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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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Kuhn I, Erber B, Goller SS. [Adhesive capsulitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:119-124. [PMID: 37801107 DOI: 10.1007/s00117-023-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (CA; also called Frozen shoulder) is a common, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. COURSE OF THE DISEASE The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CLINICAL DIAGNOSIS AND IMAGING CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as a complementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. TREATMENT Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. PROGNOSIS CA is self-limiting and usually persists for 2-3 years. However, the patients may even suffer from pain and limited range of motion beyond this time.
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Affiliation(s)
- Isabella Kuhn
- Muskuloskelettales Universitätszentrum München (MUM), LMU Klinikum, Ziemssenstr. 5, 80336, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Sophia Samira Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [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: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Ozbalci AB, Piskin A. Clinical Significance of Shear Wave Ultrasound Elastography in Patients With Idiopathic Adhesive Capsulitis: Can It Be Used Instead of Magnetic Resonance Imaging as an Early Indicator? Ultrasound Q 2022; 38:250-256. [PMID: 35394993 DOI: 10.1097/ruq.0000000000000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this study was to evaluate the elasticity of the supraspinatus (SSp) and infraspinatus (ISp) tendons and coracohumeral ligament (CHL), as well as the thickness of CHL in patients diagnosed with adhesive capsulitis (AC) using ultrasound (US) and 2D shear wave elastography (2D-SWE), determining their contributions to diagnosis and stage differentiation.This prospective case-control study was conducted between January 2020 and May 2021. In all cases, the ultrasound examinations were performed using the virtual touch quantification and expressed as shear wave velocity (SWV) in meters per second. After US examinations, magnetic resonance imaging (MRI) was planned for all cases.The measurements made in US and MRI revealed that CHL thicknesses and SWV values of CHL and SSp and ISp tendons were statistically substantially higher in the patient group. The diagnostic performance of 2D-SWE in predicting AC was evaluated using receiver operating characteristics curve analysis. When the cutoff value of the mean SWE for CHL was taken as 4.67 m/s, the sensitivity of SWE was found to be 90.2% and the specificity 85.7%.Our study results suggest that CHL thickness on B-mode US, as well as SWV values of CHL and SSp and ISp tendons in 2D-SWE examination, can be used as a useful tool for AC diagnosis without the need for MRI, a costly and time-consuming examination.
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Affiliation(s)
| | - Ahmet Piskin
- Department of Orthopedics and Traumatology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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Superior humeral head migration might be a radiological aid in diagnosing patients with adhesive capsulitis of the shoulder. JSES Int 2021; 5:1086-1090. [PMID: 34766089 PMCID: PMC8568809 DOI: 10.1016/j.jseint.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The diagnosis of adhesive capsulitis (AC) of the shoulder might be challenging, as it is a diagnosis of exclusion and mainly based on the clinical examination. The purpose of the present study was to investigate the validity and reliability of 4 commonly reported radiological parameters suggesting a superior humeral head migration on anteroposterior (a/p) shoulder radiograph in identifying patients with AC. Methods The a/p shoulder radiographs of 100 patients with AC and 100 control subjects were retrospectively reviewed. A disruption of the normal scapulohumeral arch (≥2 mm), the acromiohumeral interval (AHI), the inferior glenohumeral distance (IGHD), and the upward migration index (UMI) were measured. Results A disruption of the scapulohumeral arch was observed in 80% in the AC and 20% in the control group. The mean AHI was 9.3 ± 1.3 mm and 11.0 ± 1.7 mm (P < .001), the mean IGHD was 3.9 ± 3.0 mm and 0.9 ± 1.9 mm (P < .001), and the mean UMI was 1.37 ± 0.1 and 1.44 ± 0.1 (P < .001) in patients with AC and control subjects, respectively. The scapulohumeral arch's disruption demonstrated the best test characteristics with a sensitivity and specificity of 80% in detecting patients with an AC. Patients with a disruption of the scapulohumeral arch had 16 times increased odds of having an AC. Conclusion Measuring the superior humeral head migration might be a simple and clinically relevant tool in diagnosing an AC of the shoulder and could be reliably used by clinicians adjacent to the clinical examination without any additional cost. Especially a disruption of the scapulohumeral arch on the a/p shoulder radiograph should raise concerns of AC in the absence of a massive rotator cuff tear.
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Choi SJ. [Adhesive Capsulitis of the Shoulder]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1355-1365. [PMID: 36238892 PMCID: PMC9431985 DOI: 10.3348/jksr.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 07/23/2021] [Accepted: 11/22/2021] [Indexed: 06/16/2023]
Abstract
Adhesive capsulitis, the so-called 'frozen shoulder', is one of the common causes of pain with a limited range of motion in the shoulder joint. The condition is usually diagnosed through the clinical course and physical examinations; however, several studies on imaging findings of adhesive capsulitis using sonography, MRI, and MR angiography have been reported. In this article, various imaging findings for the diagnosis of adhesive capsulitis-related anatomy are reviewed.
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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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Lee JG, Peo H, Cho JH, Cho CH, Kim DK, Kim DH. Dynamic Ultrasonographic Measurement of Inferior Joint Capsule Thickness in Patients with Unilateral Frozen Shoulder. Diagnostics (Basel) 2021; 11:diagnostics11050898. [PMID: 34070046 PMCID: PMC8158117 DOI: 10.3390/diagnostics11050898] [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: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic value of ultrasonography (US) for frozen shoulder (FS) is not well established. This study aimed to assess the diagnostic value of US measurement of inferior joint capsule (IJC) thickness and evaluate changes in the thickness of the IJC by US depending on arm position. A total of 71 patients with clinically diagnosed unilateral FS who underwent bilateral US measurement of the IJC were enrolled in this study. The US measurement of the IJC was performed with a linear transducer positioned around the anterior axillary line with the shoulder 40° abducted and with neutral rotation of the glenohumeral joint (neutral position). We also measured the IJC thickness in the externally rotated and internally rotated positions with the shoulder 40° abducted. In the neutral position, as well as in the internally rotated and externally rotated positions, the thickness of the IJC on US was significantly higher in the affected shoulder than that in the unaffected shoulder (all p < 0.001). On both the affected and unaffected sides, the US thickness of the IJC in the neutral position was significantly higher than that in the externally rotated position (p < 0.001), but lower than that in the internally rotated position (p < 0.001). Regarding IJC thickness in the neutral position, a 3.2-mm cutoff value yielded the highest diagnostic accuracy for FS, with a sensitivity and specificity of 73.2% and 77.5%, respectively. The area under the curve for IJC thickness was 0.824 (95% confidence interval, 0.76–0.89). US measurement of the IJC in the neutral position yielded good diagnostic accuracy for FS. Because IJC thickness is affected by arm rotation, it is important to measure the IJC thickness in a standardized posture to ensure diagnostic value.
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Affiliation(s)
- Jun-Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
| | - Hyungsun Peo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
| | - Jang-Hyuk Cho
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
| | - Du-Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
- Correspondence: ; Tel.: +82-2-6299-1884
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The role of 18F-FDG PET/CT in the diagnosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2021; 29:210-215. [PMID: 32170356 DOI: 10.1007/s00167-020-05937-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Frozen shoulder is characterized by pain and reduced passive movement capability, and the diagnose is made clinically. However, pain is the major symptom in the first stage before stiffness occurs, and the condition can be mistaken for subacromial impingement. This study explored the possibility to use positron emission tomography/computed tomography (PET/CT) with a 18F Flour-Deoxy-Glucose (FDG) tracer in the diagnostic process. METHODS Eleven patients with frozen shoulder and 9 patients with subacromial impingement received a 18F-FDG PET/CT scan before being treated surgically. During arthroscopy, the diagnoses were confirmed. Images were blindly analyzed visually by two nuclear medicine physicians. Also, semi-quantified analysis applying a set of standard regions was performed, and standard uptake value in both shoulder regions was recorded. RESULTS Both the visual description of the pictures and the semi-quantified analysis generally showed increased FDG uptake in the affected shoulder regions of patients that had frozen shoulder and no uptake in patients with subacromial impingement. Kappa for interobserver agreement in the visual assessments was 0.74. Sensitivity was 92% and specificity 93% of the visual assessment, 77% and 93%, respectively, of the semi-quantified analyses, and by combining the two types of analyses sensitivity was 100% and specificity was 93% for the distinction between frozen shoulders and subacromial impingement/unaffected shoulders. CONCLUSION 18F-FDG PET/CT seems to be a valid method to diagnose frozen shoulder. This is clinically relevant in diagnostically challenging cases, for instance in the first phase of frozen shoulder, which can be difficult to distinguish from subacromial impingement. LEVEL OF EVIDENCE II.
