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Al Khayyat SG, Stella SM, Trentanni C, Falsetti P, Frediani B, Del Chiaro A, Galletti S. Ultrasound definition of subacromial chronic "fibro-adhesive" bursitis and its treatment via ultrasound guided hydrodilation: a prospective pilot study. J Ultrasound 2024; 27:599-604. [PMID: 38703325 DOI: 10.1007/s40477-024-00894-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/10/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE The shoulder pain is one of the main causes that lead the patient to medical evaluation. Today, the ultrasound (US) represents an essential tool in the orthopaedical, rheumatological and rehabilitative setting to address the musculoskeletal causes of pain. Amongst the commonest causes of shoulder complains lay the frequent subacromial chronic bursitis (SACB). In this condition, the thickening of the bursal walls and subsequent fusion of the two synovial sheets leads to the reciprocal loss of bursal walls gliding under the subacromial space and consequently pain. This condition represents a common cause of shoulder pain and may be easily addressed by musculoskeletal sonographers. The purpose of this paper will be to describe the US appearance of SACB and to evaluate the efficacy of US-guided hydrodilation in its treatment. METHODS We included patients with painful shoulder attending our outpatient clinic for shoulder complains with the diagnosis of SACB with a bursal wall > 1.5 mm. A group was treated via US-guided hydrodilation, while the control group was treated via a classical blind approach using triamcinolone acetonide. Both groups underwent the same rehabilitation program following the injections. The shoulder functionality was assessed via qDASH questionnaire at baseline, days 3, 7, 14, 30, 60, and 90. A p <0.05 was considered significant. RESULTS Both groups displayed a significant reduction of pain; nevertheless, in the group treated with US-hydrodilation, there was no need for re-treatment. CONCLUSIONS The US-guided hydrodilation for SACB should be the preferred technique to detach bursal walls and improve patient symptoms, since it requires fewer invasive maneuvers.
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Affiliation(s)
- Suhel G Al Khayyat
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy.
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy.
| | - Salvatore Massimo Stella
- Department of Clinical and Experimental Medicine, SIUMB Advanced School for Musculoskeletal Ultrasound, University Post-Graduate Course, Santa Chiara University Hospital, Pisa, Italy
| | - Cesare Trentanni
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
- Azienda Ospedaliera Carlo Poma-ASST, Mantua, Italy
| | - Paolo Falsetti
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Andrea Del Chiaro
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
- Orthopaedic and Traumatology Operating Unit, San Luca Hospital, Lucca, Italy
| | - Stefano Galletti
- Advanced Musculoskeletal Ultrasound, SIUMB School of Bologna, Maggiore Hospital, Bologna, Italy
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Vita F, Pederiva D, Tedeschi R, Spinnato P, Origlio F, Faldini C, Miceli M, Stella SM, Galletti S, Cavallo M, Pilla F, Donati D. Adhesive capsulitis: the importance of early diagnosis and treatment. J Ultrasound 2024; 27:579-587. [PMID: 38844748 DOI: 10.1007/s40477-024-00891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Adhesive capsulitis (AC), more commonly known as "frozen shoulder", is a painful shoulder condition. The illness progresses through three phases: freezing, frozen and thawing. A gold standard treatment for adhesive capsulitis is not defined. The goal of any treatment is to reduce pain and restore shoulder movement. OBJECTIVE Objective of the present study is to evaluate the efficacy of gleno-humeral hydrodistension associated with physical therapy in patients with diagnosed adhesive capsulitis comparing the outcomes in term of pain and range of motion in patients with a phase 1 and a phase 2 disease. METHOD Between January 2022 and April 2023, We evaluated 87 patients with adhesive capsulitis, 47 were excluded for others concomitant pathologies, finally 40 patients were enrolled for the study, of whom 23 had capsulitis in stage 1 and 17 in stage 2. Patients were evaluated at baseline and at 2, 4 and 6 months after infiltration recording range of motion in all planes, pain and functionality scores. RESULTS A significant improvement was recorded in shoulder range of motion in all planes with the except of extension in both groups. Phase 2 patients were able to regain shoulder range of motion in all planes except internal rotation which was recovered with more difficulty. Pain and functionality scores improved significantly between baseline and follow-up visits. CONCLUSION Ultrasound-assisted hydrodistention of the glenohumeral joint combined with targeted exercise has been successful in improving pain relief, reducing disability, and increasing range of motion in subjects with stage 1 and 2 adhesive capsulitis, especially if diagnosed before phase 2 (when the range of motion is completely reduced).
