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Power Doppler Ultrasonography in the Early Diagnosis of Primary/Idiopathic Adhesive Capsulitis: An Exploratory Study. J Manipulative Physiol Ther 2013; 36:428-35. [DOI: 10.1016/j.jmpt.2013.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/19/2013] [Accepted: 05/17/2013] [Indexed: 11/20/2022]
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Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture. Eur Radiol 2013; 23:2802-6. [DOI: 10.1007/s00330-013-2874-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
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MARMERY H. Imaging the shoulder. IMAGING 2013. [DOI: 10.1259/imaging.20110061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Juel NG, Oland G, Kvalheim S, Løve T, Ekeberg OM. Adhesive capsulitis: one sonographic-guided injection of 20 mg triamcinolon into the rotator interval. Rheumatol Int 2012; 33:1547-53. [DOI: 10.1007/s00296-012-2503-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 08/23/2012] [Indexed: 11/30/2022]
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Kim I, Yi JH, Lee J, Bae JH, Lim JK, Yoon JP, Jeon IH. Limited subacromial gliding of the supraspinatus tendon during dynamic ultrasonography can predict a decrease in capacity and MR arthrographic features of the shoulder joint. Eur Radiol 2012; 22:2365-70. [PMID: 22898934 DOI: 10.1007/s00330-012-2513-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/18/2012] [Accepted: 04/23/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this prospective study was to compare the painful subacromial gliding limitation of the supraspinatus tendon (SGLS) during dynamic ultrasonography, the features of magnetic resonance arthrography (MRA), and the maximum intra-articular injection volume to predict decreased joint capacity of the shoulder joint. METHODS Between January 2003 and August 2011, 67 patients prospectively underwent ultrasonography including dynamic examination and MRA. Ultrasonography and ultrasonography-guided injection of contrast medium was performed before MRA, and each SGLSdU was compared with injected contrast volume, which was assumed as the maximum joint capacity and MRA features. RESULTS Forty-seven patients (70.1%) were revealed as SGLS-positive, and 20 patients (29.9%) were revealed as SGLS-negative by dynamic ultrasonography. Pearson's correlation coefficient between SGLS and the injection volume was -0.764 (P < 0.001). The value between SGLS and MRA features was 0.711 (P < 0.001). The mean injected volume of the SGLS-positive (22.0 ml) and negative group (10.7 ml) was significantly different (P < 0.001). CONCLUSIONS SGLS at ultrasonography correlated well with MRA features and the maximum intra-articular injection volume. This sign could predict the decreased capacity of the shoulder joint, an important feature of adhesive capsulitis, and increase the usefulness of dynamic ultrasonography. KEY POINTS • Dynamic ultrasound is increasingly used in the evaluation of the shoulder. • This can assess subacromial gliding limitation of the supraspinatus tendon (SGLS) • SGLS appeared inversely proportional to the maximum volume of intra-articular injection. • Dynamic ultrasonography findings correlated well with MR arthrographic features of adhesive capsulitis.
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Affiliation(s)
- In Kim
- Department of Radiology, Kyungpook National University Hospital, 700-721, 200 Dongduk-Ro, Jung-Gu, Daegu, Republic of Korea.
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Oh JH, Oh CH, Choi JA, Kim SH, Kim JH, Yoon JP. Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: a prospective, randomized short-term comparison study. J Shoulder Elbow Surg 2011; 20:1034-40. [PMID: 21816628 DOI: 10.1016/j.jse.2011.04.029] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/09/2011] [Accepted: 04/22/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenohumeral (GH) joint steroid injection is one of the most well-known treatments for frozen shoulder. However, the low accuracy of GH joint injections and the improvement of symptoms after subacromial (SA) steroid injections led us to design a study that compares the efficacy of a steroid injection for primary frozen shoulder according to the injection site. MATERIALS AND METHODS Patients with primary frozen shoulder were randomly divided into 2 groups according to the location of the injection: a GH group of 37 for the glenohumeral joint and an SA group of 34 for the subacromial space. Injections were completed using ultrasonographic guidance. Evaluations using a visual analog scale (VAS) for pain, the Constant score, and passive range of motion (ROM) were completed at 3, 6, and 12 weeks after the injection. RESULTS The GH group showed lower pain VAS at 3 weeks, but no statistical difference was found between the 2 groups at 6 and 12 weeks. Improvement in pain was evident at every follow-up visit compared with the preinjection evaluation. There was no significant difference between the 2 groups with respect to the Constant score or ROM at serial follow-up. CONCLUSIONS The GH steroid injection was not superior to a SA injection for patients with primary frozen shoulder even though injection at the GH joint led to earlier pain relief compared with the SA injection. SA steroid injection along with a GH injection is an alternative modality, and the treatment should be individualized and tailored appropriately.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
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Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics 2011; 31:791-810. [PMID: 21571657 DOI: 10.1148/rg.313105507] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The biceps pulley or "sling" is a capsuloligamentous complex that acts to stabilize the long head of the biceps tendon in the bicipital groove. The pulley complex is composed of the superior glenohumeral ligament, the coracohumeral ligament, and the distal attachment of the subscapularis tendon, and is located within the rotator interval between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. Because of its superior depiction of the capsular components, direct magnetic resonance arthrography is the imaging modality of choice for demonstrating both the normal anatomy and associated lesions of the biceps pulley. Oblique sagittal images and axial images obtained with a high image matrix are valuable for identifying individual components of the pulley system. Various pathologic processes occur in the biceps pulley as well as the rotator interval. These processes can be traumatic, degenerative, congenital, or secondary to injuries to the surrounding structures. The term hidden lesion refers to an injury of the biceps pulley mechanism and is derived from the difficulty in making clinical and arthroscopic identification. Pathologic conditions associated with pulley lesions include anterosuperior impingement, instability of the biceps tendon, biceps tendinopathy or tendinosis, superior labrum anterior and posterior lesions, and adhesive capsulitis. It is important to be familiar with the normal appearance of the biceps pulley so that abnormalities can be correctly assessed and effectively managed.