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Gacaferi H, Kolk A, Visser CPJ. Arthroscopic bursectomy less effective in the degenerative shoulder with chronic subacromial pain. JSES Int 2020; 5:220-227. [PMID: 33681841 PMCID: PMC7910744 DOI: 10.1016/j.jseint.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background Varying results after surgery in patients with subacromial pain syndrome (SAPS) have raised the question on whether there is a subgroup of patients that can benefit from surgery. Therefore, we aimed to identify preoperative and peroperative factors associated with a favorable patient-reported outcome after arthroscopic bursectomy in patients with SAPS. Methods Patients with chronic SAPS who underwent arthroscopic bursectomy after failed conservative management were included (n = 94). Patients were evaluated at the baseline, and 2 weeks, 8 weeks, 6 months, and 1 year after surgery. The primary outcome was the Western Ontario Rotator Cuff index (WORC) score one year after surgery. The secondary outcome measure was a visual analog scale for pain. Mixed model analyses were used to identify prognostic factors. Results The mean WORC (mean difference 39%, 95% confidence interval (CI) 32.8-45.3, P < .001) and visual analog scale pain scores (mean difference 41 mm points, 95% CI 3.37-4.88, P < .001) significantly improved one year after surgery. Nineteen patients (20%) developed a postoperative frozen shoulder. A longer duration of preoperative complaints and the peroperative identification of degenerative glenoid cartilage were associated with significantly worse WORC scores, with -0.086% per month (95% CI -0.156 to -0.016, P = .016) and -20% (95% CI -39.4 to -1.26, P = .037), respectively. Conclusion We identified demographic and clinical factors that predict the course after arthroscopic subacromial bursectomy. We found that arthroscopic bursectomy is less effective in patients with SAPS with a degenerative shoulder. This finding suggests that an improved treatment effect of arthroscopic subacromial bursectomy can be expected in patients with chronic SAPS if intra-articular pathologies such as glenohumeral osteoarthritis are sufficiently excluded.
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Affiliation(s)
- Hamez Gacaferi
- Department of Orthopedics, Alrijne Hospital, Leiden, the Netherlands.,Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Arjen Kolk
- Department of Orthopedics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Choi YH, Kim DH. Correlations between clinical features and MRI findings in early adhesive capsulitis of the shoulder: a retrospective observational study. BMC Musculoskelet Disord 2020; 21:542. [PMID: 32791997 PMCID: PMC7427071 DOI: 10.1186/s12891-020-03569-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/04/2020] [Indexed: 12/05/2022] Open
Abstract
Background This retrospective study investigated the association between clinical features and MRI findings in patients with early adhesive capsulitis of the shoulder. Methods The study included 29 patients with early adhesive capsulitis of the shoulder. The clinical diagnostic criteria were significantly restricted passive range of motion (ROM) and a symptom duration of up to 9 months. Various measurements related to adhesive capsulitis, including humeral and glenoid capsular thickness in the axillary recess, maximal axillary capsular thickness, coracohumeral ligament thickness, and anterior capsular thickness were measured on MRI. Abnormal humeral and glenoid capsular hyperintensity in the axillary recess, abnormal hyperintensity in the rotator interval, and obliteration of the subcoracoid fat triangle were also evaluated. Correlations between MRI findings and clinical features, including limited ROM, pain, and symptom duration were sought. Results Maximal axillary and humeral capsular thickness measured on MRI were negatively correlated with ROM for internal rotation. Also, hyperintensity in axillary recess and glenoid capule were correlated with ROM for abduction. Humeral capsular hyperintensity was correlated with ROM for forward flexion. There were no MRI findings that showed correlations with ROM for external rotation and severity of pain. The hyperintensity in the humeral capsule among MRI findings was only correlated with duration of symptoms. Conclusions MRI can be useful for assessment of several measures of clinical impairment in patients with adhesive capsulitis. Thickening and hyperintensity of the joint capsule in the axillary recess on MRI is associated with limited ROM and duration of symptoms.
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Affiliation(s)
- Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, 04401, South Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, 07061, South Korea.
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Inui H, Sashi R, Nobuhara K. Fibrosis in the rotator interval associated with articular vs. bursal side partial-thickness rotator cuff tears. JSES Int 2020; 4:900-905. [PMID: 33345232 PMCID: PMC7738449 DOI: 10.1016/j.jseint.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The pathogenesis of articular- and bursal-sided partial-thickness rotator cuff tears (PTRCTs) is considered to be different, and associated lesions with PTRCTs need to be examined. Methods The current study consisted of 76 shoulders of 73 patients (27 men, 46 women, 64.0 ± 8.3 years old) who underwent mini-open repair after conversion to full-thickness tears for either articular side (group A; n = 56) or bursal side (group B; n = 20) PTRCT with at least a 2-year follow-up. Clinical outcomes and their images were compared between the groups. Plain radiographs were used with the arm passively elevated in maximum elevation to assess restriction of glenohumeral motion. Results The retear rate was not significantly different between the groups. Both groups showed significant improvement in functional scores at the final follow-up. Patients in group A showed a higher incidence of preoperative fibrosis in the rotator interval (69.6% vs. 35.0%, respectively; P = .006) and a lower incidence of an acromial spur (7.1% vs. 35.0%, respectively; P = .008) compared with group B. Plain radiographs with arm elevation showed restriction of glenohumeral movement in 49 of 76 shoulders (64.5%) preoperatively, including 36 of the 46 shoulders with fibrosis and 13 of the other 30 shoulders. Conclusion Both articular- and bursal-sided PTRCTs showed significant functional improvements after surgery. The articular-sided tears had a lower incidence of an acromial spur, but had a higher incidence of fibrosis in the rotator interval, which led to a limitation in glenohumeral motion.
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Affiliation(s)
- Hiroaki Inui
- Department of Orthopaedic Surgery, Nobuhara Hospital and Institute of Biomechanics, Tatsunoshi, Hyogo, Japan
| | - Ryuzi Sashi
- Department of Orthopaedic Surgery, Nobuhara Hospital and Institute of Biomechanics, Tatsunoshi, Hyogo, Japan.,Department of Radiology, Yaesu Clinic, Nihonbashi, Chuoku, Tokyo, Japan
| | - Katsuya Nobuhara
- Department of Orthopaedic Surgery, Nobuhara Hospital and Institute of Biomechanics, Tatsunoshi, Hyogo, Japan
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Wu PY, Hsu PC, Chen TN, Huang JR, Chou CL, Wang JC. Evaluating Correlations of Coracohumeral Ligament Thickness with Restricted Shoulder Range of Motion and Clinical Duration of Adhesive Capsulitis with Ultrasound Measurements. PM R 2020; 13:461-469. [PMID: 32500656 DOI: 10.1002/pmrj.12432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The primary objective of this study is to evaluate, using ultrasound measurements, the correlation between coracohumeral ligament (CHL) thickness and restricted shoulder range of motion (ROM) in patients with adhesive capsulitis (AC). The secondary objective is to investigate the correlation between CHL thickness and disease duration. DESIGN Prospective cross-sectional survey. SETTING Clinical research of a tertiary care hospital. METHODS Overall, 65 patients with clinically diagnosed AC were enrolled. Ultrasound measurements of CHL thickness in the axial oblique plane were obtained under maximal external rotation of the glenohumeral joint. Both Shoulder Pain and Disability Index (SPADI) and shoulder ROM were prospectively evaluated by an experienced investigator. CHL thickness was compared with shoulder ROM and SPADI. The association between CHL thickness and disease duration was also investigated. RESULTS Simple linear regression analysis showed significant inverse correlation between CHL thickness and shoulder ROM including external rotation (ER) (r = -0.335, P = .006) and internal rotation (IR) (r = -0.409, P = .001). CHL thickness also correlated with disease duration (r = -0.352, P = .004). Multiple linear regression analysis demonstrated that CHL thickness was significantly associated with restricted ER (r = -0.293, P = .02) and IR (r = -0.363, P = .003) after adjusting for age and disease duration. On the other hand, CHL thickness showed no significant correlation with abduction (r = -0.210, P = .09), flexion (r = -0.170, P = .176), or total SPADI score (r = 0.176, P = .16). Moreover, CHL was significantly thicker in patients with disease duration >6 months (P = .004, difference in means: 0.55 mm, 95% confidence interval: -0.922, -0.183). CONCLUSIONS CHL was significantly thicker in later-stage AC. CHL thickness correlated negatively with ER and IR of the shoulder. Furthermore, CHL thickening could be observed in the early stage of the disease course. These imaging findings may assist in confirming the diagnosis of AC, leading to early intervention and treatment options.
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Affiliation(s)
- Pin-Yi Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, 10845, Taiwan
| | - Tzu-Ning Chen
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Jian-Ru Huang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.,Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taipei, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.,Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taipei, Taiwan
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14
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Cho HR, Cho BH, Kang KN, Kim YU. Optimal Cut-Off Value of the Coracohumeral Ligament Area as a Morphological Parameter to Confirm Frozen Shoulder. J Korean Med Sci 2020; 35:e99. [PMID: 32301291 PMCID: PMC7167408 DOI: 10.3346/jkms.2020.35.e99] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thickened coracohumeral ligament (CHL) is one of the important morphological changes of frozen shoulder (FS). Previous research reported that coracohumeral ligament thickness (CHLT) is correlated with anterior glenohumeral instability, rotator interval and eventually FS. However, thickness may change depending on the cutting angle, and measurement point. To reduce measurement mistakes, we devised a new imaging criteria, called the coracohumeral ligament area (CHLA). METHODS CHL data were collected and analyzed from 52 patients with FS, and from 51 control subjects (no evidence of FS). Shoulder magnetic resonance imaging was performed in all subjects. We investigated the CHLT and CHLA at the maximal thickened view of the CHL using our picture archiving and communications system. The CHLA was measured as the whole area of the CHL including the most hypertrophied part of the MR images on the oblique sagittal plane. The CHLT was measured at the thickest point of the CHL. RESULTS The average CHLA was 40.88 ± 12.53 mm² in the control group and 67.47 ± 19.88 mm² in the FS group. The mean CHLT was 2.84 ± 0.67 mm in the control group and 4.01 ± 1.11 mm in the FS group. FS patients had significantly higher CHLA (P < 0.01) and CHLT (P < 0.01) than the control group. The receiver operator characteristic analysis showed that the most suitable cut-off score of the CHLA was 50.01 mm², with 76.9% sensitivity, 76.5% specificity, and area under the curve (AUC) of 0.87. The most suitable cut-off value of the CHLT was 3.30 mm, with 71.2% sensitivity, 70.6% specificity, and AUC of 0.81. CONCLUSION The significantly positive correlation between the CHLA, CHLT and FS was found. We also demonstrate that the CHLA has statistically equivalent power to CHLT. Thus, for diagnosis of FS, the treating physician can refer to CHLA as well as CHLT.