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Affiliation(s)
- Fabio Vita
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Davide Pederiva
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Flavio Origlio
- Physical Therapy and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Cesare Faldini
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Salvatore Massimo Stella
- SIUMB Advanced School for Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, University Post-Graduate Course, Santa Chiara University Hospital, Pisa, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, Bologna, Italy
| | - Marco Cavallo
- Department of Shoulder and Elobow UnitIRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Federico Pilla
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico Universitario di Modena, Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
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Tuè G, Masuzzo O, Tucci F, Cavallo M, Parmeggiani A, Vita F, Patti A, Donati D, Marinelli A, Miceli M, Spinnato P. Can Secondary Adhesive Capsulitis Complicate Calcific Tendinitis of the Rotator Cuff? An Ultrasound Imaging Analysis. Clin Pract 2024; 14:579-589. [PMID: 38666803 PMCID: PMC11049113 DOI: 10.3390/clinpract14020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. MATERIALS AND METHODS We prospectively enrolled all the patients admitted at our single institution (October 2022-June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. RESULTS A total of 78 patients (54F, 24M-mean age = 50.0 and range = 31-71 y.o.) were enrolled in the study. In 26 of those patients (26/78-33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2-p < 0.00001. CONCLUSION US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies.
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Affiliation(s)
- Giovanni Tuè
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Oriana Masuzzo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Tucci
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Alberto Patti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Wagan AA, Surahyo P. Un-resolving frozen shoulder: Are we really treating it? Pak J Med Sci 2024; 40:165-169. [PMID: 38196471 PMCID: PMC10772408 DOI: 10.12669/pjms.40.1.7440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 09/20/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To perform ultrasound examination in un-resolving frozen shoulder disorder, in Pakistani cohort visiting rheumatology clinic. Methods This cross sectional study was carried out at Department of Rheumatology, Indus Medical College Tando Mohhamad Khan, from 16th March 2022 to 30th October 2022. Patients diagnosed as unilateral frozen shoulder on clinical grounds and received intra-articular injection (s) in last six months, never been investigated, still persisting with pain and restricted range of shoulder motion were enrolled. After the demographic details and shoulder examination, ultrasound examination of both shoulder joints was performed by senior musculoskeletal radiologist, to know the exact diagnosis. Results In 138 cases on ultrasound examination following injuries were noted: rotator cuff tendinopathy (RCT) (61%), adhesive capsulitis (21%), mixed lesion (rotator cuff tendinopathy and adhesive capsulitis) (14%).In age group < 50 years rotator cuff tendinopathy was the major lesion, while in cases >50 years age group: adhesive capsulitis (AC) was predominant lesion (p-0.05).Rotator cuff tendinopathy had significant association with supraspinatus tears (p<0.5). Conclusion In Un-resolving frozen shoulder pain, ultrasound examination of involved joint helps in reaching the exact cause which may differ from the existing diagnosis and guides to further management.
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Affiliation(s)
- Abrar Ahmed Wagan
- Abrar Ahmed Wagan, MBBS, FCPS (Medicine), FCPS (Rheumatology), FACR. Associate Professor of Rheumatology, Indus Medical College, Tando Mohammad Khan, Pakistan
| | - Paras Surahyo
- Paras Surahyo, MBBS, FCPS (Radiology) Assistant Professor, Department of Radiology, Bilawal Medical College, Jamshoro, Pakistan
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Picasso R, Pistoia F, Zaottini F, Marcenaro G, Miguel-Pérez M, Tagliafico AS, Martinoli C. Adhesive Capsulitis of the Shoulder: Current Concepts on the Diagnostic Work-Up and Evidence-Based Protocol for Radiological Evaluation. Diagnostics (Basel) 2023; 13:3410. [PMID: 37998547 PMCID: PMC10670865 DOI: 10.3390/diagnostics13223410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Adhesive capsulitis is an idiopathic and disabling disorder characterized by intense shoulder pain and progressive limitation of active and passive glenohumeral joint range of motion. Although adhesive capsulitis has been traditionally considered a diagnosis of exclusion that can be established based on a suggestive medical history and the detection of supporting findings at the physical exam, imaging studies are commonly requested to confirm the diagnostic suspicion and to exclude other causes of shoulder pain. Indeed, clinical findings may be rather unspecific, and may overlap with diseases like calcific tendinitis, rotator cuff pathology, acromioclavicular or glenohumeral arthropathy, autoimmune disorders, and subacromial/subdeltoid bursitis. Magnetic resonance imaging, magnetic resonance arthrography, and high-resolution ultrasound have shown high sensitivity and accuracy in diagnosing adhesive capsulitis through the demonstration of specific pathological findings, including thickening of the joint capsule and of the coracohumeral ligament, fibrosis of the subcoracoid fat triangle, and extravasation of gadolinium outside the joint recesses. This narrative review provides an updated analysis of the current concepts on the role of imaging modalities in patients with adhesive capsulitis, with the final aim of proposing an evidence-based imaging protocol for the radiological evaluation of this condition.