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Affiliation(s)
- Waka Nakata
- Department of Radiology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan.
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Abstract
PURPOSE To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL) associated with shoulder pain in patients with breast cancer- related lymphedema (BCRL). MATERIALS AND METHODS Using patient history, physical examination, and ultrasound (US), we classified patients with BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale (VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the World Health Organization Quality of Life Assessment Instrument (WHOQOL- BREF). RESULTS 28.9% of patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with DASH scores and negatively correlated with QOL. CONCLUSION We found that BCRL with shoulder pain and evidence of shoulder pathology on US was associated with reduced QOL and increased disability. Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in patients with BCRL.
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Affiliation(s)
- Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Young-Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ki Hun Hwang
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ghi Chan Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
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Abstract
Ultrasound is used increasingly in the investigation of the rotator cuff. It is as accurate as magnetic resonance imaging in the detection of rotator cuff tears and the assessment of tear size and can demonstrate atrophy and fatty infiltration in the rotator cuff muscles. This article reviews the anatomy and technique of shoulder ultrasound, the ultrasound findings in rotator cuff disease, the accuracy of ultrasound and magnetic resonance imaging in the assessment of rotator cuff tears and the role of interventional ultrasound of the shoulder.
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Affiliation(s)
- Ian Beggs
- Department of Radiology, Royal Infirmary, Edinburgh, UK.
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Abstract
The shoulder is the most common region to be evaluated with musculoskeletal ultrasound. The shoulder's complex anatomy enables an exceptional range of mobility at the expense of static stability. Consequently, the shoulder is susceptible to a multitude of traumatic and atraumatic injuries. This article presents an overview of shoulder anatomy, recommends a standardized approach to the sonographic shoulder evaluation, and discusses common sonographically apparent pathology of the shoulder.
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The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance. AJR Am J Roentgenol 2010; 195:567-76. [PMID: 20729432 DOI: 10.2214/ajr.10.4406] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this article is to review imaging of the rotator interval, an anatomically complex region in the shoulder that plays an important role in the normal function of the shoulder joint. The rotator interval can be difficult to evaluate by imaging, and it is not routinely evaluated arthroscopically unless the clinical examination or imaging findings suggest an abnormality of the rotator interval. Rotator interval pathology is implicated in glenohumeral instability, biceps instability and adhesive capsulitis-entities which remain a challenge to diagnose and treat. CONCLUSION Imaging can play an important role in increasing suspicion for injury to the rotator interval so that this region can be evaluated and appropriate treatment can be initiated.
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[The usefulness of ultrasonography in synovial disease]. RADIOLOGIA 2010; 52:301-10; quiz 377-8. [PMID: 20378135 DOI: 10.1016/j.rx.2010.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 01/21/2010] [Accepted: 02/02/2010] [Indexed: 11/22/2022]
Abstract
Synovial disease is common in clinical practice and can have different causes. The development of high resolution ultrasonography (US) has led to greater use of US in the study of synovial disease. In this context, US is useful because (1) it can detect not only synovial disease, but also its consequences as tissue damage (erosions); (2) it can guide arthrocentesis when clinical attempts to obtain joint fluid have been unsuccessful, especially in joints that are difficult to access (hips), or sometimes when joint infections are clinically suspected; (3) it enables the efficacy of treatment for synovitis to be evaluated; and (4) it makes it possible to distinguish benign cystic lesions from other tumors. The overall evaluation of synovial disease is based on semiologic criteria that enables these alterations to be classified into four main groups: (a) joint effusion, (b) cystic synovial lesions, (c) intra-articular free bodies, and (d) synovial thickening.
