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de Angelis Guerra Dotta T, Assunção JH, Baptista E, E Silva FBA, Gracitelli MEC, Neto AAF, Malavolta EA. Diagnostic accuracy of non-contrast MRI in frozen shoulder. Arch Orthop Trauma Surg 2024; 144:1149-1159. [PMID: 38231206 DOI: 10.1007/s00402-023-05184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Despite being the most used exam today, few studies have evaluated the accuracy of findings on non-contrast magnetic resonance imaging (MRI). The primary objective of the study was to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of non-contrast MRI findings in frozen shoulder, isolated and in combination. The secondary objectives were to define the interobserver and intraobserver agreement of the assessments and the odds ratio for frozen shoulder because of the various findings of MRI. METHODS A retrospective diagnostic accuracy study comparing non-contrast MRI findings between the frozen shoulder group and the control group. Sensitivity, specificity, positive and negative predictive value, accuracy, odds ratio, interobserver and intraobserver agreement were calculated for each finding and their possible associations. RESULTS The hyperintensity on capsule in the axillary recess presented 84% sensitivity, 94% specificity, and 89% accuracy. The obliteration of the subcoracoid fat triangle in the rotator interval had sensitivity 34%, specificity 82% and accuracy 58%. For coracohumeral ligament thickness ≥ 2 mm had specificity 66%, 48% specificity and 57% accuracy. Capsule thickness in the axillary recess ≥ 4 mm resulted in 54% sensitivity, 82% specificity, and 68% accuracy. Regarding interobserver agreement, only the posteroinferior and posterosuperior quadrants showed moderate results, and all the others showed strong reliability. The odds ratio for hyperintensity in the axillary recess was 82.3 for frozen shoulder. The association of these findings increased specificity (95%). CONCLUSION The accuracy of non-contrast magnetic resonance imaging is high for diagnosing frozen shoulder, especially when evaluating the hyperintensity of the axillary recess. The exam has high reliability and reproducibility. The presence of an association of signs increases the specificity of the test. LEVEL OF EVIDENCE Level III, study of diagnostic test.
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Affiliation(s)
- Thiago de Angelis Guerra Dotta
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil.
| | - Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Baptista
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Fernando Brandão Andrade E Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Mauro Emilio Conforto Gracitelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
- Hospital do Coração-HCor, São Paulo, SP, Brazil
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Wilson AT, Hanney WJ, Richardson RM, Klausner SH, Bialosky JE. Biopsychosocial contributors to irritability in individuals with shoulder or low back pain. J Man Manip Ther 2023:1-12. [PMID: 38108631 DOI: 10.1080/10669817.2023.2294679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability. METHODS 40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland's criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low). RESULTS Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation. DISCUSSION/CONCLUSION Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation.
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Affiliation(s)
- Abigail T Wilson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - William J Hanney
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Randi M Richardson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Sheila H Klausner
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Joel E Bialosky
- University of Florida Department of Physical Therapy, Gainesville, FL, USA
- Brooks-PHHP Research Collaboration, Gainesville, FL, USA
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Mertens MG, Meeus M, Verborgt O, Girbes EL, Horno SMD, Aguilar-Rodriguez M, Dueñas L, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F. Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments. Braz J Phys Ther 2023; 27:100539. [PMID: 37639942 PMCID: PMC10474583 DOI: 10.1016/j.bjpt.2023.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Contradictory evidence exists regarding the clinical course of frozen shoulder (FS). OBJECTIVES To explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables. METHODS Patients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR. RESULTS Initially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15). CONCLUSION Almost all factors improved in the early phase (3-6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery, University Hospital (UZA), Edegem, Belgium
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Marta Aguilar-Rodriguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | | | | | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Nicholas Nacey, Fox MG, Blankenbaker DG, Chen D, Frick MA, Jawetz ST, Mathiasen RE, Raizman NM, Rajkotia KH, Said N, Stensby JD, Subhas N, Surasi DS, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Shoulder Pain: 2022 Update. J Am Coll Radiol 2023; 20:S49-S69. [PMID: 37236752 DOI: 10.1016/j.jacr.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | | | | | - Ross E Mathiasen
- University of Nebraska Medical Center, Omaha, Nebraska; American College of Emergency Physicians
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; American Academy of Orthopaedic Surgeons
| | - Kavita H Rajkotia
- University of Michigan Health System, Ann Arbor, Michigan; Committee on Emergency Radiology-GSER
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Hanish SJ, Resnick ML, Kim HM, Smith MJ. Predictive Factors for Failure of Intraarticular Injection in Management of Adhesive Capsulitis of the Shoulder. J Clin Med 2022; 11:jcm11206212. [PMID: 36294535 PMCID: PMC9605176 DOI: 10.3390/jcm11206212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA injections in management of adhesive capsulitis. A retrospective review found 533 patients undergoing IA corticosteroid or IA NSAID injection for adhesive capsulitis between June 2015 and May 2020 at a single healthcare institution. Patient demographics characteristics, comorbidities, pain scores, and range of motion were compared. Treatment failure was defined as need for subsequent IA injection within 6 months or progression to surgical management within 12 months. 152 patients (28.52%) experienced treatment failure of IA corticosteroid injection. Pre-injection pain scores were greater for those who experienced treatment failure (5.40 vs. 4.21, p < 0.05). Post-injection pain scores were greater for those who experienced treatment failure (3.77 vs. 2.17, p < 0.01). Reduced post-injection external rotation in abduction also predicted treatment failure (56.88° vs. 70.22°, p < 0.01). IA corticosteroid injections are associated with increased rates of failure and progression to surgical management when patients present with increased pain levels as well as with less improvement in pain levels and ROM following injection.