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Affiliation(s)
- Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Byong Hyon Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon, Korea.
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15
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Lee JS, Do JG, Yoon KJ, Chae SW, Park HJ, Park CH, Lee YT. Voxel-based Three-dimensional Segmentation of the Capsulo-synovium from Contrast-enhanced MRI Can Represent Clinical Impairments in Adhesive Capsulitis. Sci Rep 2020; 10:6516. [PMID: 32300141 PMCID: PMC7162880 DOI: 10.1038/s41598-020-63406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/30/2020] [Indexed: 11/21/2022] Open
Abstract
The purposes were to calculate total voxel volume of the entire capsulo-synovial enhanced portion on contrast-enhanced (CE) MRI in adhesive capsulitis, and to investigate its association with glenohumeral joint volume and passive range of motions (ROMs), which are a well-known diagnostic reference standard and clinical hallmark of this condition. Medical records of 169 consecutive patients who underwent ultrasound-guided intraarticular injection with adhesive capsulitis and CE-MRI to exclude other mimicking shoulder diseases were retrospectively reviewed. To calculate total voxel volume of entire capsulo-synovial enhanced portion on CE-MRI, voxel-based 3-dimensional (3D) segmentation was obtained semi-automatically using Fiji, an open-source image processing software. Pearson’s correlation coefficients were analyzed. Sixty patients who met eligibility criteria were included. Total voxel volume showed a significant inverse correlation with the glenohumeral joint volume (r = −0.528, P < 0.001), forward elevation, external rotation, and abduction (r = −0.407, P = 0.001; r = −0.342, P = 0.007; r = −0.275, P = 0.034, respectively). Intra-observer and inter-observer reliabilities, measured by intraclass correlation coefficients (ICC), were excellent (ICC = 0.87 and 0.77, respectively). This study’s results indicate that voxel-based 3D segmentation of entire capsulo-synovial enhanced portion from CE-MRI can represent the severity of clinical impairments, such as obliterated joint volume and limited passive ROMs in adhesive capsulitis.
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Affiliation(s)
- Jung-Sang Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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16
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Wang Y, Gong J. The effectiveness of intra-articular vs subacromial corticosteroid injection for frozen shoulder: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e19706. [PMID: 32311954 PMCID: PMC7440081 DOI: 10.1097/md.0000000000019706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intra-articular (IA) corticosteroid injection is a commonly used therapy for frozen shoulder (FS), but controversy still exists regarding the injection site with the best outcome. This randomized controlled trial is designed to determine whether corticosteroid injection into the subacromial space was not inferior to IA injection in patients with FS. METHODS This study will be a single-center, randomized, and double-blinded trial. Sixty patients who meet inclusion criteria will be randomized in a ratio of 1:1 to either subacromial injection or IA injection group. The outcome evaluations will be conducted at 4 time points (baseline, 4, 8, and 12 weeks after the injection) by an independent physical therapist. The primary outcome measure is visual analog scale for pain, whereas the secondary outcomes include Constant score, and shoulder passive range of motion including abduction, forward elevation, external rotation at the side, and internal rotation at the side. DISCUSSION This study has limited inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is expected to provide evidence of proper site of corticosteroid injection for the treatment of FS. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5368).
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Affiliation(s)
- Yanbiao Wang
- Department of Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences, Shandong First Medical University
| | - Jing Gong
- Department of Anesthesiology, The 960th Hospital of the People's Liberation Army Joint Logistice Support Force, Shandong, China
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17
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Wada T, Itoigawa Y, Yoshida K, Kawasaki T, Maruyama Y, Kaneko K. Increased Stiffness of Rotator Cuff Tendons in Frozen Shoulder on Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:89-97. [PMID: 31218712 DOI: 10.1002/jum.15078] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the stiffness and morphologic characteristics of the capsule, rotator cuff tendons and muscles, coracohumeral ligament (CHL), and long head of the biceps in patients with frozen shoulder using shear wave elastography (SWE) with B-mode ultrasound. METHODS Thirty-two patients with frozen shoulder were divided into freezing and frozen phases. All patients had limitations of their range of motion without rotator cuff tears. Stiffness was measured by SWE in the supraspinatus (SSp) tendon, infraspinatus (ISp) tendon, SSp muscle, ISp muscle, teres minor muscle, upper and lower trapezius muscles, posterior capsule, CHL, and long head of the biceps. The posterior capsule and CHL thicknesses were also investigated with B-mode ultrasound. All values were compared in the affected and unaffected shoulders in each phase. RESULTS The SWE values for the SSp and ISp tendons in the freezing phase and the CHL in the frozen phase were significantly greater on the affected side than the unaffected side (mean ± SD, 280.4 ± 125.3 versus 178.1 ± 73.3, 318.4 ± 110.7 versus 240.8 ± 91.5, and 287.2 ± 135.3 versus 214.1 ± 91.1 kPa, respectively; P < .05). The posterior capsule in both the freezing and frozen phases and the CHL in the frozen phase were significantly thicker on the affected side than the unaffected side (1.3 ± 0.2 versus 0.9 ± 0.3, 1.2 ± 0.4 versus 0.9 ± 0.3, and 4.4 ± 1.4 versus 3.3 ± 1.1 mm; P < .01). CONCLUSIONS The SWE values of the both SSp and ISp tendons increased in the freezing phase, and that of the CHL also increased in the frozen phase. Not only the change in thickness of the capsule but also the change in stiffness of the rotator cuff may correlate with frozen shoulder.
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Affiliation(s)
- Tomoki Wada
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Keiichi Yoshida
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Yuichiro Maruyama
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
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18
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James-Belin E, Lasbleiz S, Haddad A, Morchoisne O, Ostertag A, Yelnik A, Laredo JD, Bardin T, Orcel P, Richette P, Beaudreuil J. Shoulder adhesive capsulitis: diagnostic value of active and passive range of motion with volume of gleno-humeral capsule as a reference. Eur J Phys Rehabil Med 2019; 56:438-443. [PMID: 31742369 DOI: 10.23736/s1973-9087.19.05890-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The diagnosis of adhesive capsulitis is currently based on restricted range of motion (ROM) but its diagnostic value has only been rarely investigated. AIM The aim of this study is to assess the diagnostic value of active global and passive gleno-humeral ROM to diagnose shoulder adhesive capsulitis. DESIGN Cross-sectional descriptive study. SETTING One French center for Rehabilitation Medicine. POPULATION Patients referred for treatment of shoulder adhesive capsulitis in our center were included. Inclusion criteria were: shoulder pain; limitation of active global ROM (abduction or flexion <180°); limitation of passive gleno-humeral ROM (abduction or flexion <90° or 25% reduction at less of lateral rotation versus the opposite shoulder); no gleno-humeral arthropathy on radiography. METHODS The volume of the gleno-humeral capsule was assessed during a procedure of arthro-distension. The reference criterion for adhesive capsulitis was a volume <12 mL. We analyzed the correlation between the parameters of mobility and the volume of the gleno-humeral capsule; and the positive predictive value (PPV) of inclusion criteria, with the reference criterion for the diagnosis of adhesive capsulitis. RESULTS We included 38 patients. Passive gleno-humeral ROM in abduction only was correlated with volume of the gleno-humeral capsule: r=0.33, P=0.043. The PPV of inclusion criteria was 82% for the diagnosis of shoulder adhesive capsulitis. Rather than 90°, when we considered 80°, 60° and 40° as the threshold of passive gleno-humeral ROM in abduction, the PPV increased from 83% to 100%. CONCLUSIONS Passive gleno-humeral ROM in abduction is correlated with volume of the gleno-humeral capsule. The PPV is high for active global and passive gleno-humeral ROM for diagnosis of shoulder adhesive capsulitis. CLINICAL REHABILITATION IMPACT Limitation of active and passive shoulder ROM, especially passive abduction gleno-humeral, is a good criterion to diagnose shoulder adhesive capsulitis, in patients with shoulder pain and no gleno-humeral arthropathy on radiography.