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Affiliation(s)
- Riccardo Picasso
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Federico Pistoia
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Giovanni Marcenaro
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
| | - Maribel Miguel-Pérez
- Unidad de Anatomía y Embriología Humana, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud (Campus de Bellvitge), Universitat de Barcelona, 08904 Barcelona, Spain;
| | - Alberto Stefano Tagliafico
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
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Wise SR, Seales P, Houser AP, Weber CB. Frozen Shoulder: Diagnosis and Management. Curr Sports Med Rep 2023; 22:307-312. [PMID: 37678349 DOI: 10.1249/jsr.0000000000001097] [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: 09/09/2023]
Abstract
ABSTRACT Frozen shoulder is a common condition that causes pain and restriction of movement of the shoulder unrelated to secondary causes. It has three classic phases (freezing, frozen, and thawing), and is resolved in most cases within 1 to 2 years. Diagnosis is clinical based on global motion restriction and pain. Imaging plays an ancillary role to narrow the differential diagnosis. Physical therapy, nonsteroidal anti-inflammatories, and injection therapies are standard treatments, although none have been shown to alter the long-term course of the condition. Ultrasound guidance is recommended for injection-based therapy, although not required. Further study should focus on long-term outcomes and treatments that significantly alter the natural course of the disease.
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Affiliation(s)
- Sean R Wise
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | | | | | - Chase B Weber
- National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA
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Donati D, Vita F, Tedeschi R, Galletti S, Biglia A, Gistri T, Arcuri P, Origlio F, Castagnini F, Faldini C, Pederiva D, Benedetti MG. Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1211. [PMID: 37512023 PMCID: PMC10386626 DOI: 10.3390/medicina59071211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy.
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Affiliation(s)
- Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Fabio Vita
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, 40136 Bologna, Italy
| | - Alessandro Biglia
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Tommaso Gistri
- Family Medicine Department, ASL Tuscany, 55049 Viareggio, Italy
| | - Pasquale Arcuri
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
| | - Flavio Origlio
- Physical Therapy and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Francesco Castagnini
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Cesare Faldini
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Davide Pederiva
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Therapy and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
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Al Khayyat SG, Falsetti P, Conticini E, Frediani B, Galletti S, Stella SM. Adhesive capsulitis and ultrasound diagnosis, an inseparable pair: a novel review. J Ultrasound 2023; 26:369-384. [PMID: 36284048 PMCID: PMC10247624 DOI: 10.1007/s40477-022-00725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Adhesive Capsulitis (AC) is a musculoskeletal disorder initially described by Codman in 1934. The disease is characterized by pain-limited restriction in active and passive glenohumeral range of motion (ROM) despite the lack of a structural deficit. In the last decades, arthroscopy and magnetic resonance imaging (MRI) has been the only diagnostic tools able to highlight the characteristic alterations of the glenohumeral capsular-ligament apparatus in AC; nevertheless, both arthroscopy and MRI are burdened by intrinsic limitations. The aim of this narrative review is to summarize the most significant evidence supporting the use of ultrasound (US) for the diagnosis of AC. METHODS We extensively searched via PubMed library the terms "frozen-shoulder" and "adhesive capsulitis" each combined with "ultrasound". RESULTS We found 3723 papers on PubMed and selected those inherent to AC diagnosis, US imaging, correlation with arthroscopic and MRI findings. Forty papers which were strictly related to the topic of this narrative review were initially chosen, then 20 studies which described and exploited US for AC diagnosis were finally included. Coracohumeral ligament (2.65 ± 0.4 mm) and axillary pouch thickening (3.34 ± 0.8 mm), as well as an increase in vascularity at rotator interval (78/214, 36.44%), represented the commonest US signs useful for AC diagnosis and for which the most significant cut-off values were reported. CONCLUSIONS The evidence collected in this review testify that musculoskeletal US is as reliable as MRI for AC diagnosis, therefore we believe that in this context US should be considered a first-line imaging technique.