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Ruiz Ibán MA, Alonso Güemes S, Ruiz Díaz R, Diaz Heredia J, de Rus Aznar I, Lorente Moreno R. Assessment of isolated glenohumeral range of motion in patients with adhesive capsulitis can help predict failure of conservative treatment: a pilot study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2099-2104. [PMID: 34825917 DOI: 10.1007/s00167-021-06804-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To prospectively evaluate a cohort of patients with adhesive capsulitis and identify predictors of failure of conservative treatment in the first 2 months of therapy. METHODS This was a single-cohort, prospective observational study that included 20 participants (13 females/7 males; median age of 51.8 years [interquartile range: 8.65]) with primary adhesive capsulitis managed conservatively and evaluated clinically every month for at least 2 years of follow-up (29 [5] months). The evaluation included stage of the disease, treatment applied, radiological findings, pain levels and range of motion (active and passive ROM in the four planes and isolated glenohumeral passive ROM in abduction [GH-ABD], external rotation [GH-ER] and internal rotation). The main outcome assessed was failure of conservative treatment defined as the need for surgery and persistent pain or CMS below 70 points at the 1-year follow-up. RESULTS Seven patients (7/20, 35%) were considered to have failed conservative treatment because they required arthroscopic capsular release 5.2 (2.1) months after the initial diagnosis. Of all the clinical and epidemiological variables, absence of improvement during the first 2 months in isolated glenohumeral ROM abduction and external rotation predicted failure of conservative treatment: improvement in GH-ABD (10° or more) occurred in 10/13 patients in the conservative treatment group and in 1/7 patients in the surgery group (p = 0.017). Improvement in GH-ER (10° or more) occurred in 9/13 patients in the conservative treatment group and in 0/7 patients in the surgery group (p = 0.005). CONCLUSIONS Precise assessment of isolated glenohumeral ROM in patients with adhesive capsulitis can help identify patients in which conservative treatment might fail. In this study, patients who did not experience early improvements in isolated glenohumeral ROM often required surgery. LEVEL OF EVIDENCE III (Prospective cohort study).
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain. .,Department of Surgery, Medical and Social Sciences, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain.
| | - Susana Alonso Güemes
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Raquel Ruiz Díaz
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain.,Department of Surgery, Medical and Social Sciences, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Jorge Diaz Heredia
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain.,Department of Surgery, Medical and Social Sciences, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Ignacio de Rus Aznar
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Rafael Lorente Moreno
- Servicio de Traumatologia y Cirugia Ortopedica, Hospital Universitario de Badajoz, Badajoz, Spain
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Lin P, Yang M, Huang D, Lin H, Wang J, Zhong C, Guan L. Effect of proprioceptive neuromuscular facilitation technique on the treatment of frozen shoulder: a pilot randomized controlled trial. BMC Musculoskelet Disord 2022; 23:367. [PMID: 35443651 PMCID: PMC9020070 DOI: 10.1186/s12891-022-05327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives Frozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder. Materials and methods Forty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients. Results The primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05). Conclusion As an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.