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Affiliation(s)
- Etienne James-Belin
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France - .,Department of Physical and Rehabilitation Medicine, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France -
| | - Sandra Lasbleiz
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Albert Haddad
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Odile Morchoisne
- Department of Physical and Rehabilitation Medicine, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Agnès Ostertag
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Alain Yelnik
- Department of Physical and Rehabilitation Medicine, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Jean-Denis Laredo
- Department of Musculoskeletal Radiology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Thomas Bardin
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Philippe Orcel
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
| | - Johann Beaudreuil
- Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France.,Department of Physical and Rehabilitation Medicine, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France
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19
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Typische Veränderungen bei der „frozen shoulder“ in der bildgebenden MRT-Untersuchung. Unfallchirurg 2019; 122:944-949. [DOI: 10.1007/s00113-019-00728-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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McKean D, Yoong P, Brooks R, Papanikitas J, Hughes R, Pendse A, McElroy BJ. Shoulder manipulation under targeted ultrasound-guided rotator interval block for adhesive capsulitis. Skeletal Radiol 2019; 48:1269-1274. [PMID: 30446788 DOI: 10.1007/s00256-018-3105-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe and evaluate the outcome following shoulder manipulation under rotator interval block for the treatment of adhesive capsulitis. MATERIALS AND METHODS Patients with adhesive capsulitis referred by our local orthopaedic shoulder surgeons consented to targeted ultrasound-guided injection of the glenohumeral joint via the rotator interval. Inclusion criteria included a failure to respond to conservative treatment and the absence of a full-thickness rotator cuff tear. Twelve millilitres of a mixture of local anaesthetic and steroid was injected into the rotator interval using a 21-gauge needle, with a small volume of the same solution instilled into the subacromial bursa. Following injection, under local anaesthetic block, patients were gently manipulated into abduction, external rotation and internal rotation as far as they could comfortably tolerate. Patients were assessed pre-injection with documented pain scores from 0 to 10 on a visual analogue scale (VAS) and the Oxford Shoulder Score (OSS) questionnaire. Initial follow-up comprised a VAS pain score at 1 h, 24 h and 2 weeks. Clinical review by the referring orthopaedic surgeon was performed at 2 months post-injection. Long-term follow-up involved a VAS pain score and the OSS questionnaire at 5 months. RESULTS Forty patients were suitable for inclusion in the study. Twenty-three were female (57.5%) and 17 were male. The mean age was 52 years (range, 31-73 years). Twelve patients were post-operative. The duration of symptoms ranged from 3 months to 18 months. Mean pre-procedure OSS was recorded as 23.3 (range, 4-36). The mean VAS pain score was 7.7 before the procedure (range, 4 - 10), 3.4 at 1 h (range, 0-8), 2.9 at 24 h (range, 0-8), and 1.8 at 2 weeks (range 1-4). Orthopaedic follow-up at an average of 66 days post-injection was recorded in 18 patients. All patients reported initial improvement of their shoulder pain and return to near full range of movement; however, recurrence of adhesive capsulitis symptoms was recorded in 5 patients. One case of rupture of the long head of the biceps tendon was reported, but the patient remained asymptomatic. Long-term follow-up at 5 months was obtained in 31 patients, with a mean OSS of 42 (range, 21-60) and VAS of 2.3 (range, 0-7). CONCLUSION Manipulation under general anaesthesia is a well-recognised treatment for adhesive capsulitis. We report that targeted ultrasound-guided injection of the rotator interval and manipulation of the shoulder under local anaesthetic blockade result in good outcomes in reducing shoulder pain and symptoms of adhesive capsulitis with low recurrence and complication rates.
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Affiliation(s)
- David McKean
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK.
| | - Philip Yoong
- Radiology Department, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Rebecca Brooks
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Richard Hughes
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Aniruddha Pendse
- Orthopaedic Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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21
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Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol 2019; 48:1171-1184. [PMID: 30607455 DOI: 10.1007/s00256-018-3139-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
Adhesive capsulitis, commonly referred to as "frozen shoulder," is a debilitating condition characterized by progressive pain and limited range of motion about the glenohumeral joint. It is a condition that typically affects middle-aged women, with some evidence for an association with endocrinological, rheumatological, and autoimmune disease states. Management tends to be conservative, as most cases resolve spontaneously, although a subset of patients progress to permanent disability. Conventional arthrographic findings include decreased capsular distension and volume of the axillary recess when compared with the normal glenohumeral joint, in spite of the fact that fluoroscopic visualization alone is rarely carried out today in favor of magnetic resonance imaging (MRI). MRI and MR arthrography (MRA) have, in recent years, allowed for the visualization of several characteristic signs seen with this condition, including thickening of the coracohumeral ligament, axillary pouch and rotator interval joint capsule, in addition to the obliteration of the subcoracoid fat triangle. Additional findings include T2 signal hyperintensity and post-contrast enhancement of the joint capsule. Similar changes are observable on ultrasound. However, the use of ultrasound is most clearly established for image-guided injection therapy. More aggressive therapies, including arthroscopic release and open capsulotomy, may be indicated for refractory disease, with arthroscopic procedures favored because of their less invasive nature and relatively high success rate.
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22
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Value of MR arthrography findings for pain relief after glenohumeral corticosteroid injections in the short term. Eur Radiol 2019; 29:6416-6424. [DOI: 10.1007/s00330-019-06237-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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23
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Park J, Choi YH, Chai JW, Cha SW, Lim JH, Jo CH, Kim DH. Anterior capsular abnormality: another important MRI finding for the diagnosis of adhesive capsulitis of the shoulder. Skeletal Radiol 2019; 48:543-552. [PMID: 30206678 DOI: 10.1007/s00256-018-3064-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/26/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the usefulness of anterior capsular abnormality, thickening, and abnormal signal intensity on MRI for the diagnosis of adhesive capsulitis of the shoulder. MATERIALS AND METHODS This retrospective study included 29 patients with adhesive capsulitis and 20 controls. Clinical criteria with significant restricted passive motion was used for the diagnosis of adhesive capsulitis. The anterior capsular thickness and signal intensity were evaluated on the thickest portion of anterior glenohumeral joint capsule, located deep to the subscapularis muscle. In addition, the previously known MR findings of adhesive capsulitis, such as humeral and glenoid capsular thickness in axillary recess, maximal axillary capsular thickness, and coracohumeral ligament thickness, were measured. The presence of humeral and glenoid capsular abnormal hyperintensity in axillary recess, abnormal hyperintensity, and obliteration of the subcoracoid fat triangle were also evaluated. RESULTS All MRI findings significantly differed between adhesive capsulitis and controls. Among MR findings, multivariable analysis showed that anterior capsular thickness, maximal axillary capsular thickness, and anterior capsular abnormal hyperintensity were variables that could differentiate adhesive capsulitis from the control group, with odds ratios of 7.97, 17.75, and 12.41, respectively (p < 0.05). In ROC analysis, the anterior capsular thickness showed high diagnostic performances with an AUC of 0.897. The cut-off value of anterior capsular thickness at 3.5 mm showed excellent diagnostic accuracy, with sensitivity of 68.97% and specificity of 100%. CONCLUSIONS Anterior capsular abnormality, thickening, and abnormal hyperintensity can be used for the diagnosis of adhesive capsulitis of shoulder, in addition to previously known abnormal MRI findings.
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Affiliation(s)
- Jina Park
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jee Won Chai
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Seung Woo Cha
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Joo Hee Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Chris Hyunchul Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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Determination of magnetic resonance imaging criteria for diagnosis of adhesive capsulitis. Rheumatol Int 2019; 39:453-460. [PMID: 30617512 DOI: 10.1007/s00296-018-04238-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
The objective of this study was to identify optimal magnetic resonance imaging (MRI) parameters and their cutoff values for diagnosing adhesive capsulitis (AC). One hundred shoulder MRI images with stage 2 AC (AC group) and 100 MRI images without AC (control group) were randomly reviewed by two experienced shoulder specialists. They were asked whether MRI findings were compatible with AC and measurement of MRI parameters. Sensitivity, specificity, and accuracy were calculated. Correlation between MRI parameters and the range of motions was also analyzed. The mean capsular thickness in the axillary recess (AR) (5.9 mm in the AC group vs. 3.6 mm in the control group) on coronal oblique T2-weighted images and the rotator interval (RI) (7.2 mm vs. 4.8 mm, respectively) on oblique sagittal proton-density images were significantly greater in the AC group than in the control group, whereas the width of RI showed no significant difference between two groups. The highest diagnostic cutoff values were 4.5 mm for the AR and 6 mm for the RI, with sensitivity (91% and 88%, respectively), specificity (90% and 90%), and accuracy (90% and 89%). Capsular thickness in the AR and RI was significantly correlated with external rotation (P = 0.047) and internal rotation (P = 0.023). On conventional MRI, capsular thickness greater than 4.5 mm in the AR or 6 mm in the RI can be an optimal criterion for diagnosing AC. Capsular thickness in the AR and RI was correlated with the range of rotational motion.
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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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Ogul H, Tas N, Tuncer K, Polat G, Ogul Y, Pirimoglu B, Kantarci M. 3D volumetric MR arthrographic assessment of shoulder joint capacity in patients with primary adhesive capsulitis. Br J Radiol 2018; 92:20180496. [PMID: 30394797 DOI: 10.1259/bjr.20180496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To evaluate the three-dimensional (3D) volumetric MR arthrographic findings of shoulder joint capacity in patients with primary adhesive capsulitis. METHODS Thin-section 3D volumetric MR arthrography sequences of the shoulder joint were obtained in 28 patients with clinically and radiologically proven primary adhesive capsulitis and in 25 controls. Volumetric measurements of the total glenohumeral joint capacity, extra-articular contrast material leakage, and the rotator interval, axillary recess, and biceps tendon sheath capacities were performed for the study and control groups. RESULTS Mean volume of the rotator interval was 7.67 ± 2.6 cm3 in the study group, which was significantly lower than in the control group (12.31 ± 2.5 cm3) (p < 0.0001). Mean volume of the bicipital groove was significantly decreased in the patient group compared to the control group (1.67 ± 0.9 cm3 vs 2.88 ± 0.9 cm3) (p ≤ 0.0001). Mean volume of extra articular contrast material extravasation was 9.93 ± 1.7 cm3 in the patient group, which was significantly higher than in the control group (5.1 ± 1.4 cm3) (p = 0.002). Mean total glenohumeral joint volume was 22.52 ± 1.1 cm3 in the patient group and 26.01 ± 1.2 cm3 in the control group (p = 0.003). CONCLUSION On 3D volumetric MR arthrographic examination, obliterations in the biceps tendon sheath and rotator interval as well as decreased joint capacity may be useful imaging criteria for diagnosing primary adhesive capsulitis. ADVANCES IN KNOWLEDGE In the present study, MR arthrography showed contrast material extravasation in 71% of the patients and showed extra articular contrast material extravasation in 48% of the control subjects. On 3D volumetric MR arthrographic examination, obliterations in the biceps tendon sheath and rotator interval as well as decreased joint capacity may be useful imaging criteria for diagnosing primary adhesive capsulitis.In patients with primary adhesive capsulitis, thin-section 3D volumetric MR arthrography is a useful imaging modality to evaluate both joint capacity and capsular structure.
