I know it’s my Aunt Minnie because it looks like Aunt Minnie

This 65-year-old woman presents with limited range of motion which radiates down to the elbow. She felt pain in her shoulder after reaching backward in a car three weeks ago. What findings do you see on the two sagittal and two coronal images below?

Sagittal T2

Sagittal T2

Coronal PD Mid-glenoid

Coronal PD Anterior

The clinical history is typical, and the demographic is also classic (middle-aged female with decreased range of motion, worse with reaching backward in the dominant arm). This is an important cause of shoulder pain as the differential diagnosis includes labral and rotator cuff pathology. On the current study, note ill-defined intermediate smudgy T1 / PD (arrows, Image 3) signal in the superior labrum / axillary, inferior glenohumeral ligament (IGHL) recess and rotator interval. The rotator cuff (vertical arrow, image 4) is infiltrated by inflamatory tissue and appears “grey”. The green oblique arrows (images 2 and 4) represent secondary bursitis. Finally, a “corona sign” (e.g. high signal) surrounding the glenoid cup (arrows, image 1) is definitive. Our Aunt Minnie is the MR manifestation of clinical adhesive capsulitis.

For more case review, check out MRI Online.

Dr. Stephen Pomeranz

Dr. Nick Trane

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