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Affiliation(s)
- Ping Lin
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Moudan Yang
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Deqing Huang
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Huan Lin
- Department of Radiology, The Fushun People's Hospital, 490 Jixiang Road, Fushi Street Zigong, Fushun, China
| | - Jialin Wang
- Department of Radiology, The Fushun People's Hospital, 490 Jixiang Road, Fushi Street Zigong, Fushun, China
| | - Chaoping Zhong
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Li Guan
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China.
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Kim KI, Lee YS, Kim JY, Chung SW. Effect of diabetes and corticosteroid injection on glenohumeral joint capsule in a rat stiffness model. J Shoulder Elbow Surg 2021; 30:2814-2823. [PMID: 34273535 DOI: 10.1016/j.jse.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate the effects of diabetes and corticosteroid injected in the joints on the shoulder motion, gait, and joint capsular properties in a rat stiffness model. METHODS A total of 27 rats were randomly distributed into 3 groups-nondiabetes group (group A), diabetes group (group B), and diabetes plus steroid injection group (group C). The diabetes model was developed by inducing hyperglycemia with a submaximal dose of streptozotocin and the stiffness model by completely immobilizing the right shoulder of each animal in all groups with sutures passed between the scapula and humeral shaft. The left shoulder was used as an untreated control in all groups. Three weeks after immobilization, the sutures were removed in all groups, and a single dose of triamcinolone acetonide (0.5 mg/kg) was injected into the glenohumeral joint in group C. After 3 weeks of free activity, range of motion (ROM) evaluation, gait analysis by stride length, and capsular area measurement were performed in all rats. RESULTS Hyperglycemia was successfully induced with a mean blood glucose level of 448.9±55.9 mg/dL in group B and 431.6±17.8 mg/dL in group C, which were significantly higher than 136.5±13.4 mg/dL in group A (P < .001). A significantly smaller ROM and stride length were found in the right (stiffness-induced) shoulder than that in the left (control) shoulder only in group B, and significantly larger capsular area in the right shoulder than that in the left shoulder in groups A and B (all P < .05). However, in group C, there were no differences between the right and left shoulders in all measurements (all P > .05). In case of the right shoulders in each group, group C showed significantly larger ROM (68° ± 11° vs. 42° ± 7°) and smaller capsular area (3934.4 ± 537.1 pixels vs. 7402.3 ± 1840.3 pixels) than group B (all P < .0167). CONCLUSIONS The diabetic model had a detrimental effect on the development of stiffness by thickening the joint capsule, and an intra-articular steroid injection resolved the thickened joint capsule and restored shoulder motion.
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Affiliation(s)
- Kwang Il Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Lee
- Joint Center, Barunsesang Hospital, Seongnam, Republic of Korea
| | - Ja Yeon Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Hayashi D, Gould E, Shroyer R, van Staalduinen E, Yang J, Mufti M, Huang M. Shoulder adhesive capsulitis in cancer patients undergoing positron emission tomography - computed tomography and the association with shoulder pain. World J Radiol 2021; 13:344-353. [PMID: 34786189 PMCID: PMC8567438 DOI: 10.4329/wjr.v13.i10.344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/03/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment. Positron emission tomography - computed tomography (PET-CT) is routinely performed as a follow-up study in cancer patients after therapy. Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.
AIM To assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.
METHODS Our prospective study received Institutional Review Board approval. Written informed consent was obtained from all patients, who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study, between March 2015 and April 2019. Patients with advanced glenohumeral arthrosis, metastatic disease or other mass in the shoulder, or shoulder arthroplasty were excluded. Patterns of shoulder capsule 18F-fluorodeoxyglucose (FDG) uptake were noted. Standard Uptake Value (SUV)max and SUVmean values were measured at rotator interval (RI) and deltoid muscle in bilateral shoulders. Normalized SUV (SUV of RI/SUV of deltoid muscle) was also calculated. We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders. Covariates were age, gender, and therapy type (surgery, chemotherapy, radiation). Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age, SUV measurements between symptomatic and asymptomatic patients. Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status, after adjusting for covariates. Statistical significance level was set at P < 0.05.