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Affiliation(s)
- Hayri Ogul
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
| | - Nurmuhammet Tas
- 2 Department of Physical Medicine Rehabilitation and Rheumatology, MedicalFaculty, Ataturk University , Erzurum , Turkey
| | - Kutsi Tuncer
- 3 Department of Orthopaedics and Traumatology, Medical Faculty, AtaturkUniversity , Erzurum , Turkey
| | - Gokhan Polat
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
| | - Yasemin Ogul
- 4 Department of Biochemistry, Erzurum Training and Research Hospital , Erzurum , Turkey
| | - Berhan Pirimoglu
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
| | - Mecit Kantarci
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
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Kim DH, Cho CH, Sung DH. Ultrasound measurements of axillary recess capsule thickness in unilateral frozen shoulder: study of correlation with MRI measurements. Skeletal Radiol 2018; 47:1491-1497. [PMID: 29770850 DOI: 10.1007/s00256-018-2959-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this study were to compare the ultrasound thickness of the affected axillary recess capsule (ARC) with that of the unaffected ARC in patients with frozen shoulder (FS), to analyze whether the ultrasound measurements of the ARC thickness correlate with those obtained using MRI, and to assess whether the ultrasound thickness of the ARC correlates with the patterns of range of motion limitation. MATERIALS AND METHODS Forty-four patients with clinically diagnosed unilateral FS and MRI evaluation performed ultrasound measurement of ARC. The ultrasound measurement of the ARC thickness was performed with the patients in a supine position with their shoulder abducted by 40°. The ARC thickness was also measured by MRI on oblique coronal images by another physician blinded to the ultrasound measurements. With both ultrasound and MRI, ARC thickness was determined at the widest portion of the capsule. RESULTS The ultrasound thickness of ARC was significantly higher in the affected shoulder (4.4 ± 1.1 mm) than in the unaffected one (2.2 ± 0.5 mm) (p < 0.001). The ultrasound thickness of the ARC in the affected shoulder correlated with that measured by MRI (8.9 ± 1.9 mm) (p < 0.001, r = 0.83). The ARC thickness, whether measured by ultrasound or MRI, was not significantly related to the limitation of movement in specific directions. CONCLUSION Ultrasound can demonstrate the difference in ARC thickness between affected and unaffected shoulders in patients with unilateral FS. The ARC thickness measured by ultrasound correlates with that measured by MRI.
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Affiliation(s)
- Du Hwan Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea.
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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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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Rao A, Gandikota G. Beyond ulcers and osteomyelitis: imaging of less common musculoskeletal complications in diabetes mellitus. Br J Radiol 2018; 91:20170301. [PMID: 29419313 DOI: 10.1259/bjr.20170301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Metabolic perturbations in diabetes mellitus affect various organ systems and can lead to end-organ failure. Though most musculoskeletal (MSK) complications of diabetes mellitus are usually not life-threatening, they are often the cause of significant morbidity. While some of the MSK complications have a proven association with diabetes mellitus, others have been loosely associated because of their frequent coexistence, as are the rheumatologic complications. While many of these conditions are well-known, some are overlooked in routine clinical practice. This article focuses on highlighting key imaging features of less common MSK complications and associations of diabetes mellitus.
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Affiliation(s)
- Anuradha Rao
- 1 Department of Radiology, Apollo Hospitals , Bangalore , India
| | - Girish Gandikota
- 2 Department of Radiology, Musculoskeletal division, University of Michigan , Ann Arbor, MI , USA
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Yoon MA, Hong SJ, Hong S, Kang CH, Kim BH, Kim IS. The Association between the Magnetic Resonance Imaging Findings of Adhesive Capsulitis and Shoulder Muscle Fat Quantification Using a Multi-Echo Dixon Method. Korean J Radiol 2018; 19:63-71. [PMID: 29354001 PMCID: PMC5768509 DOI: 10.3348/kjr.2018.19.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/24/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the association between the magnetic resonance imaging (MRI) findings of adhesive capsulitis and shoulder muscle fat percentages using a multi-echo Dixon method. Materials and Methods Twenty-four patients with clinical diagnoses of adhesive capsulitis and either intact rotator cuffs or Ellman grade 1 partial tears as indicated by MRI scans were included. Two radiologists independently evaluated MRI scans of adhesive capsulitis as follows: presence or absence of axillary recess capsular and extracapsular hyperintensities; thickness of the coracohumeral ligament; thickness of abnormal rotator interval soft tissue; and thickness of glenoidal/humeral axillary recess capsules. Fat quantifications of the supraspinatus, infraspinatus, teres minor, subscapularis, teres major and posterior deltoid muscles were performed using multi-echo Dixon imaging at three locations. Inter-rater agreement was assessed. Differences in fat percentages were assessed and correlations between fat percentages and quantitative measurements were evaluated. Results The fat percentage of the supraspinatus was significantly higher in patients with extracapsular hyperintensity (present, 3.00 ± 1.74%; absent, 1.81 ± 0.80%; p = 0.022). There were positive correlations between the fat percentage of the teres minor and the thicknesses of the abnormal rotator interval soft tissue (r = 0.494, p = 0.014) and the glenoidal axillary recess capsule (r = 0.475, p = 0.019). After controlling for the effects of age, sex and clinical stage, the relationship between the teres minor fat percentage and the thickness of the abnormal rotator interval soft tissue was statistically significant (r = 0.384, p = 0.048). Inter-rater agreement was almost perfect for fat quantification (intraclass correlation coefficients [ICC] > 0.9) and qualitative analyses (k = 0.824), but were variable for quantitative measurements (ICC, 0.170-0.606). Conclusion Several MRI findings of adhesive capsulitis were significantly related to higher fat percentages of shoulder muscles.
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Affiliation(s)
- Min A Yoon
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Suk-Joo Hong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Sun Hong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
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Hydrodilatation With Corticosteroid for the Treatment of Adhesive Capsulitis: A Systematic Review. PM R 2017; 10:623-635. [PMID: 29129609 DOI: 10.1016/j.pmrj.2017.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current evidence suggests that corticosteroid injection alone expedites the recovery of pain-free range of motion (ROM) in patients with adhesive capsulitis compared to physiotherapy or placebo. However, it remains unclear whether the addition of hydrodilatation with corticosteroid provides improvement in pain-free ROM as well as pain relief. OBJECTIVE A review of the literature was conducted to determine whether the combined intervention of hydrodilatation and corticosteroid injection expedites restoration of pain-free ROM compared to a control treatment of corticosteroid injection in patients with adhesive capsulitis. METHODS EMBASE, MEDLINE, and CINAHL were searched from database inception to January 2017. Relevant studies were determined as randomized controlled trials written in English, comparing the outcomes of hydrodilatation and corticosteroid injection to a control group treated with corticosteroid injection alone in patients with adhesive capsulitis. Two independent reviewers assessed manuscripts for study inclusion and extracted data. RESULTS A total of 2276 studies were identified through the search, of which 6 randomized controlled studies (involving 410 shoulders) met criteria for inclusion in this review. Mean age ranged from 51-61 years, with mean symptom duration of 4-9 months. Studies varied significantly regarding the volume of injectate, anatomical injection approach, symptom duration, and the method of glenohumeral capsule distension (capsular rupture versus preservation). Two studies demonstrated clinically and statistically significant improvement in the combination group at 3-month follow-up, and one study demonstrated clinically significant improvement only in ROM and/or pain/functional scales, compared to 3 studies demonstrating no benefit when compared to corticosteroid injection alone. CONCLUSION Combining hydrodilatation with corticosteroid injection potentially expedites recovery of pain-free ROM. The greatest benefit is experienced within the first 3 months of intervention. Differences in hydrodilatation techniques, inclusion of capsular preservation, anatomical approach, and length of symptoms may explain the variability in efficacy demonstrated. Further trials using larger sample sizes, better anatomical approaches, image guidance, and hydrodilatation techniques are required to determine the true nature of benefits of hydrodilatation with corticosteroid injection. LEVEL OF EVIDENCE II.