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Smith J, Finnoff JT. Diagnostic and Interventional Musculoskeletal Ultrasound: Part 2. Clinical Applications. PM R 2009; 1:162-77. [DOI: 10.1016/j.pmrj.2008.09.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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Abstract
UNLABELLED Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Glenohumeral intra-articular corticosteroid injections, exercise, and joint mobilization all result in improved short- and long-term outcomes. However, there is strong evidence that glenohumeral intra-articular corticosteroid injections have a significantly greater 4- to 6-week beneficial effect compared to other forms of treatment. A rehabilitation model based on evidence and intervention strategies matched with irritability levels is proposed. Exercise and manual techniques are progressed as the patient's irritability reduces. Response to treatment is based on significant pain relief, improved satisfaction, and return of functional motion. Patients who do not respond or worsen should be referred for an intra-articular corticosteroid injection. Patients who have recalcitrant symptoms and disabling pain may respond to either standard or translational manipulation under anesthesia or arthroscopic release. LEVEL OF EVIDENCE Level 5.
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70
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Abstract
The rotator interval corresponds to a defined triangular shaped anatomical region at the anterosuperior portion of the shoulder where specific pathological processes may occur. First, the morphological and functional anatomy of the region will be reviewed. Then, the role of different imaging modalities will be described along with pathological imaging features. Normal structures of the rotator interval may be imaged with modern techniques, including MR and CT arthrography. On the other hand, clinical evaluation of rotator interval pathology remains difficult; and no consensus exists concerning their management. Imaging characterization of rotator interval pathology could be a key factor for pre-therapeutic work-up.
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Affiliation(s)
- T Le Corroller
- Service de Radiologie, Hôpital La Timone, 13005 Marseille.
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71
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Shoulder ultrasound imaging-integrating anatomy, biomechanics and disease processes. Eur J Radiol 2008; 68:137-46. [PMID: 18430537 DOI: 10.1016/j.ejrad.2008.02.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 02/09/2008] [Accepted: 02/19/2008] [Indexed: 12/13/2022]
Abstract
This article brings together the anatomy, biomechanics and the imaging of shoulder disease using ultrasound to enable a better understanding of the strengths and weaknesses of ultrasound when imaging the shoulder.
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Lim JB, Kim YK, Kim SW, Sung KW, Jung I, Lee C. Ultrasound Guided Shoulder Joint Injection through Rotator Cuff Interval. Korean J Pain 2008. [DOI: 10.3344/kjp.2008.21.1.57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jong Bum Lim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Young Ki Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Sung Woo Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Kyu Wan Sung
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Il Jung
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Chung Lee
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, College of Medicine, Eulji University, Daejeon, Korea
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Provencher MT, Saldua NS. The Rotator Interval of the Shoulder: Anatomy, Biomechanics, and Repair Techniques. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.oto.2008.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Homsi C, Bordalo-Rodrigues M, da Silva JJ, Stump XMGRG. Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool? Skeletal Radiol 2006; 35:673-8. [PMID: 16724200 DOI: 10.1007/s00256-006-0136-y] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 01/25/2006] [Accepted: 03/29/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the accessibility of the coracohumeral ligament (CHL) by ultrasound (US) and to determine CHL thickness in adhesive capsulitis of the shoulder. DESIGN AND PATIENTS US examinations were carried out in 498 consecutive shoulders of 306 individuals (194 women and 112 men), mean age 47.4 years (range 15-92 years), in order to identify and measure the maximum thickness of the CHL. The patients were divided into three study groups: asymptomatic shoulders (n=121), painful shoulders (n=360) and shoulders with arthrographic evidence of adhesive capsulitis (n=17). The mean maximal thickness of CHL was compared among the 3 study groups (non-parametric test of Kruskal-Wallis, p<0.05). RESULTS The CHL was visualized in 92 out of 121 shoulders in the asymptomatic group (76.0%), in 227 out of 360 shoulders in the painful shoulder group (63.0%), and in 15 out of 17 shoulders in the adhesive capsulitis group (88.2%). The average thickness of the CHL was significantly greater in adhesive capsulitis (3 mm) than in the asymptomatic (1.34 mm) and painful (1.39 mm) shoulders. No significant difference was found between asymptomatic and painful shoulders. CONCLUSION CHL depiction can be achieved in a reasonable proportion of shoulders. A thickened CHL is suggestive of adhesive capsulitis. More studies are needed for clinical validation of these data.
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Affiliation(s)
- Carlos Homsi
- Diagnostic Imaging Division, Hospital Alemão Oswaldo Cruz, Rua João Julião 331, Paraíso 01323-903, São Paulo-SP, Brazil.
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77
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Abstract
Ultrasound examination of the shoulder and elbow requires careful technique, appreciation of normal anatomy, and appropriate high-end equipment. Ultrasound provides detailed diagnostic information. Its accuracy is comparable to that of MRI in the assessment of the rotator cuff. Ultrasound is cheaper than MRI and is preferred by patients.
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Affiliation(s)
- Ian Beggs
- Royal Infirmary, Edinburgh EH16 4SA, United Kingdom.
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