RESULTS Of 252 patients initially enrolled for the study (mean age 66 years, 67 symptomatic), shoulder PET-CT data were obtained in 200 patients (52 were excluded due to exclusion criteria above). The most common cancer types were lymphoma (n = 61), lung (n = 54) and breast (n = 53). No significant difference was noted between symptomatic and asymptomatic patients in terms of age, gender, proportion of patients who had surgical therapy and radiation therapy. A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder (65% vs 48%, P = 0.012). No such difference was seen for the left shoulder. In both shoulders, SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders (Left SUVmax 2.0 vs 1.6, SUVmean 1.6 vs 1.3, both P < 0.002; Right SUVmax 2.2 vs 1.8, SUVmean 1.8 vs 1.5, both P < 0.01). For lung cancer patients, bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders. For other cancer patients, symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.
CONCLUSION In symptomatic patients metabolic activities in RI were higher than asymptomatic patients. Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.
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Affiliation(s)
- Daichi Hayashi
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
| | - Elaine Gould
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
| | - Robert Shroyer
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
| | - Eric van Staalduinen
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Musa Mufti
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
| | - Mingqian Huang
- Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
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Huang J, Zhu S, Zhao C, Huang W, Shui W, Hu N, Chen H. [Effectiveness of arthroscopic 360° capsular release for frozen shoulder]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1141-1146. [PMID: 34523279 DOI: 10.7507/1002-1892.202103080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder. Methods Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S 1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up. Results All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively ( P<0.05). The range of internal rotation restored to the level of T 6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation ( Z=-0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant ( P<0.05); and with time, the VAS scores and ASES scores improved further ( P<0.05). Conclusion Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.
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Affiliation(s)
- Jiaxing Huang
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Sizheng Zhu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Chen Zhao
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Wei Huang
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Wei Shui
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Ning Hu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Hong Chen
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
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Gillet R, Zhu F, Padoin P, Rauch A, Hossu G, Teixeira PAG, Blum A. MR Imaging Biomarkers for Clinical Impairment and Disease Progression in Patients with Shoulder Adhesive Capsulitis: A Prospective Study. J Clin Med 2021; 10:jcm10173882. [PMID: 34501330 PMCID: PMC8432015 DOI: 10.3390/jcm10173882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment. PURPOSE To determine the correlation of MRI findings with the Constant-Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients. MATERIALS AND METHODS This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment. RESULTS There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal (p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening (p < 0.05). CONCLUSIONS In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up.
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Affiliation(s)
- Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
- Correspondence: ; Tel.: +33-3-83-85-21-61; Fax: +33-3-83-85-97-25
| | - François Zhu
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Pierre Padoin
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Aymeric Rauch
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Gabriela Hossu
- CIC-IT, CHRU Nancy, Université de Lorraine, 54000 Nancy, France;
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
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12
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Hydrodilatation with corticosteroids is the most effective conservative management for frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2021; 29:2553-2563. [PMID: 33420809 DOI: 10.1007/s00167-020-06390-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this overview is to summarise the findings of meta-analyses of randomised controlled trials that compare conservative treatment options for frozen shoulder. METHODS The authors conducted an electronic literature search for meta-analyses published using PubMed, Web of Science and the Cochrane Library. Two researchers independently applied selection criteria and assessed quality of meta-analyses using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Short-, medium- and long-term outcomes were synthesised narratively. RESULTS A total of 319 studies were identified, of which 8 meta-analyses were eligible for inclusion. All included meta-analyses were judged to be low or critically low quality according to AMSTAR-2, however, their data synthesis and interpretation was considered valid. Physiotherapy, intra-articular and subacromial corticosteroid injection (CSI), and arthrographic distension/hydrodilatation with corticosteroid were reported with sufficient evidence. Intra-articular CSI and arthrographic distension/hydrodilatation with corticosteroid provide advantages over placebo in short-term pain relief, range of motion (ROM) and shoulder function, with improvements in ROM continuing into the medium and long term. Arthrographic distension/hydrodilatation with corticosteroid provides medium-term and long-term improvements in ROM over intra-articular CSI and physiotherapy. Proprioceptive neuromuscular facilitation provides advantages over conventional physiotherapy for pain improvement and external rotation in the short term. CONCLUSIONS Arthrographic distension/hydrodilatation with corticosteroid provides superior pain relief in the short term and improvement in range of motion across all time frames for frozen shoulder when compared to CSI or physiotherapy. LEVEL OF EVIDENCE Level IV.
