The axillary recess is the redundant inferior fold of glenohumeral joint capsule that normally accommodates full arm elevation without capsular tightening. It hangs as a fold in adduction and flattens and smooths out as the arm is elevated. The anterior and posterior bands of the inferior glenohumeral ligament (IGHL) form its anterior and posterior boundaries, with the axillary pouch between them. This recess is the key structure affected in adhesive capsulitis.
In adhesive capsulitis (frozen shoulder), the axillary recess is the primary site of fibrotic contracture: the redundant capsular fold becomes adherent and obliterated, reducing joint volume from a normal 20-30 mL to as little as 5 mL. This restricts external rotation and elevation most severely. On MRI, thickening and signal change of the axillary recess capsule and inferior glenohumeral ligament confirms the diagnosis. Hydrodilatation targets the axillary recess with high-volume saline injection to distend and rupture the fibrotic capsule.
Fibrotic obliteration of the axillary recess produces the insidious global shoulder stiffness of frozen shoulder, with loss of external rotation and elevation in a capsular pattern; treated with physiotherapy, corticosteroid injection into the axillary recess, hydrodilatation, or arthroscopic capsular release.
Excessive axillary pouch volume and laxity in multidirectional instability allows inferior humeral head subluxation, evidenced by a positive sulcus sign, managed with posterior capsular shift surgery that plicates and tightens the axillary recess.