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Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2017; 25:3242-3250. [PMID: 26611904 DOI: 10.1007/s00167-015-3887-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the correlation between indirect magnetic resonance (MR) arthrographic imaging findings and the clinical symptoms and prognosis of patients with frozen shoulder. METHODS Indirect MR arthrography was performed for 52 patients with primary frozen shoulder (mean age 55.1 ± 9.0 years) and 52 individuals without frozen shoulder (mean age 53.1 ± 10.7 years); capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were evaluated. Clinical symptom severity was assessed using the Visual Analogue Scale for Pain (VAS Pain), simple shoulder test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). At 6-month follow-up, we evaluated whether MR arthrography findings correlated with the clinical symptoms and prognosis. RESULTS Capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were significantly greater in the patient group than in the controls (p < 0.001). Capsular thickening of the axillary recess did not correlate with clinical symptoms or ROM (n.s.); however, capsular enhancement correlated with clinical symptom severity according to VAS Pain (p = 0.005), SST (p = 0.046), and ASES scores (p = 0.009). Soft tissue thickening of the rotator interval did not correlate with clinical symptom severity, but was associated with external rotation limitation (p = 0.002). However, none of the parameters correlated with clinical symptoms at 6-month follow-up. CONCLUSIONS Indirect MR arthrography provided ancillary findings, especially with capsular enhancement, for evaluating clinical symptom severity of frozen shoulder, but did not reflect the prognosis. MR findings in frozen shoulder should not replace clinical judgments regarding further prognosis and treatment decisions. LEVEL OF EVIDENCE IV.
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Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Mathiassen SE, Barbe MF, Ali S. Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders. BMC Musculoskelet Disord 2017; 18:395. [PMID: 28899384 PMCID: PMC5596923 DOI: 10.1186/s12891-017-1694-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/24/2017] [Indexed: 01/04/2023] Open
Abstract
Background This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs? Methods PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies. Results Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity. Conclusions Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1694-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith E Gold
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden. .,Gold Standard Research Consulting, 830 Montgomery Ave, Bryn Mawr, PA, USA.
| | - David M Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Fredrik Hellström
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Martin Björklund
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Albert G Crenshaw
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Svend Erik Mathiassen
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University Medical School, Philadelphia, PA, USA
| | - Sayed Ali
- Department of Radiology, Temple University Medical School, Philadelphia, PA, USA
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Correlation of Joint Volume and Passive Range of Motion With Capsulo-Synovial Thickness Measured by Contrast-Enhanced Magnetic Resonance Imaging in Adhesive Capsulitis. PM R 2017; 10:137-145. [PMID: 28729060 DOI: 10.1016/j.pmrj.2017.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 06/13/2017] [Accepted: 06/30/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND No study has investigated the relationship between the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) and the joint volume of the shoulder, which has been considered the standard reference for diagnosis of adhesive capsulitis (AC). OBJECTIVE To investigate the relationships among the capsulo-synovial thickness measured by CE-MRI, joint volume, and passive range of motion (ROM) in patients with AC. DESIGN This was a retrospective study. SETTING The study took place at an institutional practice. PATIENTS Medical record of 103 patients (46 male and 57 female), who were treated with sonographically guided intra-articular injection with diagnosis of AC and underwent CE-MRI to rule out other concomitant shoulder disease, were retrospectively reviewed. METHODS Passive ROM and glenohumeral joint (GHJ) volume were measured before and during sonographically guided injection. The thickness of the enhancing portion of the capsulo-synovium was measured at the axillary recess and rotator interval on CE-MRI. MAIN OUTCOME MEASUREMENTS The relationship among the thickness of the enhancing portion on CE-MRI, GHJ volume, and passive ROM was analyzed using the Pearson correlation coefficient. RESULTS Capsulo-synovial thickness measured by CE-MRI at the enhancing portion of the axillary recess inversely correlated with GHJ volume (ρ = -0.444, P < .001), whereas at the rotator interval, this finding was not observed. At the axillary recess, the capsulo-synovial thickness inversely correlated with abduction (ρ = -0.400, P < .001), forward elevation (ρ = -0.378, P < .001), and external rotation (ρ = -0.297, P < .01), but at the rotator interval, such statistically significant correlations were not shown. CONCLUSION The capsulo-synovial thickness measured by CE-MRI at the enhancing portion of the axillary recess could represent obliterated joint capacity and clinical impairment (restricted passive ROM), which could help in diagnosing AC and in differentiating other shoulder diseases that may mimic this condition. LEVEL OF EVIDENCE III.
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Cheng X, Zhang Z, Xuanyan G, Li T, Li J, Yin L, Lu M. Adhesive Capsulitis of the Shoulder: Evaluation With US-Arthrography Using a Sonographic Contrast Agent. Sci Rep 2017; 7:5551. [PMID: 28717193 PMCID: PMC5514045 DOI: 10.1038/s41598-017-05491-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/30/2017] [Indexed: 11/09/2022] Open
Abstract
Adhesive capsulitis (AC) is a painful and disabling disorder, which caused restricted motion and chronic pain of shoulder. Intracavitary contrast-enhanced ultrasound has been recently applied to assess obstructive bile duct diseases, tubal patency, vesicoureteric reflux and so on. The aim of this study was to detect the value of US-arthrography by injecting the contrast agent SonoVue into glenohumeral joint compared with US in diagnosing AC. Utrasound (US) and US-arthrography images of 45 patients with AC were compared with that of 45 control subjects without AC with MRI as a gold standard. Patients with AC had a significantly thickened coracohumeral ligment (CHL, 3.1 mm) and inferior capsule (3.5 mm) on US, and a decreased volume of axillary recess (1.14 ml) on US-arthrography compared with the control subjects (1.59 ml). Filling defect (91.1%) and synovitis-like abnormality (75.6%) in the joint on US-arthrography were more sensitive than that of rotator interval abnormality (71.1%), thickened CHL more than 3 mm (64.4%), thickened inferior capsule more than 3.5 mm (66.7%) on US respectively for diagnosis of AC. Consequently, US-arthrography was more effective method than US for assessment of AC. Filling defects of joint cavity and synovitis-like abnormality in the joint are characteristic US-arthrography findings for diagnosing AC.
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Affiliation(s)
- Xueqing Cheng
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenqi Zhang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guo Xuanyan
- Department of Ultrasound, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Longlin Yin
- Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Non-contrast MRI diagnosis of adhesive capsulitis of the shoulder. Clin Imaging 2017; 44:46-50. [DOI: 10.1016/j.clinimag.2017.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/03/2017] [Accepted: 04/04/2017] [Indexed: 11/22/2022]
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Cerny M, Omoumi P, Larbi A, Manicourt D, Perozziello A, Lecouvet FE, Berg BV, Dallaudière B. CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable? Eur J Radiol Open 2017; 4:40-44. [PMID: 28409175 PMCID: PMC5379909 DOI: 10.1016/j.ejro.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine if diagnostic signs of adhesive capsulitis (AC) of the shoulder at Magnetic Resonance Imaging (MRI) and arthrography (MRA) are applicable to CT arthrography (CTA). METHODS 22 shoulder CTAs with AC were retrospectively reviewed for features described in MR literature. The control group was composed of 83 shoulder CTA divided into four subgroups 1) normal (N = 20), 2) omarthrosis (N = 19), 3) labral injury (N = 23), and 4) rotator cuff tear (N = 21). Two musculoskeletal radiologists assessed the rotator interval (RI) for obliteration, increased width and thickening of coracohumeral ligament (CHL). The width and capsule thickness of the axillary recess were measured. RESULTS The width of the axillary recess was significantly decreased in the AC group (4.6 ± 2.6 mm versus 9.9 ± 4.6 mm, p ≤ 0.0001; sensitivity and specificity of 84% and 80%). Thickness of the medial and lateral walls of the axillary capsule was significantly increased in the AC group (5.9 ± 1.3 mm versus 3.7 ± 1.1 mm, p ≤ 0.0001 and 5.7 ± 1 mm versus 3.5 ± 1.3 mm, p ≤ 0.0001, respectively). CHL thickness was significantly increased in the AC group (4.1 ± 1 mm (p ≤ 0.001)) in comparison to others groups. Obliteration of the RI was statistically significantly more frequent in patients with AC (72.7% (16/22) vs. 12% (10/83), p < 0.0001). Width of the RI did not differ significantly between patients and controls (p ≥ 0.428). CONCLUSION Decreased axillary width, and thickened axillary capsule are MR signs of AC applicable to CTA. Evaluation of rotator interval seems useful and reproducible only for obliteration.
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Affiliation(s)
- Milena Cerny
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Ahmed Larbi
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Daniel Manicourt
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | | | - Frederic E Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Bruno Vande Berg
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Benjamin Dallaudière
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Négrevergne, 33700 Mérignac, France
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Sridharan R, Engle MP, Garg N, Wei W, Amini B. Focal uptake at the rotator interval or inferior capsule of shoulder on 18F-FDG PET/CT is associated with adhesive capsulitis. Skeletal Radiol 2017; 46:533-538. [PMID: 28161721 PMCID: PMC5381154 DOI: 10.1007/s00256-017-2587-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/21/2016] [Accepted: 01/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if focal increased uptake at the rotator interval (RI) and/or inferior capsule (IC) on18F-FDG PET/CT ("positive PET") predicts the presence of adhesive capsulitis (AC). MATERIALS AND METHODS Three populations were retrospectively examined. Group 1 included 1,137 consecutive 18F-FDG PET/CT studies and was used to determine the prevalence of focal uptake at the RI or IC. Group 2 included 361 cases from a 10-year period with 18F-FDG PET/CT and MRI of shoulder performed within 45 days of each other and was used to enrich the study group. Group 3 included 109 randomly selected patients from the same time frame as groups 1 and 2 and was used to generate the control group. The study group consisted of 15 cases from the three groups, which had positive PET findings. PET/CT images were assessed in consensus by two musculoskeletal radiologists. The reference standard for a diagnosis of AC was clinical and was made by review of the medical record by a pain medicine physician. RESULTS The prevalence of focal activity at either the RI or IC ("positive PET") was 0.53%. Nine patients had a clinical diagnosis of AC and 15 patients had a positive PET. The sensitivity and specificity of PET for detection of AC was 56% and 87%, respectively. PET/CT had a positive likelihood ratio for AC of 6.3 (95% CI: 2.8-14.6). CONCLUSIONS Increased uptake at the RI or IC on PET/CT confers a moderate increase in the likelihood of AC.