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13
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Zhao H, Kong L, Shen J, Ma Y, Wu Z, Li H, He Y. Tetrandrine inhibits the occurrence and development of frozen shoulder by inhibiting inflammation, angiogenesis, and fibrosis. Biomed Pharmacother 2021; 140:111700. [PMID: 34044279 DOI: 10.1016/j.biopha.2021.111700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Frozen shoulders (FS) is a major clinical concern, where chronic synovial inflammation, abnormal angiogenesis, and fibrosis represent the critical pathologies in the glenohumeral capsule. However, no pharmacotherapy has been introduced to treat this pathology. Tetrandrine (TET) has been proposed as a treatment for many diseases due to its strong anti-inflammatory, anti-angiogenic, and anti-fibrotic effects. PURPOSE To study the anti-inflammatory, anti-angiogenic, and anti-fibrotic effects of TET on FS, and identify whether TET can prevent the development of FS in rats. STUDY DESIGN A controlled laboratory study. METHODS Forty-eight male Sprague-Dawley (SD) rats were randomly divided into control, TET, and FS groups. The TET group was intraperitoneally injected with TET every 2 days. TET and saline treatment were started on the day of FS surgery. After 8 weeks, the animals were sacrificed, and samples were collected for X-ray examination, glenohumeral range of motion (ROM) evaluation, histology and immunohistochemistry analysis, transmission electron microscopy (TEM) observation, and profibrogenic factors as well as proinflammatory cytokines measurements. RESULTS No significant difference in shoulder ROM was observed between the TET and control groups, but a significant difference was noted between these groups and the FS group (P < 0.01). Immunohistochemical staining showed no abnormal angiogenesis or fibrosis in the TET group or the control group. However, significant angiogenesis, collagen remodeling, and fibrosis were observed in the FS group, and the expression and proportion of type I and type III collagen in the FS group were significantly higher than those in the TET group or the control group (P < 0.01). TEM observation showed that TET protected the ultrastructure of collagen fibrous reticular arrangement of the articular capsule and prevented the formation of scar-like fibrotic structures, which are unique to FS. The significantly increased expression of Smad7 and the suppressed expression of Smad 2 in the TET group compared with that of the FS group indicated that TET also significantly inhibited the TGF-β1 intracellular signal pathway. The expression of profibrogenic factors and proinflammatory cytokines in the TET group and the control group was significantly lower than that in the TET group (P < 0.01). CONCLUSION The results demonstrated that TET protected the normal reticular structure of the capsule during the freezing period and prevented the development of FS by inhibiting inflammation, angiogenesis, and fibrosis in a rat FS model. CLINICAL RELEVANCE TET may be a safe and effective clinical medication for preventing and treating FS.
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Affiliation(s)
- Huakun Zhao
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Lingzhi Kong
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Ji Shen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Yanhong Ma
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Zhi Wu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Haiyan Li
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China; Chemical and Environmental Engineering, School of Engineering, RMIT University, 124 La Trobe St, Melbourne, VIC 3000, Australia.
| | - Yaohua He
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
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Yun SJ, Jin W, Cho NS, Ryu KN, Yoon YC, Cha JG, Park JS, Park SY, Choi NY. Shear-Wave and Strain Ultrasound Elastography of the Supraspinatus and Infraspinatus Tendons in Patients with Idiopathic Adhesive Capsulitis of the Shoulder: A Prospective Case-Control Study. Korean J Radiol 2020; 20:1176-1185. [PMID: 31270981 PMCID: PMC6609436 DOI: 10.3348/kjr.2018.0918] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/04/2019] [Indexed: 01/05/2023] Open
Abstract
Objective To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity. Materials and Methods The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation. Results Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p < 0.001). SST- and IST-mean velocity, mean stiffness, and strain ratios showed excellent area under the ROC curve (> 0.970). The elastic modulus was little correlated with age (ρ = −0.340–0.239). Conclusion SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.
