Thickening of the glenohumeral axillary recess as an ultrasound sign of adhesive capsulitis

In the period of the COVID-19 pandemic, we have seen an increase in cases of adhesive capsulitis (AC). Patients presented with shoulder pain associated with limited external rotation and abduction movements. Clinical criteria are considered the standard for diagnosis, with magnetic resonance imaging (MRI) an excellent tool for its imaging diagnosis. Typical findings are thickening and changes in signal intensity of the joint capsule in the axillary recess and in the rotator interval, as well as thickening of the coracohumeral ligament (CHL). Ultrasonographic examination is controversial and only a few studies have attempted to prove its accuracy, based on the evaluation of CHL thickening and increased vascularity in the rotator interval. Recently, the measurement of the capsule of the axillary recess has been proposed as an ultrasound sign of AC, allowing easy analysis and possible during a bilateral comparative examination. A thickness greater than 2.0 mm in the axillary recess capsule measured on ultrasound was correlated with signs of AC on MRI. In all the cases that we evaluated during this period we observed the same correlation.