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Affiliation(s)
- Radhika Sridharan
- Department of Diagnostic Imaging, Universiti Kebangsaan Malaysia Medical Centre, JalanYaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia., +60 3-7145-5555
| | - Mitchell Philip Engle
- Department of Pain Medicine, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 0409, Houston, TX 77030
| | - Naveen Garg
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1475, Houston, TX 77030
| | - Wei Wei
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1411, Houston, TX 77030
| | - Behrang Amini
- Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1475, Houston, TX 77030
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Won KS, Kim DH, Sung DH, Song BI, Kim HW, Song KS, Lee SW, Cho CH. Clinical correlation of metabolic parameters on 18F-FDG PET/CT in idiopathic frozen shoulder. Ann Nucl Med 2017; 31:211-217. [PMID: 28168397 PMCID: PMC5352775 DOI: 10.1007/s12149-016-1147-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022]
Abstract
Objective Because positron emission tomography/computed tomography (PET/CT) using fluorine-18-fluorodeoxyglucose (18F-FDG) can be used to visualize inflammation of the musculoskeletal system, it may help elucidate the pathophysiology of frozen shoulder (FS). The purpose of this study was to characterize the uptake pattern on 18F-FDG PET/CT in patients with idiopathic FS and to determine if there is a correlation between its metabolic parameters and clinical findings. Methods 18F-FDG PET/CT was conducted to 35 patients with unilateral idiopathic FS. Clinical data including pain, functional scores, and passive range of motion (ROM) were collected. Maximum standardized uptake values (SUVmax) were measured at the four regions of interest (ROIs): rotator interval (RI), anterior joint capsule (AJC), axillary recess (AR), and posterior joint capsule (PJC) from the attenuation-corrected axial images. Results Mean SUVmax values for four ROIs of the affected shoulder were significantly higher than those of the unaffected shoulder. Mean SUVmax values of RI and AR were significantly higher than those of AJC and PJC and mean SUVmax of AJC was significantly higher than that of PJC in the affected side. Three recognizable patterns of increased uptake were noted: (1) AR dominant type (15 patients); (2) RI dominant type (9 patients); (3) both RI and AR dominant type (11 patients). The SUVmax of AR showed negative correlation with abduction and forward flexion. The SUVmax of RI showed negative correlation with external rotation and internal rotation. The SUVmax of AJC showed negative correlation with all ROMs. However, there was no significant correlation between the SUVmax of PJC and any ROM. Conclusion Our study demonstrates that the anterior–inferior capsular portion, including RI and AR, is the main pathologic site of idiopathic FS and reveals significant correlations between ROM and metabolic parameters on 18F-FDG PET/CT. These results imply that AR and RI lesions are related to elevational limitations and rotational limitations, respectively.
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Affiliation(s)
- Kyoung Sook Won
- Department of Nuclear Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea
| | - Kwang-Soon Song
- Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea
| | - Si-Wook Lee
- Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea.
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Sasanuma H, Sugimoto H, Fujita A, Kanaya Y, Iijima Y, Saito T, Takeshita K. Characteristics of dynamic magnetic resonance imaging of idiopathic severe frozen shoulder. J Shoulder Elbow Surg 2017; 26:e52-e57. [PMID: 27539943 DOI: 10.1016/j.jse.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effectiveness of current techniques for dynamic 3-dimensional magnetic resonance imaging (MRI) in the diagnosis of idiopathic severe frozen shoulder (FS). MATERIALS AND METHODS Subjects consisted of 5 healthy volunteers and 16 patients with idiopathic severe FS. We defined severe idiopathic FS as follows: range of motion ≤100° in forward flexion, ≤10° in external rotation, and ≤L5 in internal rotation. All patients suffered from continued global range of motion loss for at least 6 months. We evaluated the diagnostic characteristics of 3-dimensional dynamic MRI in FS patients compared with those in healthy volunteers. RESULTS MRI of all FS patients displayed an abnormal intake of blood flow from the acromial arterial network and the branches of circumflex humeral arteries into the axillary pouch and the rotator interval. We named this finding "burning sign." The burning sign was present at all phases of the condition. In the FS group, the patients with enhanced deposition of contrast medium in the axillary pouch in the delayed phase (n = 11) had a statistically significant score for pain during exercise, higher than that of patients with reduced deposition of contrast medium at the same site (n = 5; P = .027). CONCLUSION Burning sign is an abnormal finding that appears in dynamic MRI of severe FS. Hence, the burning sign may be associated with pain and inflammation in idiopathic FS.
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Affiliation(s)
- Hideyuki Sasanuma
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan.
| | | | - Akifumi Fujita
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Yuji Kanaya
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuki Iijima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Toshihiro Saito
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
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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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Adhesive Capsulitis of the Shoulder Joint: Value of Glenohumeral Distance on Magnetic Resonance Arthrography. J Comput Assist Tomogr 2017; 41:116-120. [PMID: 27560018 DOI: 10.1097/rct.0000000000000475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the usefulness of glenohumeral distance (GHD) on axial images of magnetic resonance (MR) arthrography for diagnosis of adhesive capsulitis and to compare this finding with previously reported classic MR arthrographic findings of adhesive capsulitis. MATERIALS AND METHODS Our study was approved by the institutional ethical review board of our institute. We evaluated 41 patients (M-F, 35:6; mean age, 46 years; adhesive capsulitis, 21; no adhesive capsulitis, 20) who underwent MR arthrography. Two radiologists measured GHD, width of the axillary recess, and capsular thickness in consensus. The GHD was measured from the subchondral bone of the glenoid fossa to the subchondral bone of the humeral head at the level of the midline of the humeral head. Glenohumeral distance (anterior, middle, posterior, and mean), width of the axillary recess, and capsular thickness (anterior, posterior, and mean) were compared in the adhesive capsulitis and no adhesive capsulitis groups using the Mann-Whitney U test. RESULTS The mean GHD of the no adhesive capsulitis group was longer than that of the adhesive capsulitis group. The length differences were statistically significant (P < 0.05). The mean width of the axillary recess of the no adhesive capsulitis group was significantly wider than that of the adhesive capsulitis group (P < 0.001). The mean capsular thickness of the no adhesive capsulitis group was significantly thinner than that in the adhesive capsulitis group (P = 0.001). CONCLUSIONS A decreased GHD on MR arthrography can be another useful feature to diagnose adhesive capsulitis in addition to previously presented radiologic features such as capsular thickening and reduced axillary recess capacity.
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Park GY, Lee JH, Kwon DG. Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder. Ultrasonography 2016; 36:139-143. [PMID: 27764911 PMCID: PMC5381854 DOI: 10.14366/usg.16032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to measure the axillary recess (AR) thickness in an asymptomatic shoulder by using ultrasonography (US) and to analyze the factors affecting it. Methods We recruited 141 patients (52 males; 89 females; age, 57.7±9.9 years) with unilateral shoulder pain and performed US on the unaffected shoulder. Two physiatrists measured the AR thickness of the unaffected shoulder independently. All patients were examined in an upright sitting position with 90° shoulder abduction. The ultrasonographic transducer was placed longitudinally on the mid-axillary line and along the long axis of the humeral shaft. The factors affecting the AR thickness values were analyzed, and intra-class correlation coefficients were used for assessing the reproducibility of each measurement. Results The intrarater reliability values for the two physiatrists were 0.98 and 0.96, respectively. The inter-rater reliability of the mean AR thickness measurements was 0.91. The mean AR thickness in all subjects, males, and females was 2.8±0.6 mm, 3.1±0.6 mm, and 2.6±0.5 mm (P<0.01), respectively. No difference between the left and the right sides (males, P=0.086; females, P=0.535) or between the dominant and the non-dominant sides (males, P=0.173; female, P=0.244) was found. The AR thickness correlated positively with the height (r=0.313, P<0.01) and the weight (r=0.319, P<0.01). However, it did not correlate with the body mass index (r=0.152, P=0.077) or the age (r=-0.056, P=0.515). Conclusion US measurements of the AR thickness in asymptomatic shoulders demonstrated excellent intrarater and inter-rater reliabilities. The AR thickness showed anatomical variation with sex, height, and weight.