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Affiliation(s)
- Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Nam Su Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Na Young Choi
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
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15
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Usefulness of intravenous contrast-enhanced MRI for diagnosis of adhesive capsulitis. Eur Radiol 2020; 30:5981-5991. [PMID: 32591886 DOI: 10.1007/s00330-020-07003-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/21/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to compare the reliability and performance of MRI measures enhanced with intravenous (IV) injection of gadolinium contrast versus non-enhanced MRI measures for the diagnosis of adhesive capsulitis (AC). We also aimed to examine the association between MRI findings and clinical features in patients with AC. METHODS MRI of 42 patients with a clinical diagnosis of AC confirmed by arthrography and that of 42 patients in a control group were retrospectively studied by 2 blinded readers. Reliability and performance of MRI findings were compared between IV contrast-enhanced measures and non-enhanced MRI measures in T2-weighted fat-saturated and T1-weighted images. MRI findings were correlated with clinical stage, etiology, and pain. RESULTS Sensitivity (97.6%) and specificity (97.6%) of axillary-recess capsule signal enhancement for AC diagnosis were significantly superior (p = 0.02) to hyperintense signals on T2-weighted fat-suppressed images (sensitivity 90.5%, specificity 92.7%). Measures of the intensity signal in the area of the rotator interval were less performant for AC diagnosis but could be improved with joint capsule enhancement. Moreover, we found very high specificity (100%) of enhancement of the coracohumeral ligament signal for AC diagnosis. The early stage of adhesive capsulitis was positively correlated with joint capsule enhancement in the rotator interval. Secondary etiology of capsulitis was correlated with joint capsule hyperintensity signals of the rotator interval on T2-weighted fat-suppressed images. CONCLUSION IV contrast injection with MRI can be helpful for AC diagnosis in difficult cases. The stage of AC seems related to joint capsule enhancement in the rotator interval. KEY POINTS • IV gadolinium-enhanced MRI can improve the analysis of signal changes in the shoulder synovium and capsule of the shoulder that are related to adhesive capsulitis. • As an original finding, we observed that coracohumeral ligament enhancement had a 100% specificity for the diagnosis of adhesive capsulitis. • The intensity of enhanced signals in the rotator interval seems to be related to the early stage of frozen shoulder.
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16
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郑 小, 李 焱, 穆 米, 杨 瑷, 陈 前, 陈 万, 周 兵, 唐 康. [Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:737-743. [PMID: 32538565 PMCID: PMC8171525 DOI: 10.7507/1002-1892.201911033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder. METHODS Between January 2013 and December 2017, 33 patients of primary frozen shoulder were treated with manipulation under anesthesia combined with 360° arthroscopic capsular release and subacromial debridement. There were 10 males and 23 females, aged from 37 to 65 years, with a mean age of 50.9 years. The affected shoulder on left side in 17 cases and on right side in 16 cases. The disease duration was 6-13 months (mean, 8.4 months). Before and after operation, the visual analogue scale (VAS) score was used to evaluate the shoulder joint pain, Constant score was used to evaluate the shoulder joint function, and the flexion, abduction, and external rotation of shoulder joint were recorded. The internal rotation function was assessed based on the vertebral plane that the thumb could reach after internal rotation of the affected shoulder joint (the rank of internal rotation vertebra). X-ray film was taken to measure the distance of the subacromial space. RESULTS There was no fracture or labrum tear in all patients, and all the incisions healed by first intention. All the 33 patients were followed up 20-31 months, with an average of 24.1 months. During the follow-up, there was no complication such as wound infection and nerve injury. At last follow-up, the range of motion of shoulder flexion, abduction, and external rotation, the rank of internal rotation vertebra, the VAS score, Constant score, and subacromial space were significantly improved when compared with preoperative ones ( P<0.05). CONCLUSION Manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement can achieve a good mid-term effectiveness without complication for primary frozen shoulder.
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Affiliation(s)
- 小龙 郑
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 焱 李
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 米多 穆
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 瑷宁 杨
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 前博 陈
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 万 陈
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 兵华 周
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 康来 唐
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
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Sahara R, Hamada J, Yoshizaki K, Endo K, Segawa D, Yamaguchi M. Kinematic Differences between Two Types of Forward Elevations of the Shoulder Joint: Flexion and Reaching Elevation. Open Orthop J 2020. [DOI: 10.2174/1874325002014010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background:
Extension of the elbow joint is maintained during shoulder flexion. In contrast, the arm starts from the flexed position of the elbow joint and the joint gradually extends during reaching elevation.
Objectives:
This study aimed to compare the kinematic elements and electromyographic (EMG) activities of the rotator cuff muscles between flexion and reaching elevation.
Methods:
The study included 10 healthy young men. (average age, 21.5 ± 3.4 years), and measurements were performed on their dominant arms. A three-dimensional motion analyzer was used to record the following elements during shoulder flexion and reaching elevation: the angles of glenohumeral joint elevation and scapular upward rotation, scapulohumeral rhythm, external rotation of the humerus, and glenohumeral plane shifting from the coronal plane. The EMG activities in the supraspinatus, infraspinatus, subscapularis, and teres minor were recorded simultaneously.
