Superior humeral head migration might be a radiological aid in diagnosing patients with adhesive capsulitis of the shoulder

BACKGROUND: The diagnosis of adhesive capsulitis (AC) of the shoulder might be challenging, as it is a diagnosis of exclusion and mainly based on the clinical examination. The purpose of the present study was to investigate the validity and reliability of 4 commonly reported radiological parameters suggesting a superior humeral head migration on anteroposterior (a/p) shoulder radiograph in identifying patients with AC. METHODS: The a/p shoulder radiographs of 100 patients with AC and 100 control subjects were retrospectively reviewed. A disruption of the normal scapulohumeral arch (≥2 mm), the acromiohumeral interval (AHI), the inferior glenohumeral distance (IGHD), and the upward migration index (UMI) were measured. RESULTS: A disruption of the scapulohumeral arch was observed in 80% in the AC and 20% in the control group. The mean AHI was 9.3 ± 1.3 mm and 11.0 ± 1.7 mm (P < .001), the mean IGHD was 3.9 ± 3.0 mm and 0.9 ± 1.9 mm (P < .001), and the mean UMI was 1.37 ± 0.1 and 1.44 ± 0.1 (P < .001) in patients with AC and control subjects, respectively. The scapulohumeral arch's disruption demonstrated the best test characteristics with a sensitivity and specificity of 80% in detecting patients with an AC. Patients with a disruption of the scapulohumeral arch had 16 times increased odds of having an AC. CONCLUSION: Measuring the superior humeral head migration might be a simple and clinically relevant tool in diagnosing an AC of the shoulder and could be reliably used by clinicians adjacent to the clinical examination without any additional cost. Especially a disruption of the scapulohumeral arch on the a/p shoulder radiograph should raise concerns of AC in the absence of a massive rotator cuff tear.