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Affiliation(s)
- S G Al Khayyat
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - P Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - E Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - B Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - S Galletti
- Advanced Musculoskeletal Ultrasound, SIUMB School of Bologna, Maggiore Hospital, Bologna, Italy
| | - S M Stella
- SIUMB Advanced School for Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, University Post-Graduate Course, Santa Chiara University Hospital, Pisa, Italy
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Cocco G, Ricci V, Ricci C, Naňka O, Catalano O, Corvino A, Boccatonda A, Serafini FL, Izzi J, Vallone G, Cantisani V, Iannetti G, Caulo M, Ucciferri C, Vecchiet J, Pizzi AD. Ultrasound imaging of the axilla. Insights Imaging 2023; 14:78. [PMID: 37166516 PMCID: PMC10175532 DOI: 10.1186/s13244-023-01430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. To the best of our knowledge, in the pertinent literature, a detailed sonographic protocol to comprehensively assess the axillary region in daily practice is lacking. In this sense, the authors have briefly described the anatomical architecture of the axilla-also using cadaveric specimens-to propose a layer-by-layer sonographic approach to this challenging district. The most common sonographic pathological findings-for each and every anatomical compartment of the axilla-have been accurately reported and compared with the corresponding histopathological features. This ultrasound approach could be considered a ready-to-use educational guidance for the assessment of the axillary region. CRITICAL RELEVANCE STATEMENT: Axilla is a pyramidal-in-shape "virtual cavity" housing multiple anatomical structures and connecting the upper limb with the trunk. The aim of this review article was to describe the anatomical architecture of the axilla, also using cadaveric specimens, in order to propose a layer-by-layer sonographic approach to this challenging district.
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Affiliation(s)
- Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Costantino Ricci
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Ondřej Naňka
- First Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic
| | - Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, Naples, Italy
| | - Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples Parthenope, Naples, Italy.
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio, Italy
| | - Francesco Lorenzo Serafini
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti, Italy
- Unit of Radiology, Santissima Annunziata Hospital, Chieti, Italy
| | - Jacopo Izzi
- Unit of Radiology, Santissima Annunziata Hospital, Chieti, Italy
| | - Gianfranco Vallone
- Department Life and Health V. Tiberio, Università Degli Studi del Molise, Campobasso, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology, Anatomo-Pathology, Sapienza-University of Rome, Rome, Italy
| | - Giovanni Iannetti
- Ospedale S. Spirito, Università Degli Studi Chieti-Pescara, Chieti, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University, Chieti, Italy
| | - Claudio Ucciferri
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Jacopo Vecchiet
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Andrea Delli Pizzi
- Unit of Radiology, Santissima Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, University G. d'Annunzio, Chieti, Italy
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10
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Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12123097. [PMID: 36553104 PMCID: PMC9776939 DOI: 10.3390/diagnostics12123097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Shoulder disorders are very common in clinical practice. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible patterns of migration. In this paper, we have illustrated how and where these calcium depositions can migrate from the rotator cuff tendons to the peri-articular soft tissues. We have also tried to discuss the issue from the clinical side, i.e., how these particular conditions might impact the specific diagnosis, appropriate rehabilitation plan or interventional approach for optimal functional recovery.
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11
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Papalexis N, Parmeggiani A, Facchini G, Miceli M, Carbone G, Cavallo M, Spinnato P. Current concepts in the diagnosis and treatment of adhesive capsulitis: role of diagnostic imaging and ultrasound-guided interventional procedures. LA RADIOLOGIA MEDICA 2022; 127:1390-1399. [PMID: 36376543 DOI: 10.1007/s11547-022-01566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
Adhesive capsulitis is a common cause of painful shoulder, characterized by pain and restricted range of motion of the glenohumeral joint. With a well-known clinical presentation, and an increasing understanding of its clinical and radiologic features, early diagnosis of adhesive capsulitis is becoming a reality. Although often treated conservatively, for refractory cases arthroscopic release and open capsulotomy have been the only therapeutic option for a long time. Therefore, in the last years, a particular effort was put into the development of novel minimal-invasive techniques capable of pain relief and functional range improvement of the glenohumeral joint. The purpose of this literature review is to report the main updates on diagnosis and treatment for adhesive capsulitis with a focus on imaging diagnosis techniques and novel minimally invasive ultrasound-guided treatments. Results showed that ultrasound-guided procedures come with a high success rate in terms of pain reduction and improved range of motion, thus making the ultrasound a unique tool capable of giving the operator real-time diagnostic information confirming the clinical suspicion, and subsequently performing an interventional procedure.