Results:
The plane of reaching elevation was retained at 60° from the coronal plane. The glenohumeral planes (P < 0 .01) and the external rotation angles of the humerus below 90° of elevation (P < 0.05) were significantly different between both the motions. The EMG activities in the supraspinatus (P < .01), infraspinatus (P < 0.05), and teres minor (P < 0.01) were significantly lower while reaching elevation than those during flexion.
Conclusion:
The motion plane at 60° from the coronal plane, movement of the humeral external rotation, and EMG activities of the rotator cuff muscles were different during reaching elevation and shoulder flexion.
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Kanazawa K, Hagiwara Y, Sekiguchi T, Suzuki K, Koide M, Ando A, Yabe Y. Correlations between Capsular Changes and ROM Restriction in Frozen Shoulder Evaluated by Plain MRI and MR Arthrography. Open Orthop J 2018; 12:396-404. [PMID: 30450143 PMCID: PMC6198418 DOI: 10.2174/1874325001812010396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Evaluation of the Range Of Motion (ROM) is one of the important procedures for shoulder disorders. The purpose of this study was to investigate correlations between capsular changes and ROM restrictions evaluated by both plain magnetic resonance imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the same patients with frozen shoulder. Methods: Between March 2015 and June 2016, 24 patients with frozen shoulders (13 male and 11 female patients, mean age 60.5) with severe ROM restriction who underwent both MRI and MRA on the same affected side were evaluated. We evaluated 1) ROM, 2) the coracohumeral ligament (CHL) thickness, 3) the joint capsule thickness in the axillary recess (humeral and glenoid sides), 4) the area of the axillary recess, and 5) the capsular area of the axillary recess. Results: Positive correlations were found between the axillary area and forward flexion (FF) (R = 0.43, P = 0.035), lateral elevation (LE) (R = 0.66, P<0.001), external rotation (ER)(R = 0.43, P = 0.035), 90° abduction with external rotation (AER)(R = 0.56, P = 0.004), and hand behind the back (HBB)(R = 0.6, P = 0.002) on MRA. Negative correlations were found between the joint capsule at the glenoid side and ER and HBB in both MRI and MRA. Conclusion: The axillary area was significantly correlated with ROM restriction in FF, LE, ER, AER, and HBB on MRA. Thickness of the joint capsule at the glenoid side is an important factor for ROM restriction in frozen shoulder. Level of Evidence: Level 3, Study of Diagnostic Test.
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Affiliation(s)
- Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Oogawara, Miyagi, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Kazuaki Suzuki
- Department of Orthopaedic Surgery, JR Sendai Hospital, Sendai, Miyagi, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Miyagi, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Miyagi, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Park JS, Ryu KN. Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder. Eur Radiol 2018; 29:566-577. [DOI: 10.1007/s00330-018-5604-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/02/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022]
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Correlations of coracohumeral ligament and range of motion restriction in patients with recurrent anterior glenohumeral instability evaluated by magnetic resonance arthrography. J Shoulder Elbow Surg 2017; 26:233-240. [PMID: 27814944 DOI: 10.1016/j.jse.2016.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/22/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evaluation of range of motion (ROM) restriction before treatment of shoulder disorders is important for predicting the final functional outcomes. The purpose of this study was to investigate correlations of thickness of the coracohumeral ligament (CHL) and ROM restriction in patients with recurrent anterior glenohumeral instability. METHODS Between January 2005 and March 2015, 181 shoulders (137 male and 44 female patients; mean age, 29.3 years) with recurrent anterior glenohumeral instability treated with an arthroscopic Bankart repair were enrolled in this study. We evaluated preoperative ROM, thickness of the CHL, and obliteration of the subcoracoid fat triangle on magnetic resonance arthrography. ROM measurements, including forward flexion (FF), external rotation with the arm at the side (ER), and hand behind the back (HBB), were made in a standing position. RESULTS There were significant negative correlations between FF and age (P < .001) and between HBB and age (P < .001) but not between ER and age (P = .11). The thickness of the CHL significantly increased with age (P < .001). FF, ER, and HBB were significantly restricted in patients with obliteration compared with those without obliteration (P < .001, P = .004, P < .001, respectively). CONCLUSIONS Obliteration of the subcoracoid fat triangle and the thickness of the CHL positively correlated with ROM restrictions, and these changes were greater with age in patients with recurrent anterior glenohumeral instability.
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