Stephen Bird

Hi Diane,

These are lovely pictures,

You are doing them perfectly,

I think all cases are positive.

In a normal rotator cuff interval there should be no flow and you have significant flow in all cases which indicates some inflammation of the glenohumeral joint capsule which may be adhesive capsulitis or simple synovitis of the GH joint.
If it is adhesive cap range of movement will be significantly restricted and if it is simple synovitis range of movement will be preserved but there will be pain with all movements.

The RCI vascularity is best seen in the acute onset stage and then it diminishes in usefulness as the time since symptoms begin lengthens.
The thickening of the IGHL should appear at the same time as the RCI findings.

They may not both be present but one or the other of these findings raises the suspicion of adhesive cap or synovitis. The presence of both raises suspicion further.

I agree if the patient can’t raise the arm the IGHL can look a little thicker but I think in your cases it is simply thick and the inability to raise the are is caused by the fact that that ligament / joint capsule can not stretch more and hence it is thick.

The injection of the biceps sheath in that patient was funnily enough exactly the right treatment as the patient with adhesive cap or synovitis needs a catabolic injection into the GH joint and injecting the LHBT sheath achieves exactly that.

If you injected the posterior G joint in the usual way you achieve the same outcome. Once the patient stands up and moves around it is mixed evenly inside the GH joint / LHBT sheath combined space.

Remember to look at the scapulo-humeral rhythm and the external rotation range clinically as well as the posterior GH joint capsule thickness sonographically.

Lovely work,


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