened coracohumeral ligament, oblique transverse image (A), short axis image (B). Adapted from Picasso et al. [5] with CC-BY.

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  Fig. 2. Ultrasonography. Thickened inferior glenohumeral capsule, longitudinal image. Adapted from Picasso et al. [5] with CC-BY.

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  Fig. 3. Ultrasonography, oblique axial section. Thickened axillary pouch (A), normal axillary pouch (B). Adapted from Tue et al. [17] with CC-BY.

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  Fig. 4. Protocol for imaging evaluation using ultrasonography in patients with adhesive capsulitis. Adapted from Picasso et al. [5] with CC-BY.

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  Fig. 5. Sagittal T1 and T2-weighted MRI scan. Fat obliteration (arrow), thickened and hyperintensity of the anteroinferior capsule (outlined arrowhead; A,B). Adapted from Picasso et al. [5] with CC-BY. SS, supraspinatus; Ac, acromion; CI, clavicle; Co, coracoid process; Sub, subscapularis; HH, humeral head.

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  Fig. 6. Plain image. True anteroposterior view (A), outlet view (B) and axillary view (C). Provided by the authors.

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  Fig. 7. Longitudinal plane ultrasound image of supraspinatus tendon. Anechoic gap and pitting due to tear. Provided by the authors.

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  Fig. 8. Oblique coronal fat-suppressed T2-weighted MRI scan. Abnormal high signal and focal swelling of the supraspinatus tendon. Provided by the authors.

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  Fig. 9. Oblique coronal fat-suppressed T2-weighted MRI scan. Fluid signal intensity.

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  Fig. 10. Oblique sagittal and axial fat-suppressed PD-weighted MRI scan. Subscapularis full-thickness tear. Provided by the authors.

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  Fig. 11. Fatty infiltration. Normal (A), grade I (B), grade II (C), grade III (D), grade IV (E). Adapted from Yubran et al. [42] with CC-BY.

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  Fig. 12. CT: glenoid inclination (A), glenoid version (B). Provided by the authors.

Reference

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