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Affiliation(s)
- Gi-Young Park
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Hoon Lee
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Gil Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Evaluation of Adhesive Capsulitis of the Shoulder With Fat-Suppressed T2-Weighted MRI: Association Between Clinical Features and MRI Findings. AJR Am J Roentgenol 2016; 207:135-41. [DOI: 10.2214/ajr.15.15200] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim KT, Lee DG, Lee S, Kim DH. Ultrasonographic Measurement of the Thickness of Axillary Recess Capsule in Healthy Volunteers. Ann Rehabil Med 2016; 40:502-8. [PMID: 27446788 PMCID: PMC4951370 DOI: 10.5535/arm.2016.40.3.502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/20/2015] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the inter-rater and intra-rater reliability of ultrasonographic measurements of axillary recess (AR) thickness in healthy individuals, and to analyze the factors affecting the thickness of the AR capsule. Methods We recruited 20 healthy individuals (10 male, 10 female) with a mean age of 37 years (standard deviation ±10). Two physiatrists (an experienced and a novice rater) independently investigated the AR thickness in three rounds. The AR thickness was measured for each individual at three shoulder abduction angles (50°, 70°, and 90°). Intra-class correlation (ICC) coefficients were used to assess the reproducibility of each measurement. Results Excellent intra-rater reliability coefficients were observed at the three shoulder abduction angles, in the analysis of both raters. The inter-rater reliability coefficient was also was excellent in both studies. There were significant differences in the AR thickness, according to the angle of shoulder abduction. The AR was thicker at 50° than at 70° and 90° (all p<0.001), and the AR was thicker at 70° than at 90° (p<0.001). Height (r=0.62, p=0.003) and body mass index (r=0.52, p=0.019) were positively correlated with AR thickness. Males had a thicker AR capsule than females at all three angles (all p<0.001). Conclusion Ultrasonographic measurements of AR thickness in healthy individuals demonstrate excellent intra-rater and inter-rater reliability. AR thickness may depend on anthropometric variables and position of the shoulder.
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Affiliation(s)
- Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Gyu Lee
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea.; Pain Research Center, Keimyung University School of Medicine, Daegu, Korea.; Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
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Zappia M, Di Pietto F, Aliprandi A, Pozza S, De Petro P, Muda A, Sconfienza LM. Multi-modal imaging of adhesive capsulitis of the shoulder. Insights Imaging 2016; 7:365-71. [PMID: 27107871 PMCID: PMC4877356 DOI: 10.1007/s13244-016-0491-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/07/2016] [Accepted: 03/29/2016] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED Adhesive capsulitis of the shoulder is a clinical condition characterized by progressive limitation of active and passive mobility of the glenohumeral joint, generally associated with high levels of pain. Although the diagnosis of adhesive capsulitis is based mainly on clinical examination, different imaging modalities including arthrography, ultrasound, magnetic resonance, and magnetic resonance arthrography may help to confirm the diagnosis, detecting a number of findings such as capsular and coracohumeral ligament thickening, poor capsular distension, extracapsular contrast leakage, and synovial hypertrophy and scar tissue formation at the rotator interval. Ultrasound can also be used to guide intra- and periarticular procedures for treating patients with adhesive capsulitis. KEY POINTS • Diagnosis of adhesive capsulitis is mainly based on clinical findings. • Imaging may be used to exclude articular or rotator cuff pathology. • Thickening of coracohumeral and inferior glenohumeral ligaments are common findings. • Rotator interval fat pad obliteration has 100 % specificity for adhesive capsulitis. • Ultrasound can be used to guide intra- and periarticular treatments.
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Affiliation(s)
- Marcello Zappia
- Dipartimento di Medicina e di Scienze della Salute, Università degli Studi del Molise, Via De Sanctis 1, 86100, Campobasso, Italy
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, AORN A. Cardarelli, Via Antonio Cardarelli 9, 80131, Napoli, Italy
| | - Alberto Aliprandi
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milano, Italy
| | - Simona Pozza
- Dipartimento di Radiologia, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico, Via Zuretti 29, 10126, Torino, Italy
| | - Paola De Petro
- Dipartimento di Radiologia, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico, Via Zuretti 29, 10126, Torino, Italy
| | - Alessandro Muda
- UO Radiologia 1, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV 10, 16132, Genova, Italy
| | - Luca Maria Sconfienza
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milano, Italy.
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Cho CH, Kim DH, Bae KC, Lee D, Kim K. Proper site of corticosteroid injection for the treatment of idiopathic frozen shoulder: Results from a randomized trial. Joint Bone Spine 2016; 83:324-9. [PMID: 26875065 DOI: 10.1016/j.jbspin.2015.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/21/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective is to determine whether corticosteroid injection into the subacromial space was not inferior to intra-articular injection in patients with idiopathic frozen shoulder (FS), and whether combined injections had an additive effect. METHODS Patients with idiopathic FS (n=126) were randomly assigned to receive ultrasound-guided intra-articular (IA group), subacromial (SA group), or combined IA and subacromial injections (IA+SA group). All groups received a total dose of 40mg triamcinolone acetonide. The outcome measures included the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) shoulder score, subjective shoulder value (SSV), and passive range of motion before and at 3, 6, and 12 weeks after treatment. RESULTS There was significant effect of time on all measurements such that all measures improved in all groups (P<0.001) during the 12 weeks after treatment. Group-by-time interactions were significant for ASES (P=0.006), VAS (P<0.001), SSV (P=0.03), and internal rotation (P=0.014). Between-group comparisons revealed a significant improvement in the IA (P<0.001) and IA+SA (P<0.001) groups as compared to the SA group. The IA+SA group demonstrated significant improvement in internal rotation as compared to the IA group (P=0.046). CONCLUSION The efficacy of corticosteroid injection into the SA space in idiopathic FS was inferior to IA injection up to 12 weeks; however, combination injections had an additive effect on increasing the internal rotation angle. These results indicate that although the glenohumeral joint is a major site in the pathogenesis of idiopathic FS, the SA space may be a contributing site.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea; Pain Research Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea; Pain Research Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea.
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea
| | - Donggyu Lee
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea; Pain Research Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea
| | - Kyoungtae Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu 700-712, South Korea
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Jeong WK. Usefulness of musculoskeletal ultrasonography for treatment of shoulder pain. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.3.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Woong Kyo Jeong
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea
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Wu CH, Chen WS, Wang TG. Elasticity of the Coracohumeral Ligament in Patients with Adhesive Capsulitis of the Shoulder. Radiology 2015; 278:458-64. [PMID: 26323030 DOI: 10.1148/radiol.2015150888] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the elasticity of the coracohumeral ligament (CHL) in healthy individuals and patients with clinical findings suggestive of unilaterally involved adhesive capsulitis of the shoulder (ACS). MATERIALS AND METHODS The institutional review board approved this single-institution prospective study, which was performed between November 15, 2012, and July 8, 2014. Informed consent was obtained from all subjects. Measurement of CHL thickness was performed in the axial oblique plane under shoulder maximal external rotation. Shear-wave elastography (SWE) was used to evaluate elasticity of the CHL in healthy individuals (11 men, 19 women aged 22-62 years) and those with clinical findings suggestive of ACS (nine men, 11 women aged 41-70 years). SWE was performed in the shoulder-neutral position and under maximal external rotation. The Wilcoxon signed-rank test was performed to compare the thickness and elastic modulus of the CHL between bilateral shoulders. RESULTS In all subjects, the CHL elastic modulus was larger under maximal external rotation than in the neutral position (P < .001 for all). For healthy subjects, there was no significant difference in the CHL elastic modulus between the dominant and nondominant shoulders. For patients presumed to have ACS, the CHL thickness was significantly greater in the symptomatic shoulder than in the unaffected shoulder (P < .001). The CHL elastic modulus of the symptomatic shoulder (median, 234.8 kPa; interquartile range [IQR], 174.4-256.7 kPa) was significantly greater than that of the unaffected shoulder (median, 203.3 kPa; IQR, 144.1-242.7 kPa) in the shoulder-neutral position (P = .004) but not under maximal external rotation (P = .123). When bilateral shoulders were maintained at the same angle of external rotation, the CHL elastic modulus was greater in the symptomatic shoulder than in the unaffected shoulder (P = .005). CONCLUSION In patients with clinical findings suggestive of ACS, SWE showed that the CHL is stiffer in the symptomatic shoulder than in the unaffected shoulder.
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Affiliation(s)
- Chueh-Hung Wu
- From the Department of Physical Medicine and Rehabilitation, National Taiwan Hospital, College of Medicine, National Taiwan University, 7 Chan-Shan South Rd, 100 Taipei, Taiwan
| | - Wen-Shiang Chen
- From the Department of Physical Medicine and Rehabilitation, National Taiwan Hospital, College of Medicine, National Taiwan University, 7 Chan-Shan South Rd, 100 Taipei, Taiwan
| | - Tyng-Guey Wang
- From the Department of Physical Medicine and Rehabilitation, National Taiwan Hospital, College of Medicine, National Taiwan University, 7 Chan-Shan South Rd, 100 Taipei, Taiwan
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Ahn KS, Kang CH, Kim Y, Jeong WK. Diagnosis of adhesive capsulitis: comparison of contrast-enhanced MRI with noncontrast-enhanced MRI. Clin Imaging 2015; 39:1061-7. [PMID: 26362354 DOI: 10.1016/j.clinimag.2015.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/31/2015] [Accepted: 08/12/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of contrast-enhanced (CE) magnetic resonance imaging (MRI) and non-CE MRI for adhesive capsulitis (AC). METHODS CE MRI of 50 AC and 53 non-AC patients were reviewed by two radiologists independently. RESULTS Axillary capsular thickening and T2 hyperintensity (sensitivity=92-94%; specificity=53-64%) and enhancement of the axillary capsule and rotator interval (sensitivity=92-98%; specificity=38-64%) were helpful in diagnosing AC. Interobserver reliability was highest with axillary joint capsule enhancement (κ=0.92). CONCLUSION Non-CE and CE MRI are helpful in confirming the clinical diagnosis of AC. CE-MRI may improve assessment of the rotator interval and diagnostic confidence in patients with AC.
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Affiliation(s)
- Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Yura Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong-Kyo Jeong
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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