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Affiliation(s)
- Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy
| | - Giuseppe Carbone
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli 1, 40136, Bologna, Italy.
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12
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Sequential Ultrasound Assessment of Peri-Articular Soft Tissue in Adhesive Capsulitis of the Shoulder: Correlations with Clinical Impairments—Sequential Ultrasound in Adhesive Capsulitis. Diagnostics (Basel) 2022; 12:diagnostics12092231. [PMID: 36140631 PMCID: PMC9497809 DOI: 10.3390/diagnostics12092231] [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: 08/04/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Recently, ultrasound measurements of the shoulder such as thickening of the rotator interval (RI) and the axillary recess (AR) are suggested as specific indicators of adhesive capsulitis. Herein, we evaluated the sequential changes in ultrasound parameters and clinical impairments and the correlation between the two in the case of adhesive capsulitis through a prospective observational study of 56 patients with adhesive capsulitis. Clinical assessments and ultrasound parameters, including the thicknesses of the RI and AR, were surveyed at baseline and after 1, 3, and 6 months. In 56 patients with adhesive capsulitis, the thickness of the AR significantly decreased at each follow-up evaluation, but the thickness of the RI showed a significant decrease only between the baseline and 1-month evaluation. In repeated analyses of correlation, the thickness of the AR was strongly correlated with all clinical impairments except the pain at rest and range of internal rotation in the affected shoulder. The thickness of AR was correlated with clinical impairments in patients with adhesive capsulitis during the 6 months follow up and could be useful as a surrogate marker in patients with adhesive capsulitis.
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13
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Bethina NK, Torralba KD, Choi KS, Fairchild RM, Cannella AC, Salto L, Kissin EY, Yinh J, Aggarwal M, Thiele R, Nishio MJ. North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study. Clin Rheumatol 2022; 41:3825-3835. [PMID: 36008579 DOI: 10.1007/s10067-022-06337-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/24/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America. METHOD Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar's chi-square test. RESULTS Consensus was achieved for 70% of scan views of the upper extremity joints. Two views-ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand-were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation. CONCLUSIONS This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound. Key Points • Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely. • A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present. • The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.
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Affiliation(s)
- Narandra K Bethina
- Division of Rheumatology and Clinical Immunology, University of Vermont Medical Center, Burlington, VT, 05401, USA.
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kristal S Choi
- Division of Rheumatology, University of CA-Los Angeles, Los Angeles, CA, USA
| | - Robert M Fairchild
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Amy C Cannella
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lorena Salto
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University, Boston, MA, USA
| | - Janeth Yinh
- Division of Rheumatology, Harvard Medical School, Boston, MA, USA
| | - Manushi Aggarwal
- Division of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Ralf Thiele
- Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA
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14
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Stella SM, Gualtierotti R, Trentanni C, Ciampi B, Del Chiaro A, Galletti S. A Response to: Letter to the Editor Regarding Ultrasound Features of Adhesive Capsulitis. Rheumatol Ther 2022; 9:1225-1228. [PMID: 35575881 PMCID: PMC9314545 DOI: 10.1007/s40744-022-00451-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Salvatore Massimo Stella
- Advanced Musculoskeletal Ultrasound SIUMB School of Pisa, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, Pisa, Italy
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, University of Milan Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine–Hemostasis and Thrombosis, Milan, Italy
| | - Cesare Trentanni
- Diagnostic Radiology Operational Unit, Carlo Poma Hospital, Mantua, Italy
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
| | - Barbara Ciampi
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
| | - Andrea Del Chiaro
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
- Orthopedic and Traumatology Operating Unit, San Luca Hospital, Lucca, Italy
| | - Stefano Galletti
- Advanced Musculoskeletal Ultrasound, SIUMB School of Pisa, Pisa, Italy
- Advanced Musculoskeletal Ultrasound, SIUMB School of Bologna, Maggiore Hospital, Bologna, Italy
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15
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Letter to the Editor Regarding "Ultrasound Features of Adhesive Capsulitis". Rheumatol Ther 2022; 9:1221-1223. [PMID: 35511396 PMCID: PMC9314509 DOI: 10.1007/s40744-022-00447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/06/2022] [Indexed: 11/14/2